Sleeping arrangements and mass distribution of bed nets in six districts in central and northern Mozambique.
OBJECTIVE
Universal coverage with insecticide-treated bed nets is a cornerstone of modern malaria control. Mozambique has developed a novel bed net allocation strategy, where the number of bed nets allocated per household is calculated on the basis of household composition and assumptions about who sleeps with whom. We set out to evaluate the performance of the novel allocation strategy.


METHODS
A total of 1994 households were visited during household surveys following two universal coverage bed net distribution campaigns in Sofala and Nampula provinces in 2010-2013. Each sleeping space was observed for the presence of a bed net, and the sleeping patterns for each household were recorded. The observed coverage and efficiency were compared to a simulated coverage and efficiency had conventional allocation strategies been used. A composite indicator, the product of coverage and efficiency, was calculated. Observed sleeping patterns were compared with the sleeping pattern assumptions.


RESULTS
In households reached by the campaign, 93% (95% CI: 93-94%) of sleeping spaces in Sofala and 84% (82-86%) in Nampula were covered by campaign bed nets. The achieved efficiency was high, with 92% (91-93%) of distributed bed nets in Sofala and 93% (91-95%) in Nampula covering a sleeping space. Using the composite indicator, the novel allocation strategy outperformed all conventional strategies in Sofala and was tied for best in Nampula. The sleeping pattern assumptions were completely satisfied in 66% of households in Sofala and 56% of households in Nampula. The most common violation of the sleeping pattern assumptions was that male children 3-10 years of age tended not to share sleeping spaces with female children 3-10 or 10-16 years of age.


CONCLUSIONS
The sleeping pattern assumptions underlying the novel bed net allocation strategy are generally valid, and net allocation using these assumptions can achieve high coverage and compare favourably with conventional allocation strategies.
Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.|Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.
M M
MM
Plucinski
Manhiça Health Research Centre (CISM), Manhiça, Mozambique.
S
S
Chicuecue
Manhiça Health Research Centre (CISM), Manhiça, Mozambique.|National Directorate of Health, Ministry of Health, Maputo, Mozambique.
E
E
Macete
Mozambique Field Epidemiology and Laboratory Training Program, Maputo, Mozambique.
G A
GA
Chambe
National Malaria Control Program, Ministry of Health, Maputo, Mozambique.
O
O
Muguande
National Malaria Control Program, Ministry of Health, Maputo, Mozambique.
G
G
Matsinhe
Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
J
J
Colborn
Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
S S
SS
Yoon
Field Epidemiology and Laboratory Training Program, Centers for Disease Control and Prevention, Maputo, Mozambique.
T J
TJ
Doyle
Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
S P
SP
Kachur
Manhiça Health Research Centre (CISM), Manhiça, Mozambique.|National Institute of Health, Ministry of Health, Maputo, Mozambique.
P
P
Aide
Manhiça Health Research Centre (CISM), Manhiça, Mozambique.|ISGlobal, Barcelona Center for International Health Research, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
P L
PL
Alonso
Manhiça Health Research Centre (CISM), Manhiça, Mozambique.|ISGlobal, Barcelona Center for International Health Research, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
C
C
Guinovart
Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
J
J
Morgan
D000293:Adolescent; D000328:Adult; D000818:Animals; D001513:Beds; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000379:methods*; D005191:Family Characteristics; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D007306:Insecticides; D008288:Malaria / Q000517:prevention & control*; D008297:Male; D009032:Mosquito Control / Q000379:methods*; D009073:Mozambique; D011322:Primary Prevention / Q000379:methods; D012890:Sleep
D007306:Insecticides
Mozambique; bed nets; malaria; universal coverage