New Publication (from me): “Insecticide-treated net use before and after mass distribution in a fishing community along Lake Victoria, Kenya: successes and unavoidable pitfalls”
This was was years in the making but it is finally out in Malaria Journal and ready for the world’s perusal. Done.
Insecticide-treated net use before and after mass distribution in a fishing community along Lake Victoria, Kenya: successes and unavoidable pitfalls
Peter S Larson, Noboru Minakawa, Gabriel O Dida, Sammy M Njenga, Edward L Ionides and Mark L Wilson
Insecticide-treated nets (ITNs) have proven instrumental in the successful reduction of malaria incidence in holoendemic regions during the past decade. As distribution of ITNs throughout sub-Saharan Africa (SSA) is being scaled up, maintaining maximal levels of coverage will be necessary to sustain current gains. The effectiveness of mass distribution of ITNs, requires careful analysis of successes and failures if impacts are to be sustained over the long term.
Mass distribution of ITNs to a rural Kenyan community along Lake Victoria was performed in early 2011. Surveyors collected data on ITN use both before and one year following this distribution. At both times, household representatives were asked to provide a complete accounting of ITNs within the dwelling, the location of each net, and the ages and genders of each person who slept under that net the previous night. Other data on household material possessions, education levels and occupations were recorded. Information on malaria preventative factors such as ceiling nets and indoor residual spraying was noted. Basic information on malaria knowledge and health-seeking behaviours was also collected. Patterns of ITN use before and one year following net distribution were compared using spatial and multi-variable statistical methods. Associations of ITN use with various individual, household, demographic and malaria related factors were tested using logistic regression.
After infancy (<1 year), ITN use sharply declined until the late teenage years then began to rise again, plateauing at 30 years of age. Males were less likely to use ITNs than females. Prior to distribution, socio-economic factors such as parental education and occupation were associated with ITN use. Following distribution, ITN use was similar across social groups. Household factors such as availability of nets and sleeping arrangements still reduced consistent net use, however.
Comprehensive, direct-to-household, mass distribution of ITNs was effective in rapidly scaling up coverage, with use being maintained at a high level at least one year following the intervention. Free distribution of ITNs through direct-to-household distribution method can eliminate important constraints in determining consistent ITN use, thus enhancing the sustainability of effective intervention campaigns.
Did your research find that some nets were used for fishing instead/ i understand that is one of the problems they came across here in Uganda. Another during the recent distribution in Kampala accompanied with much fanfare from Western Govts including the UK was the abuse of power wielded by the agencies used to distribute the nets. Distribution was linked to the recent house-to-house Census and some people were instructed to collect the nets from a central store. Sadly some were turned away at the door. The perception allegedly, rightly or wrongly, was that nets were finding their way on to the street for sale.
It is true that many nets are being used for fishing. I do not find, though, that the diversion of nets is impacting the use of nets for malaria prevention. Often people will use old nets for fishing, or nets then simply don’t like. The Kenyan Govt distributed some nets a while back. People complained that they itched and when I poked around at nets used for fishing or covering plants, I found that a lot of them were from this distribution. The reality is that people will do thing you don’t expect or want them to do. A solution is to distribute more nets to account for this reality. People aren’t dumb. They will make decisions about the best use of something free. Sometimes a net is more valuable for earning money than preventing malaria.
As for corruption, this is Kenya. It’s a national pastime. Nets and drugs for the public sector do get sold in the markets, often at stands owned by the local government nurse.