The study was conducted in Namawala and Idete villages, located in the Kilombero Valley (8.1°S and 36.6°E) in south-eastern Tanzania (Figure 1 ). These communities experience hyper endemic malaria transmission [25 (link)], mostly transmitted by large populations of mosquitoes from the Anopheles gambiae sensu lato complex (Diptera: Culicidae) [26 (link),27 ]. In this area, this species complex is represented by two morphologically identical, but behaviourally distinctive, sibling species: A. gambiae sensu stricto (hereafter referred to as A. gambiae) and Anopheles arabiensis. A third, locally important vector species is Anopheles funestus. The ecosystem is dominated by a low lying river valley, 150 km long and up to 40 km wide, which is inter-dispersed with villages and rice farms. Annual flooding occurs during the rainy season (December - May) when large tracts of aquatic habitat suitable for immature mosquitoes are formed.
The epidemiology of malaria in the study villages has been well characterised over the past 15 years [e.g. [21 (link),22 (link),28 (link)-34 (link)]. Extremely high transmission intensities were recorded during the 1990s [21 (link)]. Since 1997, various cost-sharing schemes for subsidizing and promoting bed nets, as well as home insecticide treatment kits have been implemented in an effort to alleviate the malaria burden. The crux of the various programmes has been the generic branding of recommended nets and insecticides products which were sold in line with a price-fixing scheme that reflected a public subsidy (34% of retail value at US $5). To improve access to vulnerable pregnant women and infants, a further subsidy (17% of retail value) was provided through the use of a voucher scheme. The pregnant women and mothers of young children who attended antenatal or immunisation clinics were entitled to a discount voucher.
The initial pilot programme, KINET, distributed bed nets within the Kilombero Valley and achieved remarkably high bed net coverage of all community members [16 (link),22 (link),25 (link),35 (link)-37 (link)]. Although all KINET distributed bed nets were pre-treated with 20 mg/m2 deltamethrin [37 (link)], by 2001, insecticide levels had fallen below 5% and most nets were in poor condition containing many holes [22 (link),38 (link)]. Various national-scale distribution programmes have been implemented, commencing with PSI's Social Marketing of Insecticide Treated Nets (SMITN) programme which was run at a regional-scale during 1998-2000 and a national-scale during 2000-02 and promoted the use of nets and standard insecticide treatment kits (KO Tab, Icon® and Fendona). The sequential programme was SMARTNET from 2002, which the Tanzanian National Voucher Scheme (TNVS) was built upon in 2004. SMARTNET ensured that all bed nets manufactured in Tanzania were co-packaged with longer-lasting insecticide treatment kits, which were registered for use from 2004 onwards (Initially: KO Tab 123, target dose: 25 mg deltamethrin/m2 [39 (link),40 (link)]; and from 2008: Icon® MAXX, target dose: 50 mg lambda-cyhalothrin/m2 [41 ]).
The epidemiology of malaria in the study villages has been well characterised over the past 15 years [e.g. [21 (link),22 (link),28 (link)-34 (link)]. Extremely high transmission intensities were recorded during the 1990s [21 (link)]. Since 1997, various cost-sharing schemes for subsidizing and promoting bed nets, as well as home insecticide treatment kits have been implemented in an effort to alleviate the malaria burden. The crux of the various programmes has been the generic branding of recommended nets and insecticides products which were sold in line with a price-fixing scheme that reflected a public subsidy (34% of retail value at US $5). To improve access to vulnerable pregnant women and infants, a further subsidy (17% of retail value) was provided through the use of a voucher scheme. The pregnant women and mothers of young children who attended antenatal or immunisation clinics were entitled to a discount voucher.
The initial pilot programme, KINET, distributed bed nets within the Kilombero Valley and achieved remarkably high bed net coverage of all community members [16 (link),22 (link),25 (link),35 (link)-37 (link)]. Although all KINET distributed bed nets were pre-treated with 20 mg/m2 deltamethrin [37 (link)], by 2001, insecticide levels had fallen below 5% and most nets were in poor condition containing many holes [22 (link),38 (link)]. Various national-scale distribution programmes have been implemented, commencing with PSI's Social Marketing of Insecticide Treated Nets (SMITN) programme which was run at a regional-scale during 1998-2000 and a national-scale during 2000-02 and promoted the use of nets and standard insecticide treatment kits (KO Tab, Icon® and Fendona). The sequential programme was SMARTNET from 2002, which the Tanzanian National Voucher Scheme (TNVS) was built upon in 2004. SMARTNET ensured that all bed nets manufactured in Tanzania were co-packaged with longer-lasting insecticide treatment kits, which were registered for use from 2004 onwards (Initially: KO Tab 123, target dose: 25 mg deltamethrin/m2 [39 (link),40 (link)]; and from 2008: Icon® MAXX, target dose: 50 mg lambda-cyhalothrin/m2 [41 ]).
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