The Effect of Single or Repeated Home Visits on the Hanging and Use of Insecticide-Treated Mosquito Nets following a Mass Distribution Campaign - A Cluster Randomized, Controlled Trial

<div><p>Background</p><p>Study objective was to evaluate the effectiveness of commonly used post-campaign hang-up visits on the hanging and use of campaign nets.</p><p>Methods</p><p>A cluster-randomized trial was carried out in Uganda following an ITN distribution campaign. Five clusters (parishes, consisting of ∼11 villages each) were randomly selected for each of the three study arms with between 7,534 and 9,401 households per arm. Arm 1 received one hang-up visit, while Arm 2 received two visits by volunteers four and seven months after the campaign. Visits consisted of assistance hanging the net and education on net use. The control arm was only exposed to messages during the campaign itself. Three cross-sectional surveys with a two-stage cluster sampling design, representative of the study populations, were carried out to capture the two key outcome variables of net hanging and ITN use. Sample size was calculated to detect at least a 15 percentage-points change in net use, and was 1811 at endline. The analysis used an intention-to-treat approach.</p><p>Findings</p><p>Both hanging and use of ITN increased during follow-up in a similar way in all three study arms. The proportion of the population using an ITN the previous night was 64.0% (95% CI 60.8, 67.2), for one additional visit, 68.2% (63.8, 72.2) for two visits and 64.0% (59.4, 68.5) for the control. The proportion of households with all campaign nets hanging increased from 55.7% to 72.5% at endline (p<0.0005 for trend), with no difference between study arms. Financial cost per household visited was estimated as USD 2.33 for the first visit and USD 2.24 for the second.</p><p>Conclusions</p><p>Behavior change communication provided during the campaign or through other channels was sufficient to induce high levels of net hanging and use and additional “hang-up” activities were not cost-effective.</p></div

Proportion of households with any campaign nets that had all of their nets hanging on the day of the survey (OR = crude Odds Ratio).

<p>Proportion of households with any campaign nets that had all of their nets hanging on the day of the survey (OR = crude Odds Ratio).</p

Difference of differences for ITN use by <i>de facto</i> population, adjusting for study design.

<p>Difference of differences for ITN use by <i>de facto</i> population, adjusting for study design.</p

Recall of hang-up visit intervention.

<p>Based on self-reporting by respondent (survey) and records from the intervention implementing agency.</p><p>Recall of hang-up visit intervention.</p

Reasons for non-use of ITN: final evaluation at survey 3 (N = 1391).

<p>Reasons for non-use of ITN: final evaluation at survey 3 (N = 1391).</p

Use gap defined as population with access to an ITN but not using an ITN by survey and study arm.

<p>Error bars represent 95% confidence intervals.</p

Household characteristics and ITN ownership.

<p>HH = household.</p><p>Household characteristics and ITN ownership.</p

Map of Uganda with Kamuli District (2010 borders) and study clusters (parishes).

<p>Numbers represent the five geographical strata; orange: study arm 1; yellow: study arm 2; green study arm 3. Shaded areas were excluded from selection (details see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0119078#sec006" target="_blank">methods</a> section)</p

Proportion of the <i>de facto</i> population using an ITN the previous night (OR = crude Odds Ratio).

<p>Proportion of the <i>de facto</i> population using an ITN the previous night (OR = crude Odds Ratio).</p