Campaign process indicators.

<p>Campaign process indicators.</p

Free mass distribution of long lasting insecticidal nets lead to high levels of LLIN access and use in Madagascar, 2010: A cross-sectional observational study

<div><p>Background</p><p>Madagascar conducted the first two phases of a national free mass distribution campaign of long-lasting insecticidal nets (LLINs) during a political crisis in 2009 aiming to achieve coverage of two LLINs per household as part of the National Malaria Control Strategy. The campaign targeted households in 19 out of 91 total health districts.</p><p>Methods</p><p>A community-based cross-sectional household survey using a three-stage cluster sample design was conducted four months post campaign to assess LLIN ownership, access and use. Multivariable logistic regression analysis was used to identify factors associated with household LLIN access and individual LLIN use.</p><p>Results</p><p>A total of 2211 households were surveyed representing 8867 people. At least one LLIN was present in 93.5% (95% confidence interval [CI], 91.6–95.5%) of households and 74.8% (95% CI, 71.0–78.6%) owned at least two LLINs. Access measured as the proportion of the population that could potentially be covered by household-owned LLINs was 77.2% (77.2% (95% CI, 72.9–81.3%) and LLIN use by all individuals was 84.2% (95% CI, 81.2–87.2%). LLIN use was associated with knowledge of insecticide treated net use to prevent malaria (OR = 3.58, 95% CI, 1.85–6.94), household ownership of more LLINs (OR 2.82, 95% CI 1.85–4.3), presence of children under five (OR = 2.05, 95% CI, 1.67–2.51), having traveled to the distribution point and receiving information about hanging a bednet (OR = 1.56, 95% CI, 1.41–1.74), and having received a post-campaign visit by a community mobilizer (OR = 1.75, 95% CI, 1.26–2.43). Lower LLIN use was associated with increasing household size (OR = 0.81 95% CI 0.77–0.85) and number of sleeping spaces (OR = 0.55, 95% CI, 0.44–0.68).</p><p>Conclusions</p><p>A large scale free mass LLIN distribution campaign was feasible and effective at achieving high LLIN access and use in Madagascar. Campaign process indicators highlighted potential areas for strengthening implementation to optimize access and equity.</p></div

Proportion of households owning 1) any net 2) at least one LLIN and 3) at least two LLINs, by wealth quintile (1 = poorest, 5 = wealthiest quintile).

<p>Proportion of households owning 1) any net 2) at least one LLIN and 3) at least two LLINs, by wealth quintile (1 = poorest, 5 = wealthiest quintile).</p

Household, individual and bed net characteristics.

<p>Household, individual and bed net characteristics.</p

Average proportion of household members with access to a LLIN (at least one LLIN per 2 persons) by wealth quintile (1 = poorest, 5 = wealthiest quintile).

<p>Average proportion of household members with access to a LLIN (at least one LLIN per 2 persons) by wealth quintile (1 = poorest, 5 = wealthiest quintile).</p

Factors associated with household access to LLINs (ratio of LLINs to people).

<p>Factors associated with household access to LLINs (ratio of LLINs to people).</p

Map of Madagascar districts involved in the 2009 LLIN distribution campaign and sampled fokontany (villages) included in the evaluation.

<p>Map of Madagascar districts involved in the 2009 LLIN distribution campaign and sampled fokontany (villages) included in the evaluation.</p

LLIN use by specific age group and gender among 1) all households 2) households that own at least one LLIN and 3) households that own at least two LLINs.

<p>LLIN use by specific age group and gender among 1) all households 2) households that own at least one LLIN and 3) households that own at least two LLINs.</p

Proportion of people sleeping under a LLIN within households by LLIN to person ratio.

<p>Proportion of people sleeping under a LLIN within households by LLIN to person ratio.</p

Factors associated with LLIN use.

<p>Factors associated with LLIN use.</p