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Title: Integrating insecticide treated nets with routine antenatal care and immunization programmes : policy, practice, and coverage
Author: Theiss-Nyland, K. L.
ISNI:       0000 0004 7659 2284
Awarding Body: London School of Hygiene & Tropical Medicine
Current Institution: London School of Hygiene and Tropical Medicine (University of London)
Date of Award: 2018
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Background: Insecticide treated nets (ITNs) are the primary means of vector control for malaria prevention. As of 2015, 82 countries provided ITNs free, nationally or sub-nationally, usually via mass campaigns, for the prevention of malaria. The WHO currently recommends that ITNs be distributed through the routine facility-based channels of antenatal care (ANC) and the expanded programme on immunization (EPI), in addition to mass-distribution campaigns. This research aimed to assess routine facility-based distribution in Africa, in terms of policy, practice and coverage. Methods: Both qualitative and quantitative methods were used to assess facility-based ITN distribution. The quantitative methods used included an analysis of the availability of ITNs for routine distribution in Africa via ANC and EPI, using nationally reported ITN data provided to the WHO. A DHS analysis was also conducted to analyse ITN ownership and use, as well as coverage and equity for integrated and non-integrated country ITN programmes. A Qualitative study in four sub-Saharan African countries evaluated the operational challenges of facility-based ITN distribution. The qualitative study also gave rise to a comparison of ANC and EPI as ITN integration platforms. Results: There were more ITNs available for distribution via ANC than EPI. ANC programmes had stronger integrated practices for management, monitoring and evaluation, compared to EPI. Stock-outs and stock-out response systems are more problematic for ITNs distributed through both ANC and EPI than for other routine health service commodities, such as vaccines and HIV drugs. Countries with integrated ITN services through both ANC and EPI have higher household ITN ownership and use in children under-5 compared to countries with only ANCbased distribution, or without any ITN integration. Integration is correlated with improved coverage of ITN, and improved equity scores for EPI, compared to countries without integration. Conclusion: ITN distribution through ANC and EPI is not yet universally implemented despite WHO recommendations. While integration via ANC is easier due to the ANC systems already in place, EPI may have more to gain from integration in terms of both coverage and equity for children under five. To better measure the impact of integrated services, routine monitoring of ITN distribution is necessary.
Supervisor: Fine, P. E. ; Lines, J. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral