Effect of Incentives on Insecticide-Treated Bed Net Use in Sub-Saharan Africa: A Cluster Randomized Trial in Madagascar


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dc.contributor.author Krezanoski, Paul J en_US
dc.contributor.author Comfort, Alison B en_US
dc.contributor.author Hamer, Davidson H en_US
dc.date.accessioned 2012-01-09T20:58:40Z
dc.date.available 2012-01-09T20:58:40Z
dc.date.copyright 2010 en_US
dc.date.issued 2010-6-27 en_US
dc.identifier.citation Krezanoski, Paul J, Alison B Comfort, Davidson H Hamer. "Effect of incentives on insecticide-treated bed net use in sub-Saharan Africa: a cluster randomized trial in Madagascar" Malaria Journal 9:186. (2010) en_US
dc.identifier.issn 1475-2875 en_US
dc.identifier.uri http://hdl.handle.net/2144/2949
dc.description.abstract BACKGROUND Insecticide-treated bed nets (ITNs) have been shown to reduce morbidity and mortality due to malaria in sub-Saharan Africa. Strategies using incentives to increase ITN use could be more efficient than traditional distribution campaigns. To date, behavioural incentives have been studied mostly in developed countries. No study has yet looked at the effect of incentives on the use of ITNs. Reported here are the results of a cluster randomized controlled trial testing household-level incentives for ITN use following a free ITN distribution campaign in Madagascar. METHODS The study took place from July 2007 until February 2008. Twenty-one villages were randomized to either intervention or control clusters. Households in both clusters received a coupon redeemable for one ITN. After one month, intervention households received a bonus for ITN use, determined by visual confirmation of a mounted ITN. Data were collected at baseline, one month and six months. Both unadjusted and adjusted results, using cluster specific methods, are presented. RESULTS At baseline, 8.5% of households owned an ITN and 6% were observed to have a net mounted over a bed in the household. At one month, there were no differences in ownership between the intervention and control groups (99.5% vs. 99.4%), but net use was substantially higher in the intervention group (99% vs. 78%), with an adjusted risk ratio of 1.24 (95% CI: 1.10 to 1.40; p <0.001). After six months, net ownership had decreased in the intervention compared to the control group (96.7% vs. 99.7%), with an adjusted risk ratio of 0.97 (p <0.01). There was no difference between the groups in terms of ITN use at six months; however, intervention households were more likely to use a net that they owned (96% vs. 90%; p <0.001). CONCLUSIONS Household-level incentives have the potential to significantly increase the use of ITNs in target households in the immediate-term, but, over time, the use of ITNs is similar to households that did not receive incentives. Providing incentives for behaviour change is a promising tool that can complement traditional ITN distribution programmes and improve the effectiveness of ITN programmes in protecting vulnerable populations, especially in the short-term. en_US
dc.description.sponsorship nternational Health Summer Scholarship from the Boston University School of Medicine; Paul and Patty Gannon; Opportunity Solutions International; Global Health Education Consortium; Massachusetts Medical Society; Infectious Disease Society of America en_US
dc.language.iso en en_US
dc.publisher BioMed Central en_US
dc.rights Copyright 2010 Krezanoski et al; licensee BioMed Central Ltd. en_US
dc.rights.uri http://creativecommons.org/licenses/by/2.0 en_US
dc.title Effect of Incentives on Insecticide-Treated Bed Net Use in Sub-Saharan Africa: A Cluster Randomized Trial in Madagascar en_US
dc.type article en_US
dc.identifier.doi 10.1186/1475-2875-9-186 en_US
dc.identifier.pubmedid 20579392 en_US
dc.identifier.pmcid 2909249 en_US

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