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Spatial models for the rational allocation of routinely distributed bed nets to public health facilities in Western Kenya

BACKGROUND: In high to moderate malaria transmission areas of Kenya, long-lasting insecticidal nets (LLINs) are provided free of charge to pregnant women and infants during routine antenatal care (ANC) and immunization respectively. Quantities of LLINs distributed to clinics are quantified based on...

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Autores principales: Macharia, Peter M., Odera, Patroba A., Snow, Robert W., Noor, Abdisalan M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5596856/
https://www.ncbi.nlm.nih.gov/pubmed/28899379
http://dx.doi.org/10.1186/s12936-017-2009-3
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author Macharia, Peter M.
Odera, Patroba A.
Snow, Robert W.
Noor, Abdisalan M.
author_facet Macharia, Peter M.
Odera, Patroba A.
Snow, Robert W.
Noor, Abdisalan M.
author_sort Macharia, Peter M.
collection PubMed
description BACKGROUND: In high to moderate malaria transmission areas of Kenya, long-lasting insecticidal nets (LLINs) are provided free of charge to pregnant women and infants during routine antenatal care (ANC) and immunization respectively. Quantities of LLINs distributed to clinics are quantified based on a combination of monthly consumption data and population size of target counties. However, this approach has been shown to lead to stock-outs in targeted clinics. In this study, a novel LLINs need quantification approach for clinics in the routine distribution system was developed. The estimated need was then compared to the actual allocation to identify potential areas of LLIN over- or under-allocation in the high malaria transmission areas of Western Kenya. METHODS: A geocoded database of public health facilities was developed and linked to monthly LLIN allocation. A network analysis approach was implemented using the location of all public clinics and topographic layers to model travel time. Estimated travel time, socio-economic and ANC attendance data were used to model clinic catchment areas and the probability of ANC service use within these catchments. These were used to define the number of catchment population who were likely to use these clinics for the year 2015 equivalent to LLIN need. Actual LLIN allocation was compared with the estimated need. Clinics were then classified based on whether allocation matched with the need, and if not, whether they were over or under-allocated. RESULTS: 888 (70%) public health facilities were allocated 591,880 LLINs in 2015. Approximately 682,377 (93%) pregnant women and infants were likely to have attended an LLIN clinic. 36% of the clinics had more LLIN than was needed (over-allocated) while 43% had received less (under-allocated). Increasing efficiency of allocation by diverting over supply of LLIN to clinics with less stock and fully covering 43 clinics that did not receive nets in 2015 would allow for complete matching of need with distribution. CONCLUSION: The proposed spatial modelling framework presents a rationale for equitable allocation of routine LLINs and could be used for quantification of other maternal and child health commodities applicable in different settings. Western Kenya region received adequate LLINs for routine distribution in line with government of Kenya targets, however, the model shows important inefficiencies in the allocation of the LLINs at clinic level.
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spelling pubmed-55968562017-09-15 Spatial models for the rational allocation of routinely distributed bed nets to public health facilities in Western Kenya Macharia, Peter M. Odera, Patroba A. Snow, Robert W. Noor, Abdisalan M. Malar J Research BACKGROUND: In high to moderate malaria transmission areas of Kenya, long-lasting insecticidal nets (LLINs) are provided free of charge to pregnant women and infants during routine antenatal care (ANC) and immunization respectively. Quantities of LLINs distributed to clinics are quantified based on a combination of monthly consumption data and population size of target counties. However, this approach has been shown to lead to stock-outs in targeted clinics. In this study, a novel LLINs need quantification approach for clinics in the routine distribution system was developed. The estimated need was then compared to the actual allocation to identify potential areas of LLIN over- or under-allocation in the high malaria transmission areas of Western Kenya. METHODS: A geocoded database of public health facilities was developed and linked to monthly LLIN allocation. A network analysis approach was implemented using the location of all public clinics and topographic layers to model travel time. Estimated travel time, socio-economic and ANC attendance data were used to model clinic catchment areas and the probability of ANC service use within these catchments. These were used to define the number of catchment population who were likely to use these clinics for the year 2015 equivalent to LLIN need. Actual LLIN allocation was compared with the estimated need. Clinics were then classified based on whether allocation matched with the need, and if not, whether they were over or under-allocated. RESULTS: 888 (70%) public health facilities were allocated 591,880 LLINs in 2015. Approximately 682,377 (93%) pregnant women and infants were likely to have attended an LLIN clinic. 36% of the clinics had more LLIN than was needed (over-allocated) while 43% had received less (under-allocated). Increasing efficiency of allocation by diverting over supply of LLIN to clinics with less stock and fully covering 43 clinics that did not receive nets in 2015 would allow for complete matching of need with distribution. CONCLUSION: The proposed spatial modelling framework presents a rationale for equitable allocation of routine LLINs and could be used for quantification of other maternal and child health commodities applicable in different settings. Western Kenya region received adequate LLINs for routine distribution in line with government of Kenya targets, however, the model shows important inefficiencies in the allocation of the LLINs at clinic level. BioMed Central 2017-09-12 /pmc/articles/PMC5596856/ /pubmed/28899379 http://dx.doi.org/10.1186/s12936-017-2009-3 Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Macharia, Peter M.
Odera, Patroba A.
Snow, Robert W.
Noor, Abdisalan M.
Spatial models for the rational allocation of routinely distributed bed nets to public health facilities in Western Kenya
title Spatial models for the rational allocation of routinely distributed bed nets to public health facilities in Western Kenya
title_full Spatial models for the rational allocation of routinely distributed bed nets to public health facilities in Western Kenya
title_fullStr Spatial models for the rational allocation of routinely distributed bed nets to public health facilities in Western Kenya
title_full_unstemmed Spatial models for the rational allocation of routinely distributed bed nets to public health facilities in Western Kenya
title_short Spatial models for the rational allocation of routinely distributed bed nets to public health facilities in Western Kenya
title_sort spatial models for the rational allocation of routinely distributed bed nets to public health facilities in western kenya
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5596856/
https://www.ncbi.nlm.nih.gov/pubmed/28899379
http://dx.doi.org/10.1186/s12936-017-2009-3
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