Replacement Campaign of Long Lasting Insecticide Treated Nets in Ondo State, Southwest Nigeria, Heartland of Africas Most Efficient Vector Species

Abstract

Background: Ondo State in Southwest Nigeria, heartland of Africa’s most efficient malaria vector, conducted a Long- Lasting Insecticidal Nets (LLINs) replacement campaign at the last quarter of 2017 with the aim of achieving the recommended coverage of one LLIN per two persons, in line with the National Malaria Elimination Program (NMEP) strategy. The LLIN replacement campaign planned to reach 4,757,725 populations to achieve universal coverage, a proven intervention aimed at reducing malaria morbidity by increasing access to, as well as ownership and utilization of LLINs. The processes to achieve this goal are described in this paper. Methodology: This paper describes the modalities and scheme for LLIN distribution in one of the states in Southern Nigeria. The campaign took place in all the 18 Local Government Areas (LGAs) of the state between September 17 and November 15, 2017. Implementation trainings were held and advocacies were conducted at state level and to traditional and religious leaders followed by community mobilization in all the Local Government Authorities. Intense logistic activities included transportation and positioning of LLINs. The Implementation was endorsed by LLIN Ambassadors. End process evaluation and reverse logistics were carried out. The LLIN replacement was carried out at a time of high malaria transmission during the second rainy season of the year. Excel spreadsheet was used in data analysis. Outcome: The LLIN replacement campaign involved the training of 11,695 personnel in different cadres including teams, supervisors and monitors at state and at LGA levels, independent monitors, ward monitors and town announcers. Distribution point supervisors, health educators and crowd controllers as well as store keepers were also trained. In all 2,734,500 net cards were issued to LGAs of which 2,674,172 (98.0%) net cards were issued to beneficiaries to collect LLINs. In all, 2,444,036 (91.4%) LLINs were redeemed. Reasons for non-use of LLIN ranged from adverse reaction (11.0%) to “no mosquitoes” (1.0%). Majority (82.0%) of people heard about the LLIN campaign from town announcers and none was unaware of the campaign. Hanging rate was low at 55.0% while utilization by under-fives and by pregnant women was 67.0% and 76.0%, respectively. Conclusion: Despite the fact that replacement of LLINs in Ondo state of southwest Nigeria took place on a large scale, its utilization, especially among the at-risk groups, was still low. Aggressive follow-up campaigns to increase utilization should include more purposeful social and health advocacies to community and religious leaders. Use of local drama groups for behavioral change could be an advantage. Distribution of LLINs to school children should also be considered.