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How Nigeria plans to eliminate malaria through net substitution

By Sola Ogundipe

IN what has been largely described as an ambitious initiative, Nigeria is embarking on a malaria elimination drive through a comprehensive Long Lasting Insecticide Nets, LLINs, replacement programme.

Since the commencement of the universal mass campaign for ownership and use of the LLINs, in Nigeria in May 2009 across the 36 States of the Federation, the essence of replacement drive has been pushed forward as a means of filling in the gaps following distribution of two nets per household arrangement.

With an estimated 25 percent of the global malaria burden, Nigeria has its work cut out to stem the tide of the disorder.

Already, the National Malaria Elimination Programme, NMEP, had earlir distributed a total of 31 million nets in 13 of 17 states earmarked for a phase of the project.

A report of the campaign from the Federal Ministry of Health shows that to date, a total of 57,773,191 of the planned 64,064,949 LLINs were distributed in the 36 states of the Federation including the Federal Capital Territory, representing 90.2 percent of the total National target.

The World Health Organisation, WHO, recommends that in achieving universal coverage with LLINs in malaria control.

The LLINs have played an important role in the remarkable success in reducing malaria burden over the past decade and are regarded as a core prevention tool for people at risk of malaria.

WHO recommends Universal coverage remains the goal for all people at risk of malaria and to maintain universal coverage, it notes that countries should apply a combination of mass free distributions and continuous distributions through multiple channels, in particular antenatal and immunisation services.
Further, WHO says mass campaigns are a cost-effective way to rapidly achieve high and equitable coverage but coverage gaps start to appear almost immediately post-campaign through net deterioration, loss of nets,and population growth, requiring complementary continuous distribution channels.

Mass Campaigns

For mass campaigns, the WHO adds that one LLIN should be distributed for every two persons at risk of malaria and mass campaigns should be repeated normally at an interval of no more than three years unless there is reliable observational evidence that a longer interval could be appropriate

“There should be a single national plan, under the leadership of the national malaria control programme, for both continuous and campaign distribution strategies. This unified plan should include a comprehensive quantification and gap analysis for all public sector LLIN distribution channels.”
Among others, the global body also recommends that each national malaria control programme should develop its own LLIN distribution strategy.

But in a presentation during the 1st 2015 quarterly malaria media chat on the staus of LLIN interventions in Nigeria held in Abuja under the auspices of the National Malaria Elimination Programme, NMEP, a representative of MalariaNoMore, one of the partners, Dayo Oluwole, highlighted the distribution of nets distribution in the country.

Oluwole, who gave a presentation entitled “2014 Nigeria Malaria Knowledge, Attitudes and Practices Study: Baseline”, revealed that nets distribution in Nigeria is highest in the North East with 67.4 percent, and lowest in the South West with 23.7 percent.

Zonal distribution: Distribution in other zones is as follows: South South 45.2 percent; South East 35 percent; North West 59.7 percent and North Central 32.7 percent. Oluwole noted that while 84 percent of persons in the country know that malaria is transmitted through mosquito bites, just 4 percent, is ware that sleeping inside a LLIN is the best way to prevent malaria.

Improved commitment

“Awareness about malaria provides the foundation for improved commitment and eventually positive behaviour change. There is more to be done to close knowledge gaps around transmission, prevention, and diagnostics,” Oluwole asserted.

Giving an overview of LLIN strategy in the country, National Coordinator, NMEP, Dr. Nnenna Ezeigwe, said the concept of nets distribution was designed to saturate every state with the nets in order to achieve 100 percent ownership and at least 80 percent utilisation.

“The strategy targets all population at risk (97 percent of the total population). Common set of methodologies and tools were developed for the distribution of over 64 million LLINs through Universal Coverage campaigns planned that commenced in 2009.

“We started net distribution afresh with a coordinated strategy to deliver two nets to every household across the country. Determination of LLINs requirements for each state based on projected 2006 population census data for 2009 and 2010.

From hindsight, among objectives of the LLIN replacement campaign is to register and deliver at least two LLINs to every household in the states. Others include building the capacity of the state, LGAs, communities and partners on the benefits, management and use of the LLINs, developing and sustaining net culture in the state through advocacy and community mobilisation, contributing to the reduction of malaria morbidity and mortality, etc.

Giving an update of the household mobilization and LLINs distribution, Ezeigwe, in a presentation of the “Status of Nigeria Universal Coverage LLIN Replacement Campaign 2013-2015,” observed that the LLINs replacement campaigns objective was to deliver over 47 million LLINs to populations in 17 States where existing nets had reached their normal end of life, having being in use for three years or more.

Replacement campaigns

Ezeigwe said the LLIN replacement campaigns in the phase 1 States of Anambra, Bauchi. Gombe, Nasarawa, Jigawa and Rivers were implemented between September and November 2014. States were mostly supported with funding from the World Bank.

“The LLIN replacement campaigns in the phase 2 States of Akwa Ibom, Niger, Ekiti, Katsina, Kebbi and Abia were implemented between November 2014 and January 2015, while the Abia campaign was finally completed by the end of February.

“The cumulative number of LLINs distributed till date (13 States in Phases 1 and 2) stands at 31,878,911 LLINs. This represents 92 percent of the target set for distribution in the 13 states where campaigns have been concluded and distribution data available.”

Ezeigwe observed that an end process assessment showed a household net retention of 97 percent while the proportion of children under five years of age and pregnant women who slept inside the net the night preceding the assessment was 68 percent and 76 percent respectively.

On the campaign progress, she said implementation replacement campaign commenced in Sokoto in November 2013 as a pilot, closely followed by Ogun the second pilot state.


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