Integrating insecticide-treated bednets into a measles vaccination campaign achieves high, rapid and equitable coverage with direct and voucher-based methods


Mark Grabowsky, American Red Cross, 2025 E Street, NW, Washington, DC 20006, USA. Tel.: +1-202-303-5243; Fax: +1-202-303-0054; E-mail: (corresponding author).
Nicholas T. Farrell, CDC, 1600 Clifton Road, MS D-69, Atlanta, GA 30333, USA. Tel.: +1-404-639-7866; Fax: +1-404-639-7490; E-mail:
William A. Hawley and Adam Wolkon, Entomology Branch/Malaria Branch, Division of Parasitic Diseases, MS F-42, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. Tel.: +1-770-488-3600; Fax: +1-770-488-4258; E-mail:,
Dr John M. Chimumbwa, East Africa RBM Focal Point, C/O UNICEF ESARO, P.O. Box 44145, Nairobi, Kenya. Tel.: +254-20-621265; Fax +254-20-622678/9; E-mail:
Stefan Hoyer, C/o Regional Delegation, 42 Bates Street, Milton Park, Harare, Zimbabwe. Tel.: +263-4-705166/7; Fax: +263-4-708784; E-mail:
Joel Selanikio, Datadyne, LLC, 1505 Church Street NW, Washington, DC 20005, USA. Tel.: +1-202-986-1020; Fax: +1-202-303-0051; E-mail:


Population coverage of insecticide-treated nets (ITNs) in Africa falls well below the Abuja target of 60% while coverage levels achieved during vaccination campaigns in the same populations typically exceed 90%. Household (HH) cost of ITNs is an important barrier to their uptake. We investigated the coverage, equity and cost of linking distribution of free ITNs to a measles vaccination campaign. During a national measles vaccination campaign in Zambia, children in four rural districts were given a free ITN when they received their measles vaccination. In one urban district, children were given a voucher, which could be redeemed for a net at a commercial distribution site. About 1700 HHs were asked whether they received vaccination and an ITN during a measles campaign, as well as questions on assets (e.g. type roofing material or bicycle ownership) to assess HH wealth. Net ownership was calculated for children in each wealth quintile. In the rural areas, ITN coverage among children rose from 16.7% to 81.1% and the equity ratio from 0.32 to 0.88 and in the urban area from 50.7% to 76.2% (equity ratio: 0.66–1.19). The operational cost per ITN delivered was $0.35 in the rural area with direct distribution and $1.89 in the urban areas with voucher distribution. Mass distribution of ITNs through vaccination campaigns achieves rapid, high and equitable coverage at low cost.