Delivering an insecticide-treated net campaign in a complex operating environment: lessons from Anambra state, Nigeria.

Background: Malaria is one of the leading causes of morbidity and mortality in Nigeria. Distribution of insecticide-treated nets (ITNs) is an important vector control strategy. In 2022, despite security challenges and COVID-19 restrictions, an ITN distribution was implemented in Anambra state. This paper describes the adaptations made to the ITN distribution campaign to ensure the safety of personnel, communities and property during implementation.

Methods: Following national COVID-19 guidelines, the ITN campaign implemented a single-phase door-to-door distribution strategy. In May 2022, security risk categorization activity was carried out prior to the campaign to determine risk levels in each local government area (LGA) in the state. All LGAs and wards were classified into three risk categories as either high, medium or low. A set of adaptations were made to mitigate risk during the delivery of ITNs in high-risk locations. High risk LGAs were characterized by limited activities with comprehensive coordination involving both security agencies and existing community structures. The security situation in each LGA and ward was monitored during the campaign to ensure the correct set of actions were followed throughout.

Results: After conducting risk categorization, 11 out of the 21 LGAs in Anambra state were classified as high security risk. The adapted campaign strategy was implemented across all 11 LGAs. During the campaign 3,850,316 ITNs were delivered to 1,245,548 households across all 21 LGAs in the state. Engaging with community leaders and security agencies during the planning and implementation phases was critical for ensuring the safe delivery of ITNs to households in high-risk areas. Working with distributors from within the community and consistent use of communication technologies also helped to reduce the risk to personnel and supported the monitoring of the security situation and the progress of the distribution within each LGA.

Conclusion: Despite the insecurity in parts of Anambra state, ITNs were delivered to households in all LGAs. Engaging with existing community structures and appropriate use of technology can help to deliver malaria prevention interventions in security-compromised areas. The lessons from this campaign can help to inform and improve the strategies of future ITN distribution campaigns in complex operating environments.