加纳长效驱虫蚊帐（LLIN）普及分发运动评估：分发和悬挂活动的成本效益。
Evaluation of a universal long-lasting insecticidal net (LLIN) distribution campaign in Ghana: cost effectiveness of distribution and hang-up activities.
机构信息
Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
出版信息
Malar J. 2014 Feb 28;13:71. doi: 10.1186/1475-2875-13-71.
BACKGROUND
Between May 2010 and October 2012, approximately 12.5 million long-lasting insecticidal nets (LLINs) were distributed through a national universal mass distribution campaign in Ghana. The campaign included pre-registration of persons and sleeping places, door-to-door distribution of LLINs with 'hang-up' activities by volunteers and post-distribution 'keep-up' behaviour change communication activities. Hang-up activities were included to encourage high and sustained use.
METHODS
The cost and cost-effectiveness of the LLIN Campaign were evaluated using a before-after design in three regions: Brong Ahafo, Central and Western. The incremental cost effectiveness of the 'hang-up' component was estimated using reported variation in the implementation of hang-up activities and LLIN use. Economic costs were estimated from a societal perspective assuming LLINs would be replaced after three years, and included the time of unpaid volunteers and household contributions given to volunteers.
RESULTS
Across the three regions, 3.6 million campaign LLINs were distributed, and 45.5% of households reported the LLINs received were hung-up by a volunteer. The financial cost of the campaign was USD 6.51 per LLIN delivered. The average annual economic cost was USD 2.90 per LLIN delivered and USD 6,619 per additional child death averted by the campaign. The cost-effectiveness of the campaign was sensitive to the price, lifespan and protective efficacy of LLINs.Hang-up activities constituted 7% of the annual economic cost, though the additional financial cost was modest given the use of volunteers. LLIN use was greater in households in which one or more campaign LLINs were hung by a volunteer (OR=1.57; 95% CI=1.09, 2.27; p=0.02). The additional economic cost of the hang-up activities was USD 0.23 per LLIN delivered, and achieved a net saving per LLIN used and per death averted.
CONCLUSION
In this campaign, hang-up activities were estimated to be net saving if hang-up increased LLIN use by 10% or more. This suggests hang-up activities can make a LLIN campaign more cost-effective.
背景
2010 年 5 月至 2012 年 10 月，加纳通过全国范围内普遍的大规模分发运动分发了约 1250 万顶长效驱虫蚊帐（LLINs）。该运动包括人员和床位的预登记、志愿者挨家挨户分发 LLINs 并开展“悬挂”活动以及分发后“保持”行为改变沟通活动。开展“悬挂”活动是为了鼓励高且持续的使用率。
方法
采用前后设计，在布隆阿哈福、中部和西部地区三个地区评估 LLIN 运动的成本和成本效益。使用报告的“悬挂”活动实施情况和 LLIN 使用情况的差异来估算“悬挂”部分的增量成本效益。从社会角度估算经济成本，假设 LLIN 将在三年后更换，并包括志愿者的无偿时间和向志愿者提供的家庭贡献。
结果
在这三个地区，共分发了 360 万顶运动用 LLINs，45.5%的家庭报告收到的 LLINs 是由志愿者悬挂的。运动的财务成本为每顶 LLIN 6.51 美元。每年的平均经济成本为每顶 LLIN 2.90 美元，通过该运动每避免一名儿童死亡的额外成本为 6619 美元。该运动的成本效益对 LLINs 的价格、寿命和保护效果敏感。“悬挂”活动占年度经济成本的 7%，但考虑到志愿者的使用，额外的财务成本相对较小。在一个或多个志愿者悬挂了运动用 LLINs 的家庭中，LLIN 使用量更大（OR=1.57；95%CI=1.09，2.27；p=0.02）。每顶 LLIN 增加 0.23 美元的悬挂活动额外经济成本，实现了每顶 LLIN 使用和每例死亡避免的净节省。
结论
在这项运动中，如果“悬挂”活动使 LLIN 使用量增加 10%或更多，则估计“悬挂”活动是节省成本的。这表明“悬挂”活动可以使 LLIN 运动更具成本效益。
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