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ikaracentreihrdc
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Improving child survival in rural Tanzania:
Insecticide treated nets for malaria control in the Kilombero Valley
The KINET Project
An overview
KINET (pronounced key-net) was a large-scale social marketing programme of
insecticide-treated nets for malaria control in two rural districts in Southern
Tanzania which ran from July 1996 to June 2000.
During 1996-7, formative and market research were conducted in order to
understand the perception, knowledge, attitudes and practices of the local
population with respect to malaria, causes of child death, and the products to
be socially marketed. Further, "Zuia Mbu" (Kiswahili for "prevent
mosquitoes") was identified as a suitable brand name for both ready-treated
nets and single-dose insecticide treatment sachets.
For distribution of nets and insecticide a pragmatic mix of public and private
channels was chosen. In the first distribution area 31 net agents were appointed
and trained: 15 were shop owners, 14 were village leaders, one was a parish
priest and one a health worker. After 10 months the priest and 3 of the village
leaders were no longer active. For net treatment 37 young people were appointed
and trained as agents. Ten (27%) were no longer active after 10 months and were
replaced. Institutions in both districts such as hospitals, development agents
and employers were also involved in distribution. The social marketing area
expanded over two years to reach all 112 villages in both districts: in most
villages distribution relied on shopkeepers, with a few exceptional health
personnel. Wholesalers were recruited in each Division.
A comprehensive information, education and communication (IEC) campaign was
developed and implemented. Discount vouchers were available through MCH clinics
for pregnant women and those with young children. These vouchers could be used
as part-payment for a treated net (approximately 15%). The IEC campaign used
posters, leaflets, T-shirts, local drama groups, public launches, mobile video
shows, sports sponsorship, word-of-mouth and over-printed school exercise books.
Much of this campaign was carried out by local health and community development
personnel. Regular review and planning meetings were held for all district
health actors, including NGOs and large employers.
A total of 65 111 nets and 24 393 treatments were sold by the project between
May 1997 and June 2000. A strong evaluation component allowed the monitoring of
a number of important aspects of the project. Firstly, detailed sales records
were kept in order to be able to follow the development of the sales network. A
detailed cost analysis was also performed in order to allow a distribution cost
analysis and later a cost-effectiveness assessment.
Coverage figures were very encouraging, with 63% of children under five years in
Kilombero district using a net by mid 1999, and 31% of such children in Ulanga.
Overall, 18% of children under five were using a treated net by mid-1999.
Coverage was higher in areas which had had longer access to the socially
marketed treated nets. By mid 2000, over 50% of infants in the 25 villages where
the social marketing was started in 1997 were using a treated net.
The short-term and long-term effects of treated nets on child survival were
assessed with the help of a demographic surveillance system in a total
population of 60,000. Treated nets were associated with 27% improvement in child
survival in children aged 1 month to 4 years. Together with the coverage this
suggests that treated nets in Kilombero and Ulanga prevented approximately 100
child deaths in 1999.
A positive impact of treated net use on malaria disease was also shown for both
small children and pregnant women. Children under 2 years who used treated nets
had over 60% less anaemia and malaria than those who used untreated nets.
Pregnant women who used treated nets had 12% less anaemia than those who did not
use treated nets. There was no evidence that mosquitoes became resistant to the
insecticide.
Experience from the KINET project was used in drafting a national treated net
upscaling plan, which is hoped to provide a long-term continuation of the
activities initiated in the frame of the KINET project.
Recommendations are made for monitoring of future treated net activities.
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