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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Cost-sharing strategies combining targeted public subsidies with private-sector delivery achieve high bednet coverage and reduced malaria transmission in Kilombero Valley, southern Tanzania
BMC Infectious Diseases, Volume 7, Article 121, Year 2007
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Description
Background: Cost-sharing schemes incorporating modest targeted subsidies have promoted insecticide-treated nets (ITNs) for malaria prevention in the Kilombero Valley, southern Tanzania, since 1996. Here we evaluate resulting changes in bednet coverage and malaria transmission. Methods: Bednets were sold through local agents at fixed prices representing a 34% subsidy relative to full delivery cost. A further targeted subsidy of 15% was provided to vulnerable groups through discount vouchers delivered through antenatal clinics and regular immunizations. Continuous entomological surveys (2,376 trap nights) were conducted from October 2001 to September 2003 in 25 randomly-selected population clusters of a demographic surveillance system which monitored net coverage. Results: Mean net usage of 75% (11,982/16,086) across allage groups was achieved but now-obsolete technologies available at the time resulted in low insecticide treatment rates. Malaria transmission remained intense but was substantially reduced: Compared with an exceptionally high historical mean EIR of 1481, even non-users of nets were protected (EIR [fold reduction] = 349 infectious bites per person per year [×4]), while the average resident (244 [×6]), users of typical nets (210 [×7]) and users of insecticidal nets (105 [×14]) enjoyed increasing benefits. Conclusion: Despite low net treatment levels, community-level protection was equivalent to the personal protection of an ITN. Greater gains for net users and non-users are predicted if more expensive long-lasting ITN technologies can be similarly promoted with correspondingly augmented subsidies. Cost sharing strategies represent an important option for national programmes lacking adequate financing to fully subsidize comprehensive ITN coverage. © 2007 Killeen et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Killeen, Gerry Francis
Tanzania, Ifakara
Ifakara Health Institute
Switzerland, Allschwil
Swiss Tropical and Public Health Institute Swiss Tph
United Kingdom, Durham
Durham University
Tami, Adriana
Tanzania, Ifakara
Ifakara Health Institute
Netherlands, Amsterdam
Royal Tropical Institute - Kit
Kihonda, Japhet M.
Tanzania, Ifakara
Ifakara Health Institute
Okumu, Fredros Oketch
Tanzania, Ifakara
Ifakara Health Institute
Kenya, Eldoret
Moi University
Kotas, M. E.
United States, New Haven
Yale University
Grundmann, Hajo J.
Tanzania, Ifakara
Ifakara Health Institute
Netherlands, Bilthoven
Rijksinstituut Voor Volksgezondheid en Milieu
Kasigudi, N.
Tanzania, Ifakara
Ifakara Health Institute
Ngonyani, Hassan Ahamad
Tanzania, Ifakara
Ifakara Health Institute
Mayagaya, Valeliana
Tanzania, Ifakara
Ifakara Health Institute
Nathan, Rose
Tanzania, Ifakara
Ifakara Health Institute
Abdulla, Salim Mohammed K.
Denmark, Copenhagen
Dbl -center for Health Research and Development
Charlwood, J. D.
Denmark, Copenhagen
Dbl -center for Health Research and Development
Smith, Thomas A.
Switzerland, Allschwil
Swiss Tropical and Public Health Institute Swiss Tph
Lengeler, Christian H.
Switzerland, Allschwil
Swiss Tropical and Public Health Institute Swiss Tph
Statistics
Citations: 113
Authors: 14
Affiliations: 8
Identifiers
Doi:
10.1186/1471-2334-7-121
e-ISSN:
14712334
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Study Locations
Tanzania