Tropical medicine & international health : TM & IH
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Trop. Med. Int. Health · Jul 2007
Sustained high coverage of insecticide-treated bednets through combined Catch-up and Keep-up strategies.
Mass, free distribution (Catch-up) of insecticide-treated bednets (ITNs) during measles vaccination campaigns achieves immediate, high and equitable coverage for both ITNs and measles vaccine. Maintaining high coverage over time requires long-term, routine access to new nets (Keep-up). In many settings, only one approach--either campaign or routine delivery--has been available and have been seen as competing methods. Relying only on campaigns achieves high coverage at the cost of lack of later access. Relying solely on routine coverage builds a delivery infrastructure but may lead to slower rates of coverage and inequities. A combined Catch-up/Keep-up approach has been a common feature of vaccination programs for many years. We assessed the 3-year effects of a one-time Catch-up campaign followed by clinic-based social marketing for routine Keep-up on ITN coverage and use. ⋯ A high level of ITN coverage and use was achieved and sustained by sequential community-based mass campaign Catch-up and clinic-based Keep-up distribution. The campaign nets covered virtually all extant households while clinic-based distribution provided nets for the new sleeping spaces created post-campaign. Because nets can be shared, and most children are born into families that already have a net, the number of new nets needed to sustain high coverage is substantially lower than the number of newborn children. A Catch-up/Keep-up strategy combining mass campaigns for children and clinic-based distribution to pregnant women is an efficient strategy for achieving and sustaining high net coverage. Assuring proper use of nets is a remaining challenge.