加纳东部地区 15 个月多渠道连续分发试点对 ITN 拥有和获取情况的影响。

Impact of a 15-month multi-channel continuous distribution pilot on ITN ownership and access in Eastern Region, Ghana.

机构信息

USAID NetWorks Project, Malaria Consortium, London, UK.

USAID NetWorks and VectorWorks Projects, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Baltimore, MD, USA.

出版信息

Malar J. 2018 Mar 22;17(1):124. doi: 10.1186/s12936-018-2275-8.

DOI:10.1186/s12936-018-2275-8

PMID:29566678

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5863820/

Abstract

BACKGROUND

Insecticide-treated nets are a key intervention for malaria prevention. While mass distribution can rapidly scale up ITN coverage, multiple channels may be needed to sustain high levels of ITN access and ownership. In Ghana's Eastern Region, a continuous ITN distribution pilot, started in October 2012, 18-24 months after a mass campaign. The pilot distributed ITNs through antenatal care services (ANC), child welfare clinic services (CWC) through the Expanded Programme on Immunization, and to students in two classes of primary schools.

METHODS

ITN ownership and access were evaluated through two cross-sectional surveys, conducted at baseline in April 2012, 11-15 months after the mass campaign, and at endline in December 2013, after 1 year of continuous distribution. A representative sample was obtained using a multi-stage cluster sampling design. Household heads were interviewed using a structured questionnaire.

RESULTS

Household ownership of at least one ITN was 91.3% (95% CI 88.8-93.9) at baseline and was not statistically significant at endline 18 months later at 88.3% (95% CI 84.9-91.0) (p = 0.10). Ownership of at least 1 ITN per two people significantly decreased from 51.3% (95% CI 47.1-55.4) to 40.2% (95% CI 36.4-44.6) (p < 0.01). Population access to an ITN within the household also significantly decreased from 74.5% (95% CI 71.2-77.7) at baseline to 66.4% (95% CI 62.9-69.9) at endline (p < 0.01). The concentration index score for any CD channel was slightly positive (0.10; 95% CI 0.04-0.15).

CONCLUSION

Thirty-one months after the mass campaign, the 15 months of continuous distribution activities had maintained levels of household ownership at least one ITN, but household ownership of one ITN for every two people and population access to ITN had declined. Ownership and access were higher with the CD programme than without. However, the number of ITNs delivered via ANC, CWC and two primary school classes were insufficient to sustain coverage targets. Future programmes should implement continuous distribution strategies fully within 1 year after a campaign or widen eligibility criteria (such as increase the number of classes) during the first year of implementation to make up for programme delays.

摘要

背景

经杀虫剂处理的蚊帐是预防疟疾的重要干预措施。虽然大规模分发可以迅速提高 ITN 的覆盖率，但可能需要多种渠道来维持高水平的 ITN 可及性和拥有率。在加纳东部地区，自 2012 年 10 月开始，在大规模运动后 18-24 个月，进行了一项连续的 ITN 分发试点。该试点通过产前保健服务（ANC）、儿童福利诊所服务（CWC）通过扩大免疫规划以及向两所小学的两个班级的学生分发 ITN。

方法

通过两次横断面调查评估 ITN 的拥有率和可及性，第一次调查于 2012 年 4 月进行，即大规模运动后 11-15 个月，第二次调查于 2013 年 12 月进行，即连续分发一年后进行。使用多阶段聚类抽样设计获得代表性样本。对家庭户主进行了结构化问卷调查。

结果

家庭至少拥有一顶 ITN 的比例为 91.3%（95%置信区间 88.8-93.9），在 18 个月后的基线没有统计学意义，为 88.3%（95%置信区间 84.9-91.0）（p=0.10）。每两个人至少拥有一顶 ITN 的比例从 51.3%（95%置信区间 47.1-55.4）显著下降至 40.2%（95%置信区间 36.4-44.6）（p<0.01）。家庭内人口获得 ITN 的比例也从基线时的 74.5%（95%置信区间 71.2-77.7）显著下降至 66.4%（95%置信区间 62.9-69.9）（p<0.01）。任何 CD 渠道的集中指数评分均略为正值（0.10；95%置信区间 0.04-0.15）。

结论

大规模运动后 31 个月，15 个月的连续分发活动维持了家庭至少拥有一顶 ITN 的水平，但每两个人拥有一顶 ITN 的比例以及人口获得 ITN 的比例有所下降。通过 CD 方案获得的拥有率和可及性高于未通过 CD 方案。然而，通过 ANC、CWC 和两所小学分发的 ITN 数量不足以维持覆盖目标。未来的方案应在运动后 1 年内全面实施连续分发战略，或在实施的第一年扩大资格标准（例如增加班级数量），以弥补方案延误。