Towards achieving Abuja targets: identifying and addressing barriers to access and use of insecticides treated nets among the poorest populations in KenyaReportar como inadecuado




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BMC Public Health

, 10:137

First Online: 16 March 2010Received: 07 October 2009Accepted: 16 March 2010DOI: 10.1186-1471-2458-10-137

Cite this article as: Chuma, J., Okungu, V., Ntwiga, J. et al. BMC Public Health 2010 10: 137. doi:10.1186-1471-2458-10-137

Abstract

BackgroundEnsuring that the poor and vulnerable population benefit from malaria control interventions remains a challenge for malaria endemic countries. Until recently, ownership and use of insecticides treated nets ITNs in most countries was low and inequitable, although coverage has increased in countries where free ITN distribution is integrated into mass vaccination campaigns. In Kenya, free ITNs were distributed to children aged below five years in 2006 through two mass campaigns. High and equitable coverage were reported after the campaigns in some districts, although national level coverage remained low, suggesting that understanding barriers to access remains important. This study was conducted to explore barriers to ownership and use of ITNs among the poorest populations before and after the mass campaigns, to identify strategies for improving coverage, and to make recommendations on how increased coverage levels can be sustained.

MethodsThe study was conducted in the poorest areas of four malaria endemic districts in Kenya. Multiple data collection methods were applied including: cross-sectional surveys n = 708 households, 24 focus group discussions and semi-structured interviews with 70 ITN suppliers.

ResultsAffordability was reported as a major barrier to access but non-financial barriers were also shown to be important determinants. On the demand side key barriers to access included: mismatch between the types of ITNs supplied through interventions and community preferences; perceptions and beliefs on illness causes; physical location of suppliers and; distrust in free delivery and in the distribution agencies. Key barriers on the supply side included: distance from manufacturers; limited acceptability of ITNs provided through interventions; crowding out of the commercial sector and the price. Infrastructure, information and communication played a central role in promoting or hindering access.

ConclusionsSignificant resources have been directed towards addressing affordability barriers through providing free ITNs to vulnerable groups, but the success of these interventions depends largely on the degree to which other barriers to access are addressed. Only if additional efforts are directed towards addressing non-financial barriers to access, will high coverage levels be achieved and sustained.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2458-10-137 contains supplementary material, which is available to authorized users.

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Autor: Jane Chuma - Vincent Okungu - Janet Ntwiga - Catherine Molyneux

Fuente: https://link.springer.com/







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