title: The effect of single or repeated home visits on the hanging and use of insecticide-treated mosquito nets following a mass distribution campaign--a cluster randomized, controlled trial.
abstract: BACKGROUND
  Study objective was to evaluate the effectiveness of commonly used post-campaign hang-up visits on the hanging and use of campaign nets.
  
  
  METHODS
  A cluster-randomized trial was carried out in Uganda following an ITN distribution campaign. Five clusters (parishes, consisting of ∼11 villages each) were randomly selected for each of the three study arms with between 7,534 and 9,401 households per arm. Arm 1 received one hang-up visit, while Arm 2 received two visits by volunteers four and seven months after the campaign. Visits consisted of assistance hanging the net and education on net use. The control arm was only exposed to messages during the campaign itself. Three cross-sectional surveys with a two-stage cluster sampling design, representative of the study populations, were carried out to capture the two key outcome variables of net hanging and ITN use. Sample size was calculated to detect at least a 15 percentage-points change in net use, and was 1811 at endline. The analysis used an intention-to-treat approach.
  
  
  RESULTS
  Both hanging and use of ITN increased during follow-up in a similar way in all three study arms. The proportion of the population using an ITN the previous night was 64.0% (95% CI 60.8, 67.2), for one additional visit, 68.2% (63.8, 72.2) for two visits and 64.0% (59.4, 68.5) for the control. The proportion of households with all campaign nets hanging increased from 55.7% to 72.5% at endline (p<0.0005 for trend), with no difference between study arms. Financial cost per household visited was estimated as USD 2.33 for the first visit and USD 2.24 for the second.
  
  
  CONCLUSIONS
  Behavior change communication provided during the campaign or through other channels was sufficient to induce high levels of net hanging and use and additional "hang-up" activities were not cost-effective.
authors.affiliation: Malaria Consortium, London, United Kingdom; Tropical Health LLP, Montagut, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Kilian
authors.affiliation: Malaria Control Program, Ministry of Health, Kampala, Uganda.
authors.forename: Connie
authors.initials: C
authors.lastname: Balayo
authors.affiliation: Malaria Consortium Uganda, Kampala, Uganda.
authors.forename: Mitra
authors.initials: M
authors.lastname: Feldman
authors.affiliation: Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, Baltimore, MD, United States of America.
authors.forename: Hannah
authors.initials: H
authors.lastname: Koenker
authors.affiliation: Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, Baltimore, MD, United States of America.
authors.forename: Kojo
authors.initials: K
authors.lastname: Lokko
authors.affiliation: Malaria Consortium Uganda, Kampala, Uganda.
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Ashton
authors.affiliation: Malaria Consortium, London, United Kingdom.
authors.forename: Jane
authors.initials: J
authors.lastname: Bruce
authors.affiliation: Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, Baltimore, MD, United States of America.
authors.forename: Matthew
authors.initials: M
authors.lastname: Lynch
authors.affiliation: Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, Baltimore, MD, United States of America.
authors.forename: Marc
authors.initials: M
authors.lastname: Boulay
mesh_terms: D006293:Health Promotion / Q000191:economics / Q000379:methods; D006792:House Calls / Q000191:economics; D006801:Humans; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D008288:Malaria / Q000517:prevention & control*; D009032:Mosquito Control / Q000295:instrumentation; D010565:Persuasive Communication; D011795:Surveys and Questionnaires; D014454:Uganda