From Distribution to Utilization: Identifying Implementation Gaps and Strategic Entry Points for Long-Lasting Insecticidal Net (LLIN) Programmes in a Conflict-Affected County of South Sudan
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| Natura: | Recurso digital |
| Lingua: | inglese |
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2026
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| _version_ | 1866901072361029632 |
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| author | Ajak, Lual Kur Amum Butto, Denis Moses, Tobijo Denis Sokiri |
| author_facet | Ajak, Lual Kur Amum Butto, Denis Moses, Tobijo Denis Sokiri |
| contents | <p>Background: Despite large-scale distribution of Long-Lasting Insecticidal Nets (LLINs) in South Sudan, utilization rates remain critically below the WHO 80% threshold. Fashoda County, Upper Nile State, presents a representative case of the wider implementation gap between net distribution and consistent household use in conflict-affected, resource-constrained settings. Methods: A cross-sectional analytical study was conducted among 334 households using probability-proportional-to-size (PPS) cluster sampling across four settlement types: IDP camps, returnee settlements, rural areas, and cattle camps. A programmatic cascade analysis and Health Belief Model (HBM) mapping were applied alongside Spearman rank correlation and ordinal logistic regression to identify implementation failure points and priority intervention entry points. Results: A programmatic coverage cascade revealed successive losses from distribution (89%) through ownership, hanging, and previous-night use to consistent utilization (50.3%) and whole-household coverage (44.3%)—well below the WHO 80% target. Regression analysis identified preference for government-supplied free nets (β = +45.10, p < 0.001), household economic ambiguity (β = −62.00, p < 0.001), and easy physical access (β = +6.19, p < 0.001) as the dominant implementation levers. Cultural discouragement independently suppressed utilization (β = −1.21, p = 0.027). A policy priority matrix identified Behaviour Change Communication and ANC-integrated continuous distribution as the highest-impact, most-feasible interventions. Conclusions: The distribution-to-utilization gap in Fashoda County reflects a systemic implementation failure across knowledge, economic, cultural, and logistical domains. Addressing this gap requires a paradigm shift from cam</p> |
| format | Recurso digital |
| id | zenodo_https___doi_org_10_5281_zenodo_19046060 |
| institution | Zenodo |
| language | eng |
| publishDate | 2026 |
| publisher | Zenodo |
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| spellingShingle | From Distribution to Utilization: Identifying Implementation Gaps and Strategic Entry Points for Long-Lasting Insecticidal Net (LLIN) Programmes in a Conflict-Affected County of South Sudan Ajak, Lual Kur Amum Butto, Denis Moses, Tobijo Denis Sokiri implementation gap LLINs malaria health systems behaviour change conflict-affected South Sudan programmatic cascade <p>Background: Despite large-scale distribution of Long-Lasting Insecticidal Nets (LLINs) in South Sudan, utilization rates remain critically below the WHO 80% threshold. Fashoda County, Upper Nile State, presents a representative case of the wider implementation gap between net distribution and consistent household use in conflict-affected, resource-constrained settings. Methods: A cross-sectional analytical study was conducted among 334 households using probability-proportional-to-size (PPS) cluster sampling across four settlement types: IDP camps, returnee settlements, rural areas, and cattle camps. A programmatic cascade analysis and Health Belief Model (HBM) mapping were applied alongside Spearman rank correlation and ordinal logistic regression to identify implementation failure points and priority intervention entry points. Results: A programmatic coverage cascade revealed successive losses from distribution (89%) through ownership, hanging, and previous-night use to consistent utilization (50.3%) and whole-household coverage (44.3%)—well below the WHO 80% target. Regression analysis identified preference for government-supplied free nets (β = +45.10, p < 0.001), household economic ambiguity (β = −62.00, p < 0.001), and easy physical access (β = +6.19, p < 0.001) as the dominant implementation levers. Cultural discouragement independently suppressed utilization (β = −1.21, p = 0.027). A policy priority matrix identified Behaviour Change Communication and ANC-integrated continuous distribution as the highest-impact, most-feasible interventions. Conclusions: The distribution-to-utilization gap in Fashoda County reflects a systemic implementation failure across knowledge, economic, cultural, and logistical domains. Addressing this gap requires a paradigm shift from cam</p> |
| title | From Distribution to Utilization: Identifying Implementation Gaps and Strategic Entry Points for Long-Lasting Insecticidal Net (LLIN) Programmes in a Conflict-Affected County of South Sudan |
| topic | implementation gap LLINs malaria health systems behaviour change conflict-affected South Sudan programmatic cascade |
| url | https://doi.org/10.5281/zenodo.19046060 |