The Post-Distribution net use and condition Check-Up (PDCU) in Ntcheu, Malawi
, carried out 24 months post-distribution, has shown an 81% hang-up of nets with 49% still being in ‘very good’ condition (up to two holes of up to 2cms in size). These are strong results. The sample size was significant: 9,100 households and 19,000 nets, representing 7% of the initial nets distributed and at least 250 households in each health centre catchment area.
Equally as important as the initial coverage of a population with nets, is the continued use of the nets so they continue to protect a population and prevent malaria.
The challenging environments in which nets are distributed can lead to nets becoming damaged or worn out so the number of nets hung, and the condition they are in, will decline over time.
However, initial high levels of coverage, a community’s understanding of the importance of the use and good treatment of nets, as well as appropriate interventions by health leaders all contribute to optimising the impact of the nets.
Data showing the level of net use and condition allows an understanding of the actual net coverage as well as providing the District Health Officer (DHO) and Malaria Coordinator (MC) and their teams with information that can be helpful in deciding on additional anti-malaria related interventions and where to direct them. This is particularly valuable where resources are limited.
We track net use and condition via a series of ‘Post-Distribution Check-ups’ (PDCUs) every six to nine months that involves unannounced visits to a randomly-selected set of households across all health-centre catchment areas, representing 5% of those that received nets initially. This provides statistically significant and locally actionable information. It is time-effectively and cost-effectively gathered and collated through a partnership between AMF, the local distribution partner and the local health teams. The information is immediately available to local health leaders.
Malaria is the, or one of the, most significant health issues in the areas in which nets are distributed and nets are the most effective method of prevention. Understanding the level of net coverage in the extended period after a mass distribution, and working to sustain high levels of net coverage justifies in our view the modest investment of time and money in collecting this data.
‘Universal coverage’ is used here to mean all sleeping spaces covered. A goal of some mass distribution programmes is 80% initial sleeping space coverage. We, and our partners, believe higher levels of coverage should be the aim and are achievable. We present and colour code the PDCU data
on the basis that 90%, 85% and 80% coverage after 6 , 15 and 24 months represent a ‘very good’, and therefore the desired, outcome.