Background
Methods
Study areas
LLIN distributions
Routine ANC | GFATM funded campaign | MNM funded campaign | |
---|---|---|---|
District | Adjumani | Adjumani | Jinja |
Administrative area covered1 | All 29 district ANC facilities | 2 of the 6 sub-counties in the district | 1 of the 11 sub-counties in the district |
Distribution method | On-going distribution to pregnant women attending their 1st ANC visit | One-off campaign with house-to-house registration followed by distribution from fixed parish distribution points over two days | One-off campaign with house-to-house registration followed by distribution from fixed parish distribution points over two days |
Target groups | Pregnant women | Households with pregnant women or children under five | Households with pregnant women or children under five |
Dates of distribution | On-going since Jan 2007. LLINs delivered from Jan to Dec 2007 considered for costing; LLINs delivered during Feb - Apr 2007 followed-up for retention and use | March 2007 | September 2007 |
Number of LLINs delivered | 15,1882 | 16,378 | 12,994 |
Type of LLIN | PermaNet® 2.0 | Olyset® | PermaNet® 2.0 |
Donor | USAID | GFATM | Malaria No More (MNM) through USAID |
Component | GFATM funded campaign | MNM funded campaign |
---|---|---|
Procurement | Managed by WHO | Managed by Malaria Consortium |
Transport to district | Sub-contracted to transport company | Sub-contracted to transport company |
Storage | District MoH stores; LLINs delivered to distribution point on day of distribution | |
Training of trainers | Two day meeting in Kampala | One day meeting in Kampala |
District sensitization and training | 20 district leaders sensitized through half day sensitization; two trainers per sub-county attended full day for sensitization and training | |
Sub-county sensitization and training | Two sub-county trainers led the meeting, supervised by Malaria Consortium and central trainers. Parish and village leaders attended half-day sensitization; CMDs attended full day for sensitization and training. | |
Registration | Over two days, two community medicine distributors (CMD) per village visited each household and completed a registration form detailing size of household and details of household members, noting whether these fell into the target groups of pregnant women (PW) and children under five (U5). Sub-county supervisors, central trainers and Malaria Consortium staff supervised the activity. | |
Allocation | Registration lists were reviewed at one-day parish meetings. A pre-assigned number of LLINs was made available to each parish. Pre-defined allocation rules were followed at this meeting to determine how these nets would be allocated within the parish based on number of target groups in each household. The three-step allocation rules stated: (1) every household with a PW or U5 to be allocated at least one net; (2) a second LLIN to be allocated to each household with more than one target group; (3) a third LLIN to be allocated to each household with one PW and at least two U5. No more than three LLINs to be assigned to each household. If there are insufficient LLIN to complete the full three-step allocation then age of beneficiaries is used to prioritize which household are allocated under steps 2 and 3. | |
Distribution | Distribution points were located at parish level. CMDs from each village presented their allocation lists. Community members arriving to receive LLINs dealt with the CMD from their own village, their name was checked off the allocation list and a signature given. The LLINs was provided without the manufacturers packaging. Distribution took place during one day. | |
Post distribution follow up | Not conducted | Two CMDs per village were asked to visit around 50% of beneficiary households giving advice on use and hanging. Limited funds were available for this component, supervision was minimal and it was not possible to establish to what extent this activity took place. |
IEC approach | • Sensitization of district, parish and village leaders | • Sensitization of district, parish and village leadership |
• Health educators and practical demonstrations at distribution points | • Health educators and practical demonstrations at distribution points | |
• Print materials designed by MoH and provided in English, including: | • Print materials designed and pre-tested for use in other Malaria Consortium activities were used, these included: | |
- Posters at distribution points | - Posters at distribution points | |
- Leaflets on LLIN benefits and use distributed by community leaders | - Leaflets on net benefits and use distributed by community leaders | |
- Handout with three key messages on net use, provided with each LLIN | - Handout with three key messages on net use, provided with each net |
Campaigns
ANC delivery
Collection of quantitative data
Analysis of quantitative data
Collection of cost data
Effects
Sensitivity analysis
Collection and analysis of qualitative data
Ethical considerations
Results
Quantitative data
The sample
Variable | ANC Adjumani | Campaign Adjumani | Campaign Jinja | p value | Comparison |
---|---|---|---|---|---|
Households interviewed | N = 378 | N = 520 | N = 547 | ||
Household members
Mean (95% CI)
| 5.7 (5.3-6.1) | 5.8 (5.6-6.0) | 6.5 (6.3-6.8) | <0.0001 | Adjumani vs. Jinja |
Children under five years per household
Mean (95% CI)
| 1.8 (1.7-1.9) | 1.8 (1.6-2.0) | 2.0 (1.9-2.2) | 0.005 | Adjumani vs. Jinja |
Sleeping places
Mean (95% CI)
| 2.3 (2.1-2.5) | 2.1 (1.9-2.3) | 3.0 (2.7-3.3) | <0.0001 | Adjumani vs. Jinja |
Persons per sleeping place
Mean (95% CI)
| 2.7 (2.5-2.8) | 2.9 (2.7-3.3) | 2.5 (2.3-2.7) | 0.02 | Adjumani vs. Jinja |
Before distribution
| |||||
Households with any net previous to distribution
Percent (95% CI)
| 42.6% (32.7-52.5) | 27.3% (16.1-38.6) | 21.9% (16.6-27.3) | 0.04 | ANC vs campaign Adjumani |
Households with net to sleeping place ratio ≥ 1 before distribution
Percent (95% CI)
| 7.4% (3.8-11.0) | 4.4% (1.8-7.0) | 4.4% (1.5-7.2) | 0.15 | ANC vs campaign Adjumani |
Households with persons to net ratio of ≤ 2 before distribution
Percent (95% CI)
| 4.7% (2.6-6.9) | 2.5% (0.7-4.3) | 2.9% (1.0-4.9) | 0.11 | ANC vs campaign Adjumani |
Immediately following distribution
| |||||
LLIN distributed per household*
Mean (95% CI)
| 1.0 (n.a.) | 1.48 (1.36-1.60) | 1.83 (1.69-1.98) | <0.0001 | Campaign Adjumani vs. Jinja |
Households with net to sleeping place ratio ≥ 1 better after distribution
Percent (95% CI)
| 37.0% (26.8-47.2) | 60.4% (48.7-72.1) | 47.2% (36.6-57.8) | 0.08 | Campaign Adjumani vs. Jinja |
Households with persons to net ratio of ≤ 2 after distribution
Percent (95% CI)
| 26.7% (20.2-33.2) | 28.7% (20.7-36.6) | 34.0% (27.9-40.1) | 0.25 | Campaign Adjumani vs. Jinja |
At time of survey
| |||||
Households that obtained additional nets after distribution
Percent (95% CI)
| 15.6% (9.0-22.2) | 9.2% (5.4-13.1) | 2.7% (0.5-4.2) | <0.0001 | Campaign Adjumani vs. Jinja |
Nets owned per household*
Mean (95% CI)
| 1.68 (1.51-1.84) | 1.94 (1.70-2.17) | 2.21 (2.03-2.40) | 0.04 | Campaign Adjumani vs. Jinja |
Households with net to sleeping place ratio ≥ 1
Percent (95% CI)
| 44.7% (34.4-55.0) | 65.8% (55.2-76.8) | 49.0% (38.2-59.8) | 0.025 | Campaign Adjumani vs. Jinja |
Households with persons to net ratio of ≤ 2
Percent (95% CI)
| 35.5% (24.3-38.7) | 32.1% (23.7-40.5) | 37.5% (32.1-42.8) | 0.26 | Campaign Adjumani vs. Jinja |
Net ownership
Equity of distribution
Net retention
Variable | ANC Adjumani | Campaign Adjumani | Campaign Jinja | p value Campaign Adjumani vs. Jinja |
---|---|---|---|---|
Retention (nets) | N = 378 | N = 772 | N = 1003 | |
Mean time since distribution in months | 7.3 (7.1-7.4) | 7.5 (7.4-7.5) | 5.1 (5.0-5.1) | <0.0001 |
LLINs retained by recipient household | 99.2% (98.5 - 99.9) | 98.3% (96.4-100) | 93.6% (91.6-95.7) | 0.019 |
Retention (households)
| N = 378 | N = 520 | N = 547 | |
Households with all nets retained | - - | 97.5% (92.9-99.2) | 90.5% (87.7-92.7) | 0.017 |
Use (nets)
| N = 375 | N = 759 | N = 939 | |
LLINs retained that were slept under the previous night | 98.9% (97.2 - 100) | 97.0% (94.3-99.6) | 74.2% (74.2-81.5) | <0.0001 |
Use (households)
| N = 378 | N = 520 | N = 547 | |
Households where all U5 slept under a net the previous night | 93.9% (89.5-96.5) | 92.8% (85.8-96.5) | 56.4% (52.1-60.5) | <0.0001 |
Households where all members slept under a net the previous night | 29.6% (22.9-37.4) | 42.7% (35.3-50.5) | 18.5% (13.7-24.5) | <0.0001 |
Households with net to sleeping place ratio of ≥ 1 where all members slept under a net the previous night | 55.6% (45.7-65.1) | 57.9% (51.1-64.4) | 32.5% (22.9-43.8) | 0.0009 |
Households with person to net ratio of ≤ 2 where all members slept under a net the previous night | 62.2% (54.7-69.2) | 73.7% (64.6-81.1) | 39.0% (29.0-50.1) | 0.0001 |
Net use
Variable | Odds-ratio | 95% Confidence interval of OR | p-value |
---|---|---|---|
Order of nets in household | |||
first | 1.00 | - - | |
second | 0.38 | 0.27 - 0.52 | <0.0001 |
third | 0.16 | 0.10 - 0.23 | <0.0001 |
fourth | 0.34 | 0.13 - 0.87 | 0.025 |
fifth | 0.04 | 0.00 - 0.85 | 0.039 |
Source of net | |||
free or subsidized outside distribution | 1.00 | - - | |
distribution (ANC or campaign) | 8.39 | 3.98 - 17.74 | <0.0001 |
commercial sector | 1.69 | 0.78 - 3.64 | 0.18 |
Household is oversupplied | |||
net to sleeping place ratio >1.0 | 0.44 | 0.33 - 0.59 | <0.0001 |
Distribution | |||
ANC Adjumani | 1.00 | - - | |
campaign Adjumani | 0.35 | 0.21 - 0.57 | <0.0001 |
campaign Jinja | 0.09 | 0.05 - 0.15 | <0.0001 |
Net was obtained before ANC/campaign | 1.78 | 0.94 - 3.38 | 0.075 |
Household members 7 or more | 1.43 | 1.06 - 1.92 | 0.020 |
Children under five years in household are 5 or more | 1.93 | 0.91 - 4.11 | 0.085 |
Household received information on hanging plus demonstration | 1.44 | 0.98 - 2.11 | 0.062 |
Household reported to have had difficulties in hanging or using nets | 0.63 | 0.40 - 0.99 | 0.048 |
Household is from 2 lowest wealth quintiles | 0.75 | 0.51 - 1.11 | 0.15 |