title: Assuring access to topical mosquito repellents within an intensive distribution scheme: a case study in a remote province of Cambodia.
abstract: BACKGROUND
  The public health value of a vector control tool depends on its epidemiological efficacy, but also on its ease of implementation. This study describes an intensive distribution scheme of a topical repellent implemented in 2012 and 2013 for the purpose of a cluster-randomized trial using the existing public health system. The trial aimed to assess the effectiveness of repellents in addition to long-lasting insecticidal nets (LLIN) and occurred in a province of Cambodia. Determinants for accessibility and consumption of this tool were explored.
  
  
  METHODS
  135 individuals were appointed to be repellent distributors in 57 villages. A 2-weekly bottle exchange programme was organized. Distributors recorded information regarding the amount of bottles exchanged, repellent leftover, and reasons for not complying in household data sheets. Distributor-household contact rates and average 2-weekly consumption of repellent were calculated. Household and distributors characteristics were obtained using questionnaires, surveying 50 households per cluster and all distributors. Regression models were used to explore associations between contact and consumption rates and determinants such as socio-economic status. Operational costs for repellent and net distribution were obtained from the MalaResT project and the provincial health department.
  
  
  RESULTS
  A fourfold increase in distributor-household contact rates was observed in 2013 compared to 2012 (median2012 = 20 %, median2013 = 88.9 %). Consumption rate tripled over the 2-year study period (median2012 = 20 %, median2013 = 57.89 %). Contact rates were found to associate with district, commune and knowing the distributor, while consumption was associated with district and household head occupation. The annual operational cost per capita for repellent distribution was 31 times more expensive than LLIN distribution (USD 4.33 versus USD 0.14).
  
  
  CONCLUSIONS
  After the existing public health system was reinforced with programmatic and logistic support, an intense 2-weekly distribution scheme of a vector control tool over a 2-year period was operated successfully in the field. Lack of associations with socio-economic status suggested that the free distribution strategy resulted in equitable access to repellents. The operational costs for the repellent distribution and exchange programme were much higher than LLIN distribution. Such effort could only be justified in the context of malaria elimination where these interventions are expected to be limited in time.
authors.affiliation: National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia. hengsomony@gmail.com.|Institute of Tropical Medicine, Antwerp, Belgium. hengsomony@gmail.com.|University of Antwerp, Antwerp, Belgium. hengsomony@gmail.com.
authors.forename: Somony
authors.initials: S
authors.lastname: Heng
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium. ldurnez@itg.be.
authors.forename: Lies
authors.initials: L
authors.lastname: Durnez
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium. cgryseels@itg.be.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Gryseels
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium. kvanroey@itg.be.
authors.forename: Karel
authors.initials: K
authors.lastname: Van Roey
authors.affiliation: National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia. mean_vanna@yahoo.com.
authors.forename: Vanna
authors.initials: V
authors.lastname: Mean
authors.affiliation: National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia. uk.sambunny@yahoo.com.
authors.forename: Sambunny
authors.initials: S
authors.lastname: Uk
authors.affiliation: National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia. sivsovannaroths@gmail.com.
authors.forename: Sovannaroth
authors.initials: S
authors.lastname: Siv
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium. kpeeters@itg.be.|School of International Health Development, Nagasaki University, Nagasaki, Japan. kpeeters@itg.be.|Partners for Applied Social Sciences (PASS) International, Tessenderlo, Belgium. kpeeters@itg.be.
authors.forename: Koen Peeters
authors.initials: KP
authors.lastname: Grietens
authors.affiliation: National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia. thosochantha@gmail.com.
authors.forename: Tho
authors.initials: T
authors.lastname: Sochantha
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium. mcoosemans@itg.be.|University of Antwerp, Antwerp, Belgium. mcoosemans@itg.be.
authors.forename: Marc
authors.initials: M
authors.lastname: Coosemans
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium. vsluydts@itg.be.|University of Antwerp, Antwerp, Belgium. vsluydts@itg.be.
authors.forename: Vincent
authors.initials: V
authors.lastname: Sluydts
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D002160:Cambodia / Q000453:epidemiology; D005191:Family Characteristics; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007302:Insect Repellents / Q000008:administration & dosage* / Q000600:supply & distribution; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data / Q000600:supply & distribution*; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage*; D011634:Public Health / Q000379:methods; D019035:Rural Health Services / Q000600:supply & distribution*; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D007302:Insect Repellents; D010880:Piperidines; C483506:picaridin