A plan to distribute insecticide-treated bed nets annually to children in schools

July 11, 2018 by Stephanie Desmon, Johns Hopkins University
Schoolchildren receive free bed nets during a distribution in Tanzania. Credit: 2017 Magali Rochat/Vectorworks

Insecticide-treated bed nets—a crucial part of malaria protection throughout sub-Saharan Africa and regions of Asia—have long been distributed to people who need them through mass campaigns conducted every three years.

But what if there were a more effective way to cover more people with bed designed to protect them from being bitten by malaria-infected mosquitoes? Better yet, what if those nets could be distributed at a lower cost and with fewer of the logistical headaches associated with mass campaigns?

Those were the questions that the government of Tanzania asked Johns Hopkins Center for Communication Programs' Hannah Koenker and others in 2011. They met with officials, community members and other stakeholders. A health economist from Tulane University modeled different options, with cost and operational considerations in mind. What they came up with was a plan to distribute nets annually to children in schools to supplement the regular distribution of nets to pregnant women and infants at health facilities instead of mass campaigns.

The plan worked.

With support from the U.S. President's Malaria Initiative through USAID and the Swiss Agency for Development and Cooperation, Tanzania has delivered 2.5 million nets to schoolchildren in three southern regions since 2013: Lindi, Mtwara, and Ruvuma. According to recently released results from the 2017 Tanzania Malaria Indicator Survey, more than 70 percent of people in those regions had an insecticide-treated net to sleep under in 2017, a rate that has been maintained steadily since the program began. And Koenker, who heads PMI's VectorWorks project, says this was done by distributing a million fewer nets than a mass distribution campaign would have required, a significant increase in efficiency. VectorWorks, which is led by CCP, implements the program in support of the Tanzanian government.

"The idea of replacing mass campaigns with yearly school net distributions was pretty revolutionary, frankly. It hadn't ever been tried on such a large scale," she says. "What we found in Tanzania is that school-based net distribution has proven to be an innovation that streamlines the net delivery process and makes nets accessible to more people in a cost-effective way. You need careful planning to make the switchover to school distribution but Tanzania shows that it can work."

As the school-based program has matured, the distribution of nets has been integrated with a government education database that collects enrollment figures, simplifying the process and ensuring more accurate counts of students and of nets delivered.

A plan to distribute insecticide-treated bed nets annually to children in schools
Alex and his father open a mosquito bed net that he received at school in Tanzania. Credit: 2017 Magali Rochat/Vectorworks

Following the success in the south, Tanzania scaled up school distribution to 11 other high-burden regions in 2016. The program is now in its third year distributing nets in schools in 14 regions of the country, supplementing distribution channels that have long been in place at health facilities where prenatal care and vaccinations are provided. With PMI funding, VectorWorks has also assisted with similar school programs in Ghana, Guinea, and Mozambique.

"Since we now have evidence that school-based distribution works, our efforts have been in improving operational efficiency and reducing costs," says Waziri Nyoni, who leads VectorWorks activities in the Tanzania country office. "Fewer of our staff members are now needed to run school-based distribution, we deliver the nets and everyone knows what needs to be done."

Insecticide-treated bed nets are a critically important malaria control tool. An estimated 663 million cases of malaria have been averted in sub-Saharan Africa since 2001. The World Health Organization says an estimated 69 percent of that decline was due to the availability and use of insecticide-treated mosquito nets.

Mass distribution campaigns are usually done every three years—though they tend to take an entire year or more to complete—and take a huge amount of effort to coordinate. If nets are lost or wear out between campaigns, however, there is often no way for people to obtain new ones. They have to wait until the next cycle.

In the school-based system, nets are usually distributed to half the classes, which allows a household's children to receive nets at primary school every other year. One of the keys to success there, Koenker says, is that the schools and the government coordinate to ensure accurate student enrollment counts—and subsequent delivery of the right number of nets. If a family has multiple children, they may get multiple nets. A social and behavior change communication campaign encourages Tanzanians with extra nets to give them to family and friends who may need them.

In Tanzania where the new system has been implemented, between the nets given to pregnant women and infants at health clinics and school-based distribution, nets reach two-thirds of households. But those households encompass 85 percent of the population.

"You may be missing some families that don't have school-aged children, but that doesn't appear to be effecting the overall access to nets," she says. "We are seeing better results with school-based distribution. It's really working."

Explore further: Combining insecticide sprays and bed nets 'no more effective' in cutting malaria

Related Stories

Combining insecticide sprays and bed nets 'no more effective' in cutting malaria

December 8, 2014
There is no need to spray insecticide on walls for malaria control when people sleep under treated bed nets, according to new research.

Study finds use of bed nets by 75 percent of population could eradicate malaria

March 7, 2013
Malaria, the leading cause of death among children in Africa, could be eliminated if three-fourths of the population used insecticide-treated bed nets, according to a new study from the National Institute for Mathematical ...

Prioritizing pregnant women in malaria endemic regions for bed nets from clinics

September 9, 2014
Donors, Ministries of Health, implementing agencies, and other partners should prioritise providing pregnant women in malaria endemic regions with long-lasting insecticide treated nets (LLINs) through antenatal care clinics ...

Novel mosquito net provides children with greater protection against malaria

April 11, 2018
In a two-year community randomised trial involving more than 15,000 children in Tanzania, a long lasting insecticidal net treated with piperonyl butoxide (PBO LLIN) reduced the prevalence of malaria by 44% and 33% in the ...

Recommended for you

Deadly Rift Valley fever: New insight, and hope for the future

July 19, 2018
Health control measures alone could be ineffective in the long term fight against the deadly Rift Valley fever which affects both humans and animals, a new study in the journal PNAS reports.

New guidelines to diagnose, manage rare endocrine disorders

July 19, 2018
International guidelines have been published for the first time to help doctors around the globe diagnose and manage patients with a very rare set of endocrine diseases known as pseudohypoparathyroidism and its related disorders, ...

Overuse of antibiotics not what the doctor ordered

July 19, 2018
With increased use of antibiotics worldwide linked to growing antibiotic resistance, a world-first study co-authored by a QUT researcher has highlighted the growing impact of non-prescription supply of antibiotics in community ...

Alcohol-related cirrhosis deaths skyrocket in young adults

July 18, 2018
Deaths from cirrhosis rose in all but one state between 1999-2016, with increases seen most often among young adults, a new study shows.

Hidden blood in feces may signal deadly conditions

July 17, 2018
(HealthDay)—Even if it's not visible to the naked eye, blood in the stool can be serious—a sign of a potentially fatal disease other than colon cancer, new research suggests.

Childhood abuse linked to greater risk of endometriosis, study finds

July 17, 2018
Endometriosis, a painful condition that affects one in 10 reproductive-age women in the U.S., has been linked to childhood physical and sexual abuse, according to findings published today in the journal Human Reproduction.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.