Towards achieving Abuja targets: identifying and addressing barriers to access and use of insecticides treated nets among the poorest populations in Kenya

被引:28
作者
Chuma, Jane [1 ,2 ]
Okungu, Vincent [1 ]
Ntwiga, Janet [1 ]
Molyneux, Catherine [1 ,2 ]
机构
[1] Kenya Med Res Inst Wellcome Trust Res Programme, Kilifi, Kenya
[2] Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med, Oxford, England
来源
BMC PUBLIC HEALTH | 2010年 / 10卷
关键词
MALARIA CONTROL; COST-EFFECTIVENESS; MOSQUITO NETS; MEASLES VACCINATION; INCREASING COVERAGE; EQUITABLE COVERAGE; RURAL KENYA; AFRICA; CHILDREN; BEDNETS;
D O I
10.1186/1471-2458-10-137
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background: Ensuring that the poor and vulnerable population benefit from malaria control interventions remains a challenge for malaria endemic countries. Until recently, ownership and use of insecticides treated nets (ITNs) in most countries was low and inequitable, although coverage has increased in countries where free ITN distribution is integrated into mass vaccination campaigns. In Kenya, free ITNs were distributed to children aged below five years in 2006 through two mass campaigns. High and equitable coverage were reported after the campaigns in some districts, although national level coverage remained low, suggesting that understanding barriers to access remains important. This study was conducted to explore barriers to ownership and use of ITNs among the poorest populations before and after the mass campaigns, to identify strategies for improving coverage, and to make recommendations on how increased coverage levels can be sustained. Methods: The study was conducted in the poorest areas of four malaria endemic districts in Kenya. Multiple data collection methods were applied including: cross-sectional surveys (n = 708 households), 24 focus group discussions and semi-structured interviews with 70 ITN suppliers. Results: Affordability was reported as a major barrier to access but non-financial barriers were also shown to be important determinants. On the demand side key barriers to access included: mismatch between the types of ITNs supplied through interventions and community preferences; perceptions and beliefs on illness causes; physical location of suppliers and; distrust in free delivery and in the distribution agencies. Key barriers on the supply side included: distance from manufacturers; limited acceptability of ITNs provided through interventions; crowding out of the commercial sector and the price. Infrastructure, information and communication played a central role in promoting or hindering access. Conclusions: Significant resources have been directed towards addressing affordability barriers through providing free ITNs to vulnerable groups, but the success of these interventions depends largely on the degree to which other barriers to access are addressed. Only if additional efforts are directed towards addressing non-financial barriers to access, will high coverage levels be achieved and sustained.
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页数:14
相关论文
共 44 条
[1]   Impact on malaria morbidity of a programme supplying insecticide treated nets in children aged under 2 years in Tanzania: community cross sectional study [J].
Abdulla, S ;
Armstrong, J ;
Schellenberg, A ;
Nathan, R ;
Mukasa, O ;
Marchant, T ;
Smith, T ;
Tanner, M ;
Lengeler, C .
BMJ-BRITISH MEDICAL JOURNAL, 2001, 322 (7281) :270-273
[2]   Mosquito avoidance and bed net use in the Greater Accra Region, Ghana [J].
Agyepong, IA ;
Manderson, L .
JOURNAL OF BIOSOCIAL SCIENCE, 1999, 31 (01) :79-92
[3]   The Gambian National Impregnated Bednet Programme: Costs, consequences and net cost-effectiveness [J].
Aikins, MK ;
Fox-Rushby, J ;
D'Alessandro, U ;
Langerock, P ;
Cham, K ;
New, L ;
Bennett, S ;
Greenwood, B ;
Mills, A .
SOCIAL SCIENCE & MEDICINE, 1998, 46 (02) :181-191
[4]  
[Anonymous], 1978, PRIM HLTH CAR REP IN
[5]   First 5 years of measles elimination in southern Africa: 1996-2000 [J].
Biellik, R ;
Madema, S ;
Taole, A ;
Kutsulukuta, A ;
Allies, E ;
Eggers, R ;
Ngcobo, N ;
Nxumalo, M ;
Shearley, A ;
Mabuzane, E ;
Kufa, E ;
Okwo-Bele, JM .
LANCET, 2002, 359 (9317) :1564-1568
[6]   Lessons learned from bednet distribution in Central Mozambique [J].
Brentlinger, Paula E. ;
Ana Chadreque Correia, Maria ;
Simbe Chinhacata, Fungai ;
Gimbel-Sherr, Kenneth H. ;
Stubbs, Benjamin ;
Mercer, Mary Anne .
HEALTH POLICY AND PLANNING, 2007, 22 (02) :103-110
[7]  
*CBS, 2003, ACC POL REL CONC LOW, V1
[8]   Access and barriers to measures targeted to prevent malaria in pregnancy in rural Kenya [J].
Gikandi, Priscilla W. ;
Noor, Abdisalan M. ;
Gitonga, Carol W. ;
Ajanga, Antony A. ;
Snow, Robert W. .
TROPICAL MEDICINE & INTERNATIONAL HEALTH, 2008, 13 (02) :208-217
[9]   Cost-effectiveness of malaria control in sub-Saharan Africa [J].
Goodman, CA ;
Coleman, PG ;
Mills, AJ .
LANCET, 1999, 354 (9176) :378-385
[10]   Integrating insecticide-treated bednets into a measles vaccination campaign achieves high, rapid and equitable coverage with direct and voucher-based methods [J].
Grabowsky, M ;
Farrell, N ;
Hawley, W ;
Chimumbwa, J ;
Hoyer, S ;
Wolkon, A ;
Selanikio, J .
TROPICAL MEDICINE & INTERNATIONAL HEALTH, 2005, 10 (11) :1151-1160