Evaluation of universal coverage of insecticide-treated nets in western Kenya: field surveys
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Date
2014
Authors
Zhou, Guofa
Li, Jessica S.
Ototo, Ednah N.
Atieli, Harrysone E.
Githeko, Andrew K.
Yan, Guiyun
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Background: Mass distribution of insecticide-treated nets (ITNs) is a cost-effective way to achieve universal
coverage, but maintaining this coverage is more difficult. In addition to commonly used indicators, evaluation of
universal coverage should include coverage of effective nets and changes in coverage over time.
Methods: Longitudinal and cross-sectional household ITN surveys were carried out from 2010 to 2013 in six
locations representing a variety of settings across western Kenya. Five indicators were used to evaluate the current
status of universal coverage: 1) ITN ownership – proportion of households that own at least one ITN, 2) access index –
ratio of the number of family members over the number of ITNs owned by that household, 3) operational coverage –
proportion of the at-risk population potentially covered by ITNs, assuming one ITN for every two people, 4) effective
coverage – population coverage of effective ITNs, and 5) usage – proportion of the population that used ITNs the
previous night.
Results: ITN ownership and operational coverage increased substantially from 2010 to 2013, but this increase was
mostly due to the 2011 mass distribution campaign. In 2013, household ITN ownership was on average 84.4% (95% CI
[78.4, 90.5]) across the six study areas, and operational coverage was 83.2% (95% CI [72.5, 93.8]). The ITN access rate was
59.1% (95% CI [56.6, 61.7]), and 40.8% (95% CI [38.3, 43.4]) of the people at risk needed more nets to achieve universal
coverage. About 88.5% (95% CI [86.1, 90.9]) of the ITNs were below three years old and 16.5% (95% CI [12.1, 20.9]) of
the ITNs had hole(s). The estimated effective long-lasting insecticide-treated net (LLIN) coverage was 70.5% (95 CI [58.7,
82.3]). Approximately 18.4% (95% CI [15.5, 21.4]) of the ITNs were shared by more than three persons, and the population
ITN usage rate was about 75-87%. The reason for not using ITNs was almost exclusively “net not available”.
Conclusion: Current methods of delivering ITNs, i.e., one mass campaign every five years and regular distribution of
ITNs from health center can barely maintain the current effective coverage. Inaccessibility and loss of physical integrity
of ITNs are major hindrances to achieving and maintaining universal coverage.
Description
Research article
Keywords
Citation
Malaria Journal 2014, 13:351, http://www.malariajournal.com/content/13/1/351