The relative roles of ANC and EPI in the continuous distribution of LLINs: a qualitative study in four countries.
BACKGROUND
The continuous distribution of long-lasting insecticidal nets (LLINs) for malaria prevention, through the antenatal care (ANC) and the Expanded Programme on Immunizations (EPI), is recommended by the WHO to improve and maintain LLIN coverage. Despite these recommendations, little is known about the relative strengths and weaknesses of the ANC and EPI-based LLIN distribution. This study aimed to explore and compare the roles of the ANC and EPI for LLIN distribution in four African countries.


METHODS
In a qualitative evaluation of continuous distribution through the ANC and EPI, semi-structured, individual and group interviews were conducted in Kenya, Malawi, Mali, and Rwanda. Respondents included national, sub-national, and facility-level health staff, and were selected to capture a range of roles related to malaria, ANC and EPI programmes. Policies, guidelines, and data collection tools were reviewed as a means of triangulation to assess the structure of LLIN distribution, and the methods of data collection and reporting for malaria, ANC and EPI programmes.


RESULTS
In the four countries visited, distribution of LLINs was more effectively integrated through ANC than through EPI because of a) stronger linkages and involvement between malaria and reproductive health programmes, as compared to malaria and EPI, and b) more complete programme monitoring for ANC-based distribution, compared to EPI-based distribution.


CONCLUSIONS
Opportunities for improving the distribution of LLINs through these channels exist, especially in the case of EPI. For both ANC and EPI, integrated distribution of LLINs has the potential to act as an incentive, improving the already strong coverage of both these essential services. The collection and reporting of data on LLINs distributed through the ANC and EPI can provide insight into the performance of LLIN distribution within these programmes. Greater attention to data collection and use, by both the global malaria community, and the integrated programmes, can improve this distribution channel strength and effectiveness.
Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
Katherine
K
Theiss-Nyland
Programme National de Lutte Contre le Paludisme, Ministere de la Sante et l'Hygiene Publique, Bamako, Mali.
Diakalia
D
Koné
Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
Corine
C
Karema
Malaria Control Unit, Ministry of Health, Nairobi, Kenya.
Waqo
W
Ejersa
Disease Control Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
Jayne
J
Webster
Disease Control Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
Jo
J
Lines
D000349:Africa; D003625:Data Collection; D005260:Female; D006291:Health Policy; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D008288:Malaria / Q000517:prevention & control; D009032:Mosquito Control / Q000379:methods; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*; D036301:Qualitative Research
ANC; Continuous distribution; EPI; LLINs; monitoring and evaluation; routine distribution