TITLE:
Explanatory Factors of Poor Performance in the Routine Distribution of Insecticide-Treated Nets through Immunization Services in the Democratic Republic of Congo
AUTHORS:
Fernandine Babaka Phanzu, Aliocha Natuhoyila Nkodila, Gillon Ilombe, Narcisse Basosila, Baudouin Matela Baangi, JR Ngolo Musiti, Pomie Mutombo Mungala, Marius Ngoy Bakuwa, Jean Kanowa, Adrien Kumbi N’siala, Léon Ngoma Miezi Kintaudi, Albert Ntumba Kalonji, Philippe Ngwala Lukanu, Joris Losimba Likwela
KEYWORDS:
Insecticide-Treated Mosquito Nets, Preschool Preventive Health Services, Antenatal Care, Performance, Democratic Republic of Congo
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.13 No.10,
October
28,
2025
ABSTRACT: Background: The coverage obtained after mass distribution of insecticide-treated nets (ITNs) requires continuous distribution, particularly through antenatal care (ANC) and Expanded Programme for Immunizations (EPI) channels, to achieve the expected impact in terms of mortality and morbidity reduction. The aim of this study was to identify the factors explaining the poor performance of continuous ITN distribution in public healthcare facilities (PHFs) through EPIs in the Democratic Republic of the Congo (DRC). Methods: An analytical cross-sectional study was carried out in the PHFs of the DRC’s 7 Provincial Health Divisions (PHDs). Data on socio-demographic characteristics, ITN distribution, and the first measles vaccination dose from January to June 2023 were collected. Data was collected through ODK Collect tools, then transferred to SPSS for Windows version 26 for analysis. Logistic regression was used to identify factors associated with poor ITN distribution performance. Results: Overall, 66.9% of health areas demonstrated poor ITN distribution performance through EPI services. A 34% gap was observed between children receiving measles vaccination and those receiving ITNs. Independent predictors of poor performance included low maternal education (adjusted odds ratio [aOR]: 8.22; 95% CI: 5.59 - 12.09), low household income (aOR: 5.00; 95% CI: 3.40 - 7.35), incomplete child immunization (aOR: 4.49; 95% CI: 2.06 - 9.80), and lack of community sensitization by health workers (aOR: 3.03; 95% CI: 2.02 - 4.56). Providers cited unequal prioritization of ITNs for pregnant women, lack of ITNs at outreach sites, and weak community engagement as key barriers. Conclusion: ITN distribution through EPI services in the DRC is suboptimal and inequitable. Addressing socioeconomic disparities, strengthening community health worker engagement, and ensuring ITN availability at all service delivery points are critical to improving coverage among children under five.