Mass Distribution Campaign Within Sierra Leone

Sierra Leone is a country located in the Western part of Africa. Corrupt government and private sectors, lack of infrastructural development and incompetent provision of education and right of citizenship are considered to be the factors lead to poverty and insufficiency of economic growth in the country (Stoll, 2011). There are only 40% of the citizens are recorded as living above the national poverty line (UNDP, 2019), and Sierra Leone was ranked as the ninth poorest country around the globe by USA Today (USA TODAY, 2019).

The climate and environment in Sierra Leone make it a favourable place for the breeding of parasite-carried mosquito which is the vectors of malaria (Arab, Jackson & Kongoli, 2014), and the perennial transmission of malaria has eventually become one of the greatest burdens in Sierra Leone.

Actions for malaria control in Sierra Leone was first started in 2000 with several programs work along with each other, including the National Malaria Control Program (NMCP), Roll Back Malaria Initiative (RBM) (WHO Africa, 2015; PMI, 2017). From the Sierra Leone Malaria Control Strategic Plan 2016-2020, the Government of Sierra Leone Ministry of Health and Sanitation has committed to knock down 40% of malaria-related morbidity and mortality by 2020 (WHO Africa, 2015). With the intention to malaria reduction and prevention, several interventions including vector control strategies: mass distribution campaign of long-lasting insecticidal nets (LLINs) and promotion of the usage of insecticide-treated mosquito nets (ITNs), indoor residual spraying (IRS), larval source management (LSM); prompt diagnosis and treatment: mass drug administration (MDA) are introduced in Sierra Leone (Gerstl et al., 2010). Intermittent preventive treatment for pregnant women (IPTp) is implanted as a strategy to reduce malaria-related maternal mortality and complications throughout the course of pregnancy, who are at a higher risk with regard to acquiring malaria (PMI, 2017).

We will discuss the mass distribution campaign being carried out within Sierra Leone.

The mass distribution campaign was first conduct and brought to Sierra Leone in 2010 by the NMCP and PMI (The World Bank, 2012). With the target to give at least one net per two people being established by the RBM, around 3 million nets were handed out to the local population (The World Bank, 2012). The purpose of ITNs is to prevent the population from exposing to the vector mosquito, especially the high-risk groups (paediatrics and pregnant women), and eventually protect them from acquiring malaria (The World Bank, 2012). So far there have been 4 rounds of mass distribution campaigns being undertaken. by 2019, 76.5% of households across Sierra Leone possess at least one net comparing to 40% in 2008 and the relative incidence rate of malaria has been successfully decreased (Omonijo & Omonijo, 2019; Lim et al., 2011)

The mass distribution campaign of ITNs is a modification of the previous targeted distribution of ITNs, with the intention to address the inequality in ITN ownership among the wealthy and poor population by putting more focus to households from low-income level (Taylor, Florey & Ye, 2017). Both of the figures below demonstrate that the situation of inequity in ITN ownership has been improved and the disparities between the rich and poor has been reduced after the amendment of the campaign (Taylor, Florey & Ye, 2017).

Despite the modification, the target to reach ITNs universal coverage is yet to be achieved. It may due to the persistence of the problems mentioned in the 2012 Performance Audit Report on Anti-malaria Interventions by the Audit Service Sierra Leone of the misuse of ITNs, unequally ITNs distribution, selling of ITNs, etc. among households (ASSL, 2012) and these can be all poverty-related and interact with each other. The poor are most likely to have a low education level, which leads to inappropriate use of ITNs (Tizifa et al., 2018); besides, people with low socioeconomic status are less likely to access to their local healthcare facilities and seek for health care, causing the inequity problems of ITN ownership (Tizifa et al., 2018); selling the distributed ITNs to other households by the poor in order to make profit for their livings. Furthermore, there are other limitations that restrict the effectiveness of ITNs: vector mosquito of malaria has gradually developed resistance to the only approved insecticides, pyrethroid, used in the nets, therefore more researches and investigations have to be undertaken to address the threat (Tizifa et al., 2018); absence of effective ITNs maintenance strategy which assure regular supply of nets in Sierra Leone (Tizifa et al., 2018).