11.5.2  Replacement or ‘keep-up’ distribution

As you learned above, the aim of ITN distribution in Ethiopia is to protect everyone living in malaria-risk areas, so every effort is made to achieve 100% coverage of all people living in malaria-risk villages.

After the initial distribution of ITNs to as many people as possible via ‘catch-up’ campaigns, you need to maintain high coverage continuously, so as many people as possible remain protected and the disease can be controlled. Such follow-up distribution of ITNs is known as ‘keep-up’ distribution, and it is necessary because:

• Currently the ITNs used for malaria prevention are only functional for three to four years. After three to four years, the ITNs become damaged and have to be replaced by new ones. Nets can also be torn or damaged before three to four years, for a variety of reasons. You should replace any damaged nets regularly to keep the coverage high.
• Mothers who become pregnant after the ‘catch-up’ distribution may move to their own sleeping site separate from other family members and may need to be provided with their own ITN. Giving ITNs to all pregnant mothers attending antenatal care (ANC) will keep them protected from malaria. This could also serve as an incentive for mothers to attend ANC, where attendance in rural Ethiopia is generally low.
• Newcomers to a village and newborns will need additional ITNs.