Brentlinger Paula E, Correia Maria Ana Chadreque, Chinhacata Fungai Simbé, Gimbel-Sherr Kenneth H, Stubbs Benjamin, Mercer Mary Anne
Department of Health Services, School of Public Health and Community Medicine, P.O. Box 354809, University of Washington, Seattle, WA 98195, USA.
Health Policy Plan. 2007 Mar;22(2):103-10. doi: 10.1093/heapol/czm002. Epub 2007 Feb 8.
Malaria is an important cause of mortality and morbidity in sub-Saharan Africa. Use of insecticide-treated bednets (ITNs) is an important preventive intervention. Selection of the best mechanisms for distribution and promotion of ITNs to vulnerable populations is an important strategic issue.
Commercial shopkeepers and groups of community leaders were trained to promote and sell ITNs in 19 sites in central Mozambique between 2000 and 2004. Pregnant women and children under 5 years of age comprised the target population. Sales records, household survey results and project experiences were examined to derive 'lessons learned'.
An end-of-project household survey revealed that 40.8% of households owned one or more bednets, but only 19.6% of households owned a net that had been re-treated with insecticide within the preceding 6 months. Higher levels of bednet (treated or untreated) coverage (over 50%) were achieved in urban or peri-urban sites than in rural sites (as low as 15%). Bednet ownership was significantly associated with higher socio-economic status (odds ratios for association with bednet ownership: 5.6 for highest educational level compared with no education, 0.4 for dirt floor compared with cement or other finished flooring, 2.1 for automobile ownership compared with transportation on foot), but was negatively associated with the presence of young children in the household (odds ratio 0.5). Primary output: 23 000 ITNs were sold during the course of the project. Process lessons: Nearly all of the community leader sites failed and were replaced by shopkeepers or Ministry of Health personnel. Sales were most brisk in more prosperous urban and peri-urban sites (up to 147 nets/month) but were significantly slower in poorer, rural sites (as low as three nets/month). Remote rural sites with slow sales were more expensive to serve. Logistical difficulties were related to tariffs, transport, management of cash, warehousing and organization of re-treatment campaigns.
This project failed to achieve adequate or equitable levels of ITN coverage in a timely manner in the programme sites. However, its findings helped support a subsequent Mozambican decision to conduct targeted distribution of long-lasting nets to the neediest populations in the provinces where the project was conducted.
疟疾是撒哈拉以南非洲地区导致死亡和发病的重要原因。使用经杀虫剂处理的蚊帐（ITN）是一项重要的预防干预措施。选择向弱势群体分发和推广ITN的最佳机制是一个重要的战略问题。
2000年至2004年期间，在莫桑比克中部的19个地点对商业店主和社区领袖群体进行了培训，以推广和销售ITN。目标人群包括孕妇和5岁以下儿童。对销售记录、家庭调查结果和项目经验进行了审查，以总结“经验教训”。
项目结束时的家庭调查显示，40.8%的家庭拥有一个或多个蚊帐，但只有19.6%的家庭拥有在前6个月内重新用杀虫剂处理过的蚊帐。城市或城郊地区的蚊帐（处理过或未处理过）覆盖率较高（超过50%），而农村地区则较低（低至15%）。蚊帐拥有情况与较高的社会经济地位显著相关（与蚊帐拥有情况相关的优势比：最高教育水平与未受过教育相比为5.6，泥土地面与水泥地面或其他成品地面相比为0.4，拥有汽车与步行出行相比为2.1），但与家庭中幼儿的存在呈负相关（优势比为0.5）。主要产出：项目期间共售出23000顶ITN。过程经验教训：几乎所有由社区领袖负责的地点都失败了，后来由店主或卫生部人员取而代之。在较为繁荣的城市和城郊地区销售最为活跃（每月高达147顶蚊帐），但在较贫困的农村地区则明显较慢（低至每月3顶蚊帐）。销售缓慢的偏远农村地区服务成本更高。后勤困难与关税、运输、现金管理、仓储以及重新处理活动的组织有关。
该项目未能在项目地点及时实现足够或公平的ITN覆盖率。然而，其调查结果有助于支持莫桑比克随后做出的决定，即向项目实施省份中最需要的人群有针对性地分发长效蚊帐。
