Health Policy and Planning, Vol 14, 18-25, Copyright © 1999 by Oxford University Press
R Snow, E McCabe, D Mbogo, C Molyneux, E Some, V Mung'ala and C Nevill
The results of recently completed trials in Africa of insecticide-treated
bed nets (ITBN) offer new possibilities for malaria control. These
experimental trials aimed for high ITBN coverage combined with high
re-treatment rates. Whilst necessary to understand protective efficacy, the
approaches used to deliver the intervention provide few indications of what
coverage of net re-treatment would be under operational conditions. Varied
delivery and financing strategies have been proposed for the sustainable
delivery of ITBNs and re-treatment programmes. Following the completion of
a randomized, controlled trial on the Kenyan coast, a series of suitable
delivery strategies were used to continue net re-treatment in the area. The
trial adopted a bi-annual, house-to-house re-treatment schedule free of
charge using research project staff and resulted in over 95% coverage of
nets issued to children. During the year following the trial, sentinel
dipping stations were situated throughout the community and household
members informed of their position and opening times. This free
re-treatment service achieved between 61-67% coverage of nets used by
children for three years. In 1997 a social marketing approach, that
introduced cost-retrieval, was used to deliver the net re-treatment
services. The immediate result of this transition was that significantly
fewer of the mothers who had used the previous re-treatment services
adopted this revised approach and coverage declined to 7%. The future of
new delivery services and their financing are discussed in the context of
their likely impact upon previously defined protective efficacy and
cost-effectiveness estimates.
ARTICLES
The effect of delivery mechanisms on the uptake of bed net re-impregnation in Kilifi district, Kenya
KEMRI/Wellcome Trust Collaborative Programme, Nairobi, Kenya; Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK; Population Services International, Washington DC, USA; Clinical Research Centre, Kilifi Unit, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya; Malaria Unit, African Medical & Research Foundation, Nairobi, Kenya
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