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Comparing two models of massive distribuition of mosquito bed nets in rural districts of Mozambique
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Introdução: A disponibilização de redes mosquiteiras impregnadas com insecticida de longa duração (REMILDs) é uma das intervenções principais no controlo vectorial da malária. O uso de REMILDs está associado a uma redução da transmissão da malária. Moçambique disponibiliza as REMILDs através de dois canais: consulta pré natal e em campanhas para a cobertura universal. Este estudo testa novas estratégias de distribuição de REMILDs (intervenção) em campanha e compara os seus resultados com o das estratégias anteriores (controlo). O objetivo geral é o de comparar os dois modelos de distribuição de redes mosquiteiras em distritos rurais de Moçambique.
Métodos: Os distritos de intervenção foram: Gurue e Sussundenga; os distritos de controlo foram: Alto-Molócuè e Machaze. Usando uma abordagem quantitativa, três estudos tiveram lugar: i) antes e depois entre os meses de Outubro e Dezembro de 2015; ii) antes e depois, do tipo observacional e transversal, entre os meses de Junho e Julho de 2016; iii) análise de custo-efectividade entre os meses de Outubro e Dezembro de 2015. Três principais estratégias de implementação foram testadas: uso de cupões durante o registo das famílias (AFs), uso de autocolantes para identificar as casas registadas e um novo critério de atribuição de redes. Os principais indicadores medidos foram: i) percentagem de REMILDs distribuídas; ii) cobertura da posse e uso de REMILDs; iii) percentagem de AFs que alcançaram a cobertura universal; iv) razão incremental de custo-efectividade (RICE); iv) benefício líquido incremental.
Resultados: Cerca de 88% (302.648) de REMILDs foram distribuídas nos distritos de intervenção em comparação com 77% (219.613) nos distritos de controlo [OR: 2.14 (IC 95%: 2,11–2,16)]. Seis meses após a campanha de 2015, dos 760 AFs inqueridos nos distritos de intervenção, 98,8% tinha pelo menos uma REMILD; dos 787 AFs inqueridos nos distritos de control, 89,6% tinha pelo menos uma REMILD [OR: 9,7, (IC 95%: 5,25 – 22,76)]. Cerca de 95% e 87% dos inqueridos que tinham pelo menos uma REMILD reportaram ter dormido debaixo da mesma na noite anterior nos distritos de intervenção e controlo, respectivamente [OR: 3,2; (IC 95%: 2,12-4,69)]; 71% dos AFs inqueridos alcançaram a cobertura universal nos distritos de intervenção contra 59.6% nos distritos de controlo [OR: 1,6; (IC 95%: 1,33 – 2,03)]. A RICE por REMILD distribuída foi de US$ 0,68. O benefício líquido incremental foi positivo.
Conclusões: Os distritos de intervenção tiveram maior disponibilização de REMILDs, maior cobertura de posse e uso, e um melhor progresso para o alcance de cobertura universal. A nova estratégia foi mais custo-efectiva do que a estratégia anterior. A nova estratégia poderá acelerar o passo no controlo vectorial para a redução da morbi-mortalidade por malária e alcançe dos objectivos da Estratégia Técnica Global para a Malária 2016 – 2030.
Introduction: The provision of long lasting insecticidal nets (LLINs) has been pointed out as one of the core malaria vector control interventions. The use of LLINs is associated with a reduction in malaria transmission. LLINs delivery in Mozambique has been carried out through two delivery channels: prenatal care service and universal coverage campaigns. This study tests new delivery strategies (intervention) in universal coverage campaign and compares its results with previous strategies (control). The general objective of the thesis is to compare two bed nets delivery models in rural districts of Mozambique. Methods: The intervention districts were: Gurue and Sussundenga; the control districts were: Alto-Molocue and Machaze. Using a quantitative approach, three studies took place: i) before and after study between October and December 2015; ii) before and after, observational and cross-sectional study, between June and July 2016; and iii) cost-effectiveness analysis between October and December 2015. Three core implementation strategies were tested: use of coupons during household (HH) registration, use of stickers to identify registered houses and a new LLINs allocation criterion. The main endpoints measured were: i) percentage of distributed LLINs; ii) LLINs ownership and use coverage; iii) percentage of HHs that achieved universal coverage; iv) incremental cost-effectiveness ratio (ICER); iv) incremental net benefit (INB). Results: Approximately 88% (302,648) of LLINs were distributed in intervention districts compared to 77% (219,613) in control districts [OR: 2.14 (95% CI: 2.11-2.16)]. Six months after the 2015 campaign, of the 760 HHs surveyed in the intervention districts, 98.8% had at least one LLIN; of the 787 HHs surveyed in the control districts, 89.6% had at least one LLIN [OR: 9.7, (95% CI: 5.25 - 22.76)]. Near 95% and 87% of respondents who had at least one LLIN reported having slept under the LLIN the previous night in the intervention and control districts, respectively [OR: 3.2; (95% CI 2.12-4.69)]; 71% of the HHs surveyed achieved universal coverage in the intervention districts against 59.6% in the control districts [OR: 1.6; (95% CI: 1.33-2.03)]. ICER per distributed LLIN was US$ 0.68. INB was positive. Conclusions: Intervention districts had greater LLINs availability, greater LLINs ownership and use coverage, and a better progression toward reaching universal coverage targets. The new strategy was more cost-effective than the previous strategy. The new strategy might well accelerate the pace in vector control for reducing malaria morbidity and mortality and achieving the goals of the Global Technical Strategy for malaria 2016-2030.
Introduction: The provision of long lasting insecticidal nets (LLINs) has been pointed out as one of the core malaria vector control interventions. The use of LLINs is associated with a reduction in malaria transmission. LLINs delivery in Mozambique has been carried out through two delivery channels: prenatal care service and universal coverage campaigns. This study tests new delivery strategies (intervention) in universal coverage campaign and compares its results with previous strategies (control). The general objective of the thesis is to compare two bed nets delivery models in rural districts of Mozambique. Methods: The intervention districts were: Gurue and Sussundenga; the control districts were: Alto-Molocue and Machaze. Using a quantitative approach, three studies took place: i) before and after study between October and December 2015; ii) before and after, observational and cross-sectional study, between June and July 2016; and iii) cost-effectiveness analysis between October and December 2015. Three core implementation strategies were tested: use of coupons during household (HH) registration, use of stickers to identify registered houses and a new LLINs allocation criterion. The main endpoints measured were: i) percentage of distributed LLINs; ii) LLINs ownership and use coverage; iii) percentage of HHs that achieved universal coverage; iv) incremental cost-effectiveness ratio (ICER); iv) incremental net benefit (INB). Results: Approximately 88% (302,648) of LLINs were distributed in intervention districts compared to 77% (219,613) in control districts [OR: 2.14 (95% CI: 2.11-2.16)]. Six months after the 2015 campaign, of the 760 HHs surveyed in the intervention districts, 98.8% had at least one LLIN; of the 787 HHs surveyed in the control districts, 89.6% had at least one LLIN [OR: 9.7, (95% CI: 5.25 - 22.76)]. Near 95% and 87% of respondents who had at least one LLIN reported having slept under the LLIN the previous night in the intervention and control districts, respectively [OR: 3.2; (95% CI 2.12-4.69)]; 71% of the HHs surveyed achieved universal coverage in the intervention districts against 59.6% in the control districts [OR: 1.6; (95% CI: 1.33-2.03)]. ICER per distributed LLIN was US$ 0.68. INB was positive. Conclusions: Intervention districts had greater LLINs availability, greater LLINs ownership and use coverage, and a better progression toward reaching universal coverage targets. The new strategy was more cost-effective than the previous strategy. The new strategy might well accelerate the pace in vector control for reducing malaria morbidity and mortality and achieving the goals of the Global Technical Strategy for malaria 2016-2030.
Descrição
Palavras-chave
Parasitologia médica Saúde pública Malária Mosquitos vetores Moçambique
Contexto Educativo
Citação
Editora
Instituto de Higiene e Medicina Tropical