title: Large-scale implementation of disease control programmes: a cost-effectiveness analysis of long-lasting insecticide-treated bed net distribution channels in a malaria-endemic area of western Kenya-a study protocol.
abstract: Historically, Kenya has used various distribution models for long-lasting insecticide-treated bed nets (LLINs) with variable results in population coverage. The models presently vary widely in scale, target population and strategy. There is limited information to determine the best combination of distribution models, which will lead to sustained high coverage and are operationally efficient and cost-effective. Standardised cost information is needed in combination with programme effectiveness estimates to judge the efficiency of LLIN distribution models and options for improvement in implementing malaria control programmes. The study aims to address the information gap, estimating distribution cost and the effectiveness of different LLIN distribution models, and comparing them in an economic evaluation.
  
  
  
  Evaluation of cost and coverage will be determined for 5 different distribution models in Busia County, an area of perennial malaria transmission in western Kenya. Cost data will be collected retrospectively from health facilities, the Ministry of Health, donors and distributors. Programme-effectiveness data, defined as the number of people with access to an LLIN per 1000 population, will be collected through triangulation of data from a nationally representative, cross-sectional malaria survey, a cross-sectional survey administered to a subsample of beneficiaries in Busia County and LLIN distributors' records. Descriptive statistics and regression analysis will be used for the evaluation. A cost-effectiveness analysis will be performed from a health-systems perspective, and cost-effectiveness ratios will be calculated using bootstrapping techniques.
  
  
  
  The study has been evaluated and approved by Kenya Medical Research Institute, Scientific and Ethical Review Unit (SERU number 2997). All participants will provide written informed consent. The findings of this economic evaluation will be disseminated through peer-reviewed publications.
authors.affiliation: Centre for Applied Health Research and delivery (CAHRD), Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Elvis
authors.initials: E
authors.lastname: Gama
authors.affiliation: Centre for Applied Health Research and delivery (CAHRD), Liverpool School of Tropical Medicine, Liverpool, UK.|Kenya Medical Research Institute and U.S. Centers for Disease Control and Prevention Research and Public Health Collaboration, Kisumu, Kenya.
authors.forename: Vincent
authors.initials: V
authors.lastname: Were
authors.affiliation: Kenya Medical Research Institute and U.S. Centers for Disease Control and Prevention Research and Public Health Collaboration, Kisumu, Kenya.
authors.forename: Peter
authors.initials: P
authors.lastname: Ouma
authors.affiliation: Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Meghna
authors.initials: M
authors.lastname: Desai
authors.affiliation: Centre for Applied Health Research and delivery (CAHRD), Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Louis
authors.initials: L
authors.lastname: Niessen
authors.affiliation: Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.|U.S. President's Malaria Initiative, Nairobi, Kenya.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Buff
authors.affiliation: Kenya Medical Research Institute and U.S. Centers for Disease Control and Prevention Research and Public Health Collaboration, Kisumu, Kenya.
authors.forename: Simon
authors.initials: S
authors.lastname: Kariuki
mesh_terms: D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000379:methods*; D006801:Humans; D057148:Insecticide-Treated Bednets / Q000191:economics* / Q000706:statistics & numerical data; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000453:epidemiology* / Q000517:prevention & control*; D012107:Research Design; D012189:Retrospective Studies
keywords: Cost analysis; Economic evaluation; Insecticide-treated bed nets; Supply and distribution