Multi-country review of ITN routine distribution data: are ANC and EPI channels achieving their potential?

• Published in: Malaria Journal
• Main Authors: Jane E. Miller, Kezia Malm, Aimain Alexis Serge, Marcellin Joel Ateba, Peter Gitanya, Doudou Sene, Emmanuel H. Kooma, Balla Kandeh, Lilia Gerberg, Luigi Nuñez
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2022
• Subjects: Routine; Continuous distribution; ANC; EPI; ITNs; Pregnant women; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1186/s12936-022-04373-6; https://doaj.org/article/6dea740778394f69ac68cae197efaffd

Abstract Background Routine continuous distribution (CD) of insecticide-treated nets (ITNs) has been an important part of an overall ITN strategy to complement mass campaigns since the early 2000s. The backbone of CD implementation for many sub-Saharan African countries is distribution through antenatal care (ANC) and Expanded Programme for Immunizations (EPI) channels. Performance of these channels is often not monitored closely at the national level, nor is it reviewed globally, unlike the oversight provided to mass campaigns. The question as to why every eligible pregnant woman and child attending these services does not get an ITN remains important and yet, unanswered. Methods ANC and EPI issuing rates from seven countries were reviewed with the aim of conducting a blinded multi-country analysis. Monthly data from January to December 2021 was extracted from each country’s health management information system and analysed jointly with a National Malaria Control Programme (NMCP) focal point. VectorLink CD assessment reports were also reviewed to glean key findings. Results ITN issuing rates varied across countries at ANC (31% to 93%) and EPI (39% to 92%). Across the seven countries, the median ITN issuing rate was 64% at ANC and 78% at EPI. Results varied greatly across months per country at both ANC and EPI. NMCP focal points are aware that mass campaigns often negatively affect implementation of ITN distribution through ANC and EPI, even though global and national guidelines emphasize sustaining CD during campaigns. Concerns were also raised about the standard ITN issuing rate indicator at ANC and even more so at EPI due to the denominator. Findings from CD assessments were similar across countries: ITN stock was inconsistent and sometimes inadequate, and updated guidelines on ITN distribution and utilization and funding for social behaviour change activities were lacking at the facility level. Conclusion The importance of optimizing ANC and EPI routine channels cannot be underscored enough. They are at the ...