Academic journal article Bulletin of the World Health Organization

Strategies for Delivering Insecticide-Treated Nets at Scale for Malaria Control: A Systematic review/Strategies De Distribution De Moustiquaires Impregnees Adaptees a la Lutte Contre le Paludisme: Revue systematique/Estrategias Para la Distribucion a Escala De Mosquiteros Tratados Con Insecticida Para Controlar la Malaria: Revision Sistematica

Academic journal article Bulletin of the World Health Organization

Strategies for Delivering Insecticide-Treated Nets at Scale for Malaria Control: A Systematic review/Strategies De Distribution De Moustiquaires Impregnees Adaptees a la Lutte Contre le Paludisme: Revue systematique/Estrategias Para la Distribucion a Escala De Mosquiteros Tratados Con Insecticida Para Controlar la Malaria: Revision Sistematica

Article excerpt

Introduction

Malaria continues to represent a major public health problem in areas of endemicity, with an estimated 225 million cases worldwide in 2009.1 The 2015 goals of the World Health Organization's (WHO's) Roll Back Malaria Partnership are to reduce global malaria cases by 75% from 2000 levels and to reduce malaria deaths to near zero through universal coverage by effective prevention and treatment interventions) Among other preventive interventions, WHO recommends the use of insecticide-treated nets (ITNs), particularly long-lasting insecticidal nets, which have been shown to be cost-effective, (2-4) to reduce malaria episodes among children < 5 years of age (hereafter, "children under 5") by approximately 50% and all-cause mortality by 17%. (5,6) Universal coverage with ITNs is defined as use by > 80% of individuals in populations at risk. (6) WHO recommends supplying ITNs without charge or with a high subsidy and using a combination of periodic mass campaigns and routine delivery channels to deliver ITNs at scale. (6) Other strategies include supporting the existing commercial sector and distributing vouchers exchangeable for partially subsidized ITNs through retailers. (7) In response to the Roll Back Malaria Partnerships targets for universal coverage, considerable efforts have been made recently to scale up ITN delivery. However, there is still low coverage in many countries and a need to understand the lessons learnt from experiences of scaling up ITN delivery. We therefore conducted a systematic review to synthesize recent evidence on the delivery of ITNs (including long-lasting insecticidal nets) at scale in malaria-endemic areas by documenting

and characterizing the strategies for delivering ITNs at scale (at the district level or higher); summarizing ITN ownership among households and ITN use among children under 5, stratified by measures of equity when possible; summarizing the reported cost or cost-effectiveness of different strategies; and synthesizing information on reported factors influencing delivery of ITNs at scale.

Methods

A systematic review was conducted to identify studies that reported on the delivery of ITNs (including long-lasting insecticidal nets) at scale. The findings reported here form part of a larger systematic review on the scale-up of WHO-recommended malaria control interventions. (8) We used a definition of "scaling up" that characterized this activity as the expansion of a health intervention beyond the initial geographical area or population group covered. (9,10) We considered "at scale" to be ITN delivery in at least one district or the equivalent lowest level of health service administration in a given country.

Search strategy

Medline (Ovid), EMBASE, CAB Abstracts, Global Health and Africa Wide databases were searched using subject heading classification terms and free-text words. The following categories were combined using the AND Boolean logic operator: malaria terms, ITN and long-lasting insecticidal net terms and scaling-up terms (Box 1, available at: http://www.who.int/ bulletin/volumes/90/9/11-094771). Filters were used to limit the search to humans and to publication dates from January 2000 to December 2010. Relevant papers from the grey literature were identified by searching Eldis and WHOLIS databases and Roll Back Malaria, Malaria Consortium, Africa Malaria Network Trust, and The Global Fund to Fight AIDS, Tuberculosis and Malaria web sites. Citation data for identified papers were exported to EndNote (Thomson Reuters, Carlsbad, USA), where duplicates were removed.

Eligibility criteria

Screening was a two-stage process. First, two authors (BW and LSP) independently screened titles and abstracts to determine which papers should undergo full-text assessment for eligibility. Retained papers underwent full-text review (performed independently by BW and LSP) to determine whether they described studies that satisfied the following criteria: subjects resided in areas where Plasmodium falciparum and Plasmodium vivax are endemic; ITN delivery at scale was evaluated; ITN ownership among households, receipt by pregnant women and/or use among children under 5 was evaluated; and an individual or cluster-randomized controlled design, a nonrandomized design, a quasi-experimental design, a before-and-after design, an interrupted time series design or a cross-sectional design without temporal or geographical controls was used. …

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