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DISTRIBUTION OF FREE UNTREATED BEDNETS BUNDLED WITH INSECTICIDE VIA AN INTEGRATED CHILD HEALTH CAMPAIGN IN LINDI REGION, TANZANIA: LESSONS FOR FUTURE CAMPAIGNS

Use of insecticide-treated bednets (ITNs) to prevent malaria remains low, and effective distribution strategies are needed. An integrated child health campaign with free distribution of 162,254 untreated bednets bundled with insecticide, measles vaccination, vitamin A, and mebendazole for children < 5 years old ("under-5s") was conducted in Lindi Region, Tanzania. We conducted a representative household survey 3 months after the campaign. Altogether, 574 households with 354 under-5s were visited. In households with an under-5, possession of bednets and ITNs increased from 60.9% to 90.7% (P < 0.001) and from 16.5% to 37.3% (P < 0.001), respectively. Increases occurred in all wealth quintiles and equity improved. Reported bednet and ITN use the previous night among under-5s was 46.3% and 21.5%, respectively. Integrated campaigns rapidly and equitably increase bednet possession and use meriting continued large-scale implementation. However, our study found that bednets were rarely treated; thus, future campaigns should provide factory-treated long-lasting ITNs. Low ITN use underscores the need for further efforts to increase use after campaigns.

Received February 7, 2007. Accepted for publication March 10, 2007.

Acknowledgments: The contributions of Dr. Samson Agbo, UNICEF/Tanzania, were invaluable to the integrated child health campaign and this evaluation. The authors thank the parents and children of Lindi region who participated in the survey. A special thanks goes to the National Malaria Control Program, Expanded Program on Immunization, Tanzania Food and Nutrition Centre, for organizing the integrated child health campaign and to UNICEF for funding the bednet portion of the campaign. Jonathan Zhong provided invaluable support in programming the PDAs and technical assistance in the field. Silas Temu was instrumental as a team leader and data manager. Lastly, The authors thank the surveyors who walked many kilometers in the hot sun to map villages and conduct interviews: Elly Francis, Shafii Hamisi, Mwajuma Issa, Mansab Kadhi, Mickins Laurent, Mohamed Lihundu, Asha Mzava, Mohamed Mswala, Saad Ngaweje, Rogers Rindeni, Salome Silvesta, and Focus Zanzibar. This paper is published with permission of Dr. Hassan Mshinda, Ifakara Health Research and Development Centre, and Dr. Andrew Kitua, Director-General, National Institute for Medical Research.

Financial support: This evaluation was conducted with resources from UNICEF and the Centers for Disease Control and Prevention/ Ifakara Health Research and Development Centre Programme in Tanzania.

Disclaimer: This information is distributed solely for the purpose of pre-dissemination peer review under applicable information quality guidelines. It has not been formally disseminated by the U.S. Centers for Disease Control and Prevention or the U.S. Public Health Service. It does not represent and should not be construed to represent any agency determination or policy.

Disclosure: Dr. Skarbinski performed this work while working as an Epidemic Intelligence Service Officer at the Centers for Disease Control and Prevention.

^* Address correspondence to Jacek Skarbinski, Malaria Branch, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341-3724. E-mail: jskarbinski{at}cdc.gov

Authors’ addresses: Jacek Skarbinski, Alexander K. Rowe, and S. Patrick Kachur, Malaria Branch, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341-3724, Telephone: +1 (770) 488-7785; Fax: +1 (770) 488-7761, E-mail: jskarbinski{at}cdc.gov. Julius J. Massaga, Centre for Enhancement of Effective Malaria Interventions (CEEMI), Gates Malaria Partnership, National Institute for Medical Research, P.O. Box 9653, Dar es Salaam, Tanzania.

Reprint requests: Jacek Skarbinski, Malaria Branch, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341-3724, Telephone: +1 (770) 488-7785; Fax: +1 (770) 488-7761, E-mail: jskarbinski{at}cdc.gov.