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Evaluating malaria prevention and control with insecticide-treated nets: new indicators for "universal coverage" and the difficulties of measuring net durability
While insecticide-treated nets (ITN) have been used for over 30 years to protect from malaria infection, their widespread application in sub-Saharan Africa as a malaria control tool is more recent and was made possible by the new technology of long-lasting insecticidal treatment, which makes net retreatment redundant. With the shift in control strategy from protection of the biologically vulnerable to using ITN in the general population to bring down transmission (universal coverage), the previously used indicators for net ownership and use proved insufficient to provide a basis for strategic decisions of program managers. The rationale for the new indicators suggested by the Roll Back Malaria Partnership will be presented and their potential and limitations described based on practical examples.
Another problem that has been overlooked for many years is the “useful life” of mosquito nets or their durability, which with the massive scale-up of free, public sector distributions of ITN, has moved into the focus of discussion, as an increased durability of only one additional year could potentially save millions of dollars spent on ITN. Based on over 10 years of field research, the development of methodologies to capture net durability and the current state of affairs will be presented.
Albert Kilian is a malaria expert and co-founder of Tropical Health LLP, a small consulting firm. Originally trained as pediatrician, he has obtained a diploma in Tropical Medicine and Medical Parasitology and an MPH with a focus on Epidemiology and Statistics. Since 1992, he has been active in public health and has specialized in malaria control and monitoring and evaluation, with a strong emphasis on quantitative data collection and implementation research. His 24 years of experience with GTZ, the CDC, and the Malaria Consortium include 15 years spent in developing countries working at district and national levels and five years as malaria advisor to the Uganda Ministry of Health. More recently he moved to focus on innovative and robust monitoring and evaluation systems and tools. He regularly contributes to the Roll Back Malaria Monitoring and Evaluation Reference Group and is co-chair of the “LLIN durability workstream” of the RBM Vector Control Working Group.