Abstract

KILIAN, Albert; WIJAYANANDANA, Nayantara  and  SSEKITOLEEKO, James. Review of delivery strategies for insecticide treated mosquito nets: are we ready for the next phase of malaria control efforts?. TropIKA.net [online]. 2010, vol.1, n.1, pp. 0-0. ISSN 2078-8606.

BACKGROUND: The renewed interest in malaria elimination using long-lasting insecticidal nets (LLIN) for malaria prevention has shifted from targeted distributions of vulnerable groups to universal access.  Many countries are now reaching high net coverage levels and need to consider options for sustained control. OBJECTIVES: This review addresses the question: which LLIN distribution mechanisms might be best suited for these approaches? METHODS: We searched PudMed, EMBASE, Popline, BIDS, African Journals Online, and SciELO using a board list of search terms to identify studies on bed nets. Additional searches were conducted in Google and through reference tracking.  The net distribution mechanisms in the included studies were categorized using an open system of six characteristics with the distribution channel serving as the primary descriptive element. Studies were then further evaluated on net coverage, equity and cost per net delivered. RESULTS: Searches of the eight electronic databases produced 258 articles. The secondary search using reference lists and other search engines revealed an additional 44 sources. After an initial screening, 174 reports and studies were included in the detailed review. Community-based distributions (campaigns) achieve rapid increases in net coverage of 30-80%-points among the targeted population and no differences between different implementation models (stand-alone or integrated, house-to-house or distribution point) was found. Equity ratios post distribution were found to be around the 1.0 mark of perfect equity and remained high. However, following the campaign distributions a drop in coverage can be observed in the range of 5-13%-points per year for the first two years. Continuous distribution mechanisms through routine services and/or retail outlets avoid coverage fluctuations but are much slower in build-up, ranging between 3-5%-points increase/year for the unassisted commercial sector and 6-25%-points/year for combination of commercial market with free or highly subsidized nets through routine services. These delivery mechanisms can eventually achieve high equity when they reach high levels of coverage but this can take up to eight years. Cost per net delivered for campaigns appeared slightly better than other distribution mechanisms but no definite advantage can be stated for either mechanism, given methodological and within-study variability. CONCLUSION: Campaign distributions that target the general population are best suited for the scale-up phase of universal access to LLIN, but more work is needed to define the best distribution algorithms for full intra-household coverage, as well as indicators to measure it. For the phase of sustained control and LLIN replacement, a mix of continuous delivery mechanisms through community, routine services and retail outlets is suitable as long as equity issues are addressed with subsidies. Whether and how campaigns can also be used for replacement strategies can not be answered adequately until the concept of "useful life of a net" is better understood and more data available.

Keywords : malaria; prevention; insecticide treated nets; distribution strategies; review.