title: Distributing insecticide-treated bednets during measles vaccination: a low-cost means of achieving high and equitable coverage.
abstract: OBJECTIVE
  To achieve high and equitable coverage of insecticide-treated bednets by integrating their distribution into a measles vaccination campaign.
  
  
  METHODS
  In December 2002 in the Lawra district in Ghana, a measles vaccination campaign lasting 1 week targeted all children aged 9 months-15 years. Families with one or more children less than five years old were targeted to receive a free insecticide-treated bednet. The Ghana Health Service, with support from the Ghana Red Cross and UNICEF, provided logistical support, volunteer workers and social mobilization during the campaign. Volunteers visited homes to inform caregivers about the campaign and encourage them to participate. We assessed pre-campaign coverage of bednets by interviewing caregivers leaving vaccination and distribution sites. Five months after distribution, a two-stage cluster survey using population-proportional sampling assessed bednet coverage, retention and use. Both the pre-campaign and post-campaign survey assessed household wealth using an asset inventory.
  
  
  RESULTS
  At the campaign exit interview 636/776 (82.0%) caregivers reported that they had received a home visit by a Red Cross volunteer before the campaign and that 32/776 (4.1%) of the youngest children in each household who were less than 5 years of age slept under an insecticide-treated bednet. Five months after distribution caregivers reported that 204/219 (93.2%) of children aged 9 months to 5 years had been vaccinated during the campaign; 234/248 (94.4%) of households were observed to have an insecticide-treated bednet; and 170/249 (68.3%) were observed to have a net hung over a bed. Altogether 222/248 (89.5%) caregivers reported receiving at least one insecticide-treated bednet during the campaign, and 153/254 (60.2%) said that on the previous night their youngest child had slept under a bednet received during the campaign. For households in the poorest quintile, post-campaign coverage of insecticide-treated bednets was 10 times higher than pre-campaign coverage of households in the wealthiest quintile (46/51 (90.2%) versus 14/156 (9.0%)). The marginal operational cost was 0.32 US dollars per insecticide-treated bednet delivered.
  
  
  CONCLUSIONS
  These findings suggest that linking bednet distribution to measles vaccination campaigns may provide an important opportunity for achieving high and equitable coverage of bednets.
authors.affiliation: American Red Cross, Washington, DC 20006-5304, USA. grabowskym@usa.redcross.org
authors.forename: Mark
authors.initials: M
authors.lastname: Grabowsky
authors.forename: Theresa
authors.initials: T
authors.lastname: Nobiya
authors.forename: Mercy
authors.initials: M
authors.lastname: Ahun
authors.forename: Rose
authors.initials: R
authors.lastname: Donna
authors.forename: Miata
authors.initials: M
authors.lastname: Lengor
authors.forename: Drake
authors.initials: D
authors.lastname: Zimmerman
authors.forename: Holly
authors.initials: H
authors.lastname: Ladd
authors.forename: Edward
authors.initials: E
authors.lastname: Hoekstra
authors.forename: Aliu
authors.initials: A
authors.lastname: Bello
authors.forename: Aba
authors.initials: A
authors.lastname: Baffoe-Wilmot
authors.forename: George
authors.initials: G
authors.lastname: Amofah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D001512:Bedding and Linens / Q000191:economics / Q000600:supply & distribution*; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D019033:Delivery of Health Care, Integrated; D005260:Female; D005869:Ghana; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000458:organization & administration*; D007223:Infant; D007306:Insecticides; D008288:Malaria / Q000517:prevention & control*; D008297:Male; D008457:Measles / Q000517:prevention & control*; D008458:Measles Vaccine / Q000600:supply & distribution*; D008875:Middle Aged; D009032:Mosquito Control; D016730:Program Development
chemical_list: D007306:Insecticides; D008458:Measles Vaccine