Impact of Health Facility-Based Insecticide Treated Bednet Distribution in Malawi: Progress and Challenges towards Achieving Universal Coverage

Details

• Alternative Title:
  PLoS One
• Personal Author:
  Skarbinski, Jacek ; Mwandama, Dyson ; Luka, Madalitso ; Jafali, James ; Wolkon, Adam ; Townes, David ; Campbell, Carl ; Zoya, John ; Ali, Doreen ; Mathanga, Don P.
• Description:
  Background
  
  High levels of insecticide treated bednet (ITN) use reduce malaria burden in countries with intense transmission such as Malawi. Since 2007 Malawi has implemented free health facility-based ITN distribution for pregnant women and children <5 years old (under-5s). We evaluated the progress of this targeted approach toward achieving universal ITN coverage.
  
  Methods
  
  We conducted a cross-sectional household survey in eight districts in April 2009. We assessed household ITN possession, ITN use by all household members, and P. falciparum asexual parasitemia and anemia (hemoglobin <11 grams/deciliter) in under-5s.
  
  Results
  
  We surveyed 7,407 households containing 29,806 persons. Fifty-nine percent of all households (95% confidence interval [95% CI]: 56–62), 67% (95% CI: 64–70) of eligible households (i.e., households with pregnant women or under-5s), and 40% (95% CI: 36–45) of ineligible households owned an ITN. In households with at least one ITN, 76% (95% CI: 74–78) of all household members, 88% (95% CI: 87–90) of under-5s and 90% (95% CI: 85–94) of pregnant women used an ITN the previous night. Of 6,677 ITNs, 92% (95% CI: 90–94) were used the previous night with a mean of 2.4 persons sleeping under each ITN. In multivariable models adjusting for district, socioeconomic status and indoor residual spraying use, ITN use by under-5s was associated with a significant reduction in asexual parasitemia (adjusted odds ratio (aOR) 0.79; 95% CI: 0.64–0.98; p-value 0.03) and anemia (aOR 0.79; 95% CI 0.62–0.99; p-value 0.04). Of potential targeted and non-targeted mass distribution strategies, a campaign distributing 1 ITN per household might increase coverage to 2.1 household members per ITN, and thus achieve near universal coverage often defined as 2 household members per ITN.
  
  Conclusions
  
  Malawi has substantially increased ITN coverage using health facility-based distribution targeting pregnant women and under-5s, but needs to supplement these activities with non-targeted mass distribution campaigns to achieve universal coverage and maximum public health impact.
  
  
• Subjects:
  Adolescent Adult Anemia Censuses Child Child, Preschool Family Characteristics Female Geography Health Care Surveys Health Facilities Humans Insecticide-Treated Bednets Male Parasitemia Pregnancy Prevalence Residence Characteristics

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• Source:
  PLoS One. 2011; 6(7).
• Pubmed ID:
  21811553
• Pubmed Central ID:
  PMC3141001
• Document Type:
  Journal Article
• Funding:
  5 U01 CI000189/CI/NCPDCID CDC HHS/United States
• Place as Subject:
  Malawi
• Volume:
  6
• Issue:
  7
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:9ef8ad867f6ee332ee13b3dec1ac3828c54a0f9e3209cfe57afdbacc2756dd6e
• Download URL:
  https://stacks.cdc.gov/view/cdc/4331/cdc_4331_DS1.pdf
• File Type:
  [PDF - 256.75 KB ]