The impact of a hybrid social marketing intervention on inequities in access, ownership and use of insecticide-treated nets.
BACKGROUND
An ITN intervention was initiated in three predominantly rural districts of Eastern Province, Zambia, that lacked commercial distribution and communication infrastructures. Social marketing techniques were used for product and message development. Public sector clinics and village-based volunteers promoted and distributed subsidized ITNs priced at 2.5 dollars per net. A study was conducted to assess the effects of the intervention on inequities in knowledge, access, ownership and use of ITNs.


METHODS
A post-test only quasi-experimental study design was used to compare intervention and comparison districts. A total of 2,986 respondents were interviewed. Survey respondents were grouped into four socio-economic (SES) categories: low, medium-low, medium and high. Knowledge, access, ownership and use indicators are compared. Concentration index scores are calculated. Interactions between intervention status and SES help determine how different SES groups benefited from the intervention.


RESULTS
Although overall use of nets remained relatively low, post-test data show that knowledge, access, ownership and use of mosquito nets was higher in intervention districts. A decline in SES inequity in access to nets occurred in intervention districts, resulting from a disproportionately greater increase in access among the low SES group. Declines in SES inequities in net ownership and use of nets were associated with the intervention. The largest increases in net ownership and use occurred among medium and high SES categories.


CONCLUSIONS
Increasing access to nets among the poorest respondents in rural areas may not lead to increases in net use unless the price of nets is no longer a barrier to their purchase.
Agha
Sohail
S
Department of International Health and Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA. sagha@tulane.edu
Van Rossem
Ronan
R
Stallworthy
Guy
G
Kusanthan
Thankian
T
D000293:Adolescent; D000328:Adult; D000818:Animals; D001512:Bedding and Linens / Q000191:economics / Q000706:statistics & numerical data; D003132:Commerce; D009033:Culicidae / Q000469:parasitology; D003625:Data Collection / Q000706:statistics & numerical data; D005191:Family Characteristics; D005260:Female; D006266:Health Education / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007303:Insect Vectors / Q000469:parasitology; D007306:Insecticides; D007398:Interpersonal Relations; D008288:Malaria / Q000517:prevention & control / Q000635:transmission; D008297:Male; D008402:Mass Media / Q000706:statistics & numerical data; D008875:Middle Aged; D009032:Mosquito Control / Q000191:economics / Q000295:instrumentation* / Q000706:statistics & numerical data; D010067:Ownership; D010961:Plasmodium; D011203:Poverty; D015397:Program Evaluation; D012423:Rural Health; D012935:Social Justice; D040241:Social Marketing; D012959:Socioeconomic Factors; D015024:Zambia
D007306:Insecticides