Assuring access to topical mosquito repellents within an intensive distribution scheme: a case study in a remote province of Cambodia

Somony Heng, Lies Durnez, Charlotte Gryseels, Karel Van Roey, Vanna Mean, Sambunny Uk, Sovannaroth Siv, Koen Peeters Grietens, Tho Sochantha, Marc Coosemans, Vincent Sluydts, Somony Heng, Lies Durnez, Charlotte Gryseels, Karel Van Roey, Vanna Mean, Sambunny Uk, Sovannaroth Siv, Koen Peeters Grietens, Tho Sochantha, Marc Coosemans, Vincent Sluydts

Abstract

Background: The public health value of a vector control tool depends on its epidemiological efficacy, but also on its ease of implementation. This study describes an intensive distribution scheme of a topical repellent implemented in 2012 and 2013 for the purpose of a cluster-randomized trial using the existing public health system. The trial aimed to assess the effectiveness of repellents in addition to long-lasting insecticidal nets (LLIN) and occurred in a province of Cambodia. Determinants for accessibility and consumption of this tool were explored.

Methods: 135 individuals were appointed to be repellent distributors in 57 villages. A 2-weekly bottle exchange programme was organized. Distributors recorded information regarding the amount of bottles exchanged, repellent leftover, and reasons for not complying in household data sheets. Distributor-household contact rates and average 2-weekly consumption of repellent were calculated. Household and distributors characteristics were obtained using questionnaires, surveying 50 households per cluster and all distributors. Regression models were used to explore associations between contact and consumption rates and determinants such as socio-economic status. Operational costs for repellent and net distribution were obtained from the MalaResT project and the provincial health department.

Results: A fourfold increase in distributor-household contact rates was observed in 2013 compared to 2012 (median2012 = 20 %, median2013 = 88.9 %). Consumption rate tripled over the 2-year study period (median2012 = 20 %, median2013 = 57.89 %). Contact rates were found to associate with district, commune and knowing the distributor, while consumption was associated with district and household head occupation. The annual operational cost per capita for repellent distribution was 31 times more expensive than LLIN distribution (USD 4.33 versus USD 0.14).

Discussion: After the existing public health system was reinforced with programmatic and logistic support, an intense 2-weekly distribution scheme of a vector control tool over a 2-year period was operated successfully in the field. Lack of associations with socio-economic status suggested that the free distribution strategy resulted in equitable access to repellents. The operational costs for the repellent distribution and exchange programme were much higher than LLIN distribution. Such effort could only be justified in the context of malaria elimination where these interventions are expected to be limited in time.

Trial registration: ClinicalTrials.gov NCT01663831.

Figures

Fig. 1
Fig. 1
Pyramidal system for repellent distribution and supervision. Number of people involved in the trial by level, number of households covered by the trial and number of repellent bottles distributed in 2012 (red) and 2013 (purple)
Fig. 2
Fig. 2
Selection of households and non-responses in the household survey
Fig. 3
Fig. 3
Correlation between contact and consumption in 2012 (a) and 2013 (b). Blue lines indicate expected consumption per household per 2 weeks. An average of 9.0 and 7.5 % increase in consumption for every 10 % increase in contact rates in 2012 and 2013 respectively were observed
Fig. 4
Fig. 4
Effect of the occupation of the household head on consumption level in 2013. Households led by farmers significantly consumed more repellent than those led by sellers

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Source: PubMed

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