Malaria Consortium - Africa Regional Office, PO Box 8045, Plot 2, Sturrock Road, Kampala, Uganda.
Malar J. 2010 Apr 20;9:102. doi: 10.1186/1475-2875-9-102.
In Uganda, long-lasting insecticidal nets (LLIN) have been predominantly delivered through two public sector channels: targeted campaigns or routine antenatal care (ANC) services. Their combination in a mixed-model strategy is being advocated to quickly increase LLIN coverage and maintain it over time, but there is little evidence on the efficiency of each system. This study evaluated the two delivery channels regarding LLIN retention and use, and estimated the associated costs, to contribute towards the evidence-base on LLIN delivery channels in Uganda.
Household surveys were conducted 5-7 months after LLIN distribution, combining questionnaires with visual verification of LLIN presence. Focus groups and interviews were conducted to further investigate determinants of LLIN retention and use. Campaign distribution was evaluated in Jinja and Adjumani while ANC distribution was evaluated only in the latter district. Costs were calculated from the provider perspective through retrospective analysis of expenditure data, and effects were estimated as cost per LLIN delivered and cost per treated-net-year (TNY). These effects were calculated for the total number of LLINs delivered and for those retained and used.
After 5-7 months, over 90% of LLINs were still owned by recipients, and between 74% (Jinja) and 99% (ANC Adjumani) were being used. Costing results showed that delivery was cheapest for the campaign in Jinja and highest for the ANC channel, with economic delivery cost per net retained and used of USD 1.10 and USD 2.31, respectively. Financial delivery costs for the two channels were similar in the same location, USD 1.04 for campaign or USD 1.07 for ANC delivery in Adjumani, but differed between locations (USD 0.67 for campaign delivery in Jinja). Economic cost for ANC distribution were considerably higher (USD 2.27) compared to campaign costs (USD 1.23) in Adjumani.
Targeted campaigns and routine ANC services can both achieve high LLIN retention and use among the target population. The comparatively higher economic cost of delivery through ANC facilities was at least partially due to the relatively short time this system had been in existence. Further studies comparing the cost of well-established ANC delivery with LLIN campaigns and other delivery channels are thus encouraged.
在乌干达，长效驱虫蚊帐（LLIN）主要通过两种公共部门渠道进行分发：有针对性的运动或常规产前护理（ANC）服务。提倡将这两种渠道结合起来采用混合模式策略，以快速提高 LLIN 的覆盖率并长期维持，但关于每个系统的效率的证据很少。本研究评估了这两种分发渠道在 LLIN 保留和使用方面的效果，并计算了相关成本，以帮助为乌干达的 LLIN 分发渠道提供证据基础。
在 LLIN 分发后 5-7 个月进行家庭调查，将问卷调查与 LLIN 存在的视觉验证相结合。进行焦点小组和访谈以进一步调查 LLIN 保留和使用的决定因素。在 Jinja 和 Adjumani 评估了运动分发情况，而仅在后者地区评估了 ANC 分发情况。通过对支出数据的回顾性分析从提供者的角度计算了成本，并将效果估计为每分发一张 LLIN 的成本和每治疗用蚊帐年（TNY）的成本。这些效果是针对分发的所有 LLIN 以及保留和使用的 LLIN 计算的。
5-7 个月后，超过 90%的 LLIN 仍为接受者所有，使用率在 74%（Jinja）至 99%（ANC Adjumani）之间。成本核算结果表明，在 Jinja 举行的运动分发最便宜，而 ANC 渠道最高，每保留和使用一张蚊帐的经济分发成本分别为 1.10 美元和 2.31 美元。在同一地点，两个渠道的财务分发成本相似，Jinja 的运动分发为 1.04 美元，ANC 分发为 1.07 美元，而在不同地点（Jinja 的运动分发为 0.67 美元）则不同。与运动成本（1.23 美元）相比，ANC 分发的经济成本（2.27 美元）要高得多。
有针对性的运动和常规 ANC 服务都可以使目标人群保持较高的 LLIN 保留率和使用率。通过 ANC 设施进行分发的相对较高的经济成本至少部分归因于该系统存在的时间相对较短。因此，鼓励进一步比较成熟的 ANC 分发系统与 LLIN 运动和其他分发渠道的成本。
