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Lots Quality Assurance Survey (LQAS) as a Strategy to Achieving Quality LLIN Campaigns: The Nigerian Experience

DOI: 10.4236/oalib.1104484, PP. 1-13

Keywords: Malaria, Long-Lasting Insecticidal Nets, Mass Campaign, Nigeria, Redemption Rates, Utilization Rates, LQAS, Adamawa, Edo, Imo, Kwara, Ondo

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Abstract:

Background: Nigeria, in its quest to scale up coverage and utilization of LLINs as a strategy for malaria control, had the first long lasting insecticidal net (LLIN) mass campaign across the country between 2009-2013. The NMEP with support from its RBM partners successfully distributed over 57.7 million LLINs during the period representing over 90% of the national target. In spite this, and to achieve universal coverage, the country maintained a continuous distribution through multiple channels and in particular the antenatal care outlets and the expanded programme on immunization. The Nigerian government, with support from the Global Fund and through the National Malaria Elimination Programme (NMEP), Catholic Relief Services (CRS), and the Society for Family Health (SFH) and with technical support from the World Health Organization, once again launched the LLIN replacement campaign in some states across the country. Methods: A cross-sectional survey was conducted in five states that conducted the LLIN replacement campaign using the lots quality assurance survey (LQAS) tool developed by the World Health Organization. The period of the survey across the states is between August and December 2017. The LQAS questionnaires were administered to households (HHs) by the WHO field officers trained on the use of the tool at least one week after the campaign. A total of 240 HHs were selected from 24 settlements (clusters) in 24 wards of six LGAs (lots) from each of the five (5) states that rolled out the campaign. Data collected were double entered, cleaned, crosschecked, and the results analysed using the SPSS version 24. Results: With a total of 9740 people surveyed from 1200 HHs across the five states, the average redemption rate was 95.5% (95% CI, 91.6% - 98.8%), average retention rate was 98.4% (95% CI, 97.0% - 99.8%), average hanging rate was 82.6% (95% CI, 80.0% - 85.5%), and an average card ownership of 83.5% (95% CI, 78.6% - 88.2%). While the main source of information 35.4% (95% CI, 21.8% - 49.0%) about the LLIN campaign was the health workers, the reasons for those missed out were mainly due to team performance 32.2% (95% CI, 26.8% - 37.4%) and net cards not issued 27.4% (95% CI, 23.2% - 32.0%). Similarly, the Pearson correlation (0.942, α 0.017, p < 0.05, 2-tailed test), the ANOVA test (F value of 23.751, α 0.017, p < 0.05), and Regression analysis (R-square 0.888 and Durbin-Watson 2.487), all shows significant relationships between LLIN redemption and usage with a resultant rejection of the Null Hypothesis. Conclusion: The outcome of this research underscores the need to adopt and scale up the use of the LQAS tool to assess the quality of LLIN campaigns within the shortest possible time. While the LQAS has been in use by the WHO Expanded Programme on Immunization cluster during polio campaigns, this is the first time that the tool was deployed by the WHO malaria unit as a strategy to identify post LLIN campaign gaps immediately after implementation. The scaling up of this strategy would undoubtedly improve LLIN campaigns that would be conducted in the remaining states across the country so as to ensure that Nigeria achieve LLIN universal access in line with the Global Technical Strategy (GTS) framework toward malaria elimination.

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