title: Evaluation of a national universal coverage campaign of long-lasting insecticidal nets in a rural district in north-west Tanzania.
abstract: BACKGROUND
  Insecticide-treated nets (ITN) are one of the most effective measures for preventing malaria. Mass distribution campaigns are being used to rapidly increase net coverage in at-risk populations. This study had two purposes: to evaluate the impact of a universal coverage campaign (UCC) of long-lasting insecticidal nets (LLINs) on LLIN ownership and usage, and to identify factors that may be associated with inadequate coverage.
  
  
  METHODS
  In 2011 two cross-sectional household surveys were conducted in 50 clusters in Muleba district, north-west Tanzania. Prior to the UCC 3,246 households were surveyed and 2,499 afterwards. Data on bed net ownership and usage, demographics of household members and household characteristics including factors related to socio-economic status were gathered, using an adapted version of the standard Malaria Indicator Survey. Specific questions relating to the UCC process were asked.
  
  
  RESULTS
  The proportion of households with at least one ITN increased from 62.6% (95% Confidence Interval (CI) = 60.9-64.2) before the UCC to 90.8% (95% CI = 89.0-92.3) afterwards. ITN usage in all residents rose from 40.8% to 55.7%. After the UCC 58.4% (95% CI = 54.7-62.1) of households had sufficient ITNs to cover all their sleeping places. Households with children under five years (OR = 2.4, 95% CI = 1.9-2.9) and small households (OR = 1.9, 95% CI = 1.5-2.4) were most likely to reach universal coverage. Poverty was not associated with net coverage. Eighty percent of households surveyed received LLINs from the campaign.
  
  
  CONCLUSIONS
  The UCC in Muleba district of Tanzania was equitable, greatly improving LLIN ownership and, more moderately, usage. However, the goal of universal coverage in terms of the adequate provision of nets was not achieved. Multiple, continuous delivery systems and education activities are required to maintain and improve bed net ownership and usage.
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Tropical Medicine and Hygiene, Keppel Street, London, UK. philippa.west@lshtm.ac.uk
authors.forename: Philippa A
authors.initials: PA
authors.lastname: West
authors.forename: Natacha
authors.initials: N
authors.lastname: Protopopoff
authors.forename: Mark W
authors.initials: MW
authors.lastname: Rowland
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Kirby
authors.forename: Richard M
authors.initials: RM
authors.lastname: Oxborough
authors.forename: Franklin W
authors.initials: FW
authors.lastname: Mosha
authors.forename: Robert
authors.initials: R
authors.lastname: Malima
authors.forename: Immo
authors.initials: I
authors.lastname: Kleinschmidt
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D006302:Health Services Research; D006801:Humans; D007223:Infant; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D008288:Malaria / Q000517:prevention & control*; D008297:Male; D009032:Mosquito Control / Q000379:methods*; D010067:Ownership / Q000706:statistics & numerical data; D011247:Pregnancy; D012424:Rural Population; D013636:Tanzania; D019472:Universal Health Insurance