Mass campaign for insecticide net retreatment: Uganda

Situation:

Mass treatment of nets in areas with reasonable net coverage but a high proportion of nets that are not long-lasting insecticidal nets (LLIN) is a cost-effective way of rapidly scaling up coverage of ITNs. Uganda has a growing number of mosquito nets: in 2004 there were estimated to be more than 2.4 million, of which >70% were untreated or needed retreatment. Net retreatment rates in Africa have usually been low varying between less than 10% and up to 40% when various marketing approaches have been used or net treatment centers were established at health facilities and users were asked to bring their nets for treatment at their convenience. Only when net treatment has been done in a campaign style and free for the end user can high treatment rates be achieved. Two major issues exist that can significantly reduce the coverage during such campaigns and need to be addressed: the limitation of space to dry the nets and the reluctance of some net owners to have their net exposed to the view of the public.  

Response:

The Malaria Consortium works in partnership with the Ugandan Ministry of Health who recognised the need to establish a national net retreatment system. DFID was used to develop the net treatment model and DFID and USAID funding have been used to carry out three national campaigns over the past three years. The 2007 campaign will be funded by the US President's Malaria Initiative. The Ugandan net treatment model was designed to provide a simple, convenient, cheap and private net retreatment service to net owners. The use of existing local structures is emphasized throughout the campaign to ensure community involvement and sensitisation. Leadership for the project lies with the Ministry of Health. In the first round in 2004 a team of partners was led by the Malaria Consortium and in the second and third round the system was handed over to the Ministry for implementation with support coming from MC. The total number of nets treated increased from 486,263 in 2004 to 490,855 in 2005 and 517,777 in 2006.

The 20 districts with the highest estimated net coverage are included in the campaigns in each round. To ensure the treatment of around half a million nets over a one month period a closely coordinated cascade training and supervision system is used. A national training team which leads these campaigns is made up of Ministry of Health personnel as well as professional trainers. This team conducts sensitisation and training meetings in the twenty districts. District teams then conduct training of the dippers at the sub-county level. In total, approximately 400 sub-county sensitisation and training workshops are conducted over a two week period. The net retreatment itself takes place over a one week period in each district with over 2000 "dippers" working in their own communities to make the net treatment available to almost 20,000 communities and around 2,300,000 households. The innovative plastic bag method is used for re-treatment. The dipping team treat the net in a plastic bag which is then handed over to the net owner to be taken home to dry. This pioneering method is easy, allows high volumes of nets to be treated, ensured privacy for the net owner, and our data show that nets retreated in this way achieve as good insecticide coverage on the net as the conventional bowl treatment technique.

Points to note:

Cost of net retreatment (including all training, insecticide and delivery costs) was $0.75 US per net. There was a knock-on effect in terms of an increase in the demand for nets, discussions with commercial partners are underway to promote sales of nets around net retreatment points in any coming rounds. During the net retreatment campaigns data is collected on types of nets brought for treatment. As the proportion of nets that are LLINs in the country increases the cost effectiveness of mass net retreatment campaigns will decrease. This consideration is being taken into account in planning the coming net retreatment activities in the country.

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Photo: Alastair Penny and Kimberley Burns