***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Short-run subsidies for health products are common in poor countries . How do they affect long-run adoption ? We present a model of technology adoption in which people learn about a technology 's effectiveness by using it ( or observing others using it ) for some time , but people quit using it too early if they face higher-than-expected usage costs ( e.g. , side effects ) . The extent to which one-off subsidies increase experimentation , and thereby affect learning and long-run adoption , then depends on people 's priors on these usage costs . One-off subsidies can also affect long-run adoption through reference-dependence : People might anchor around the subsidized price and be unwilling to pay more for the product later . We estimate these effects in a two-stage r and omized field experiment in Kenya . We find that , for a new technology with a lower usage cost than the technology it replaces , short-run subsidies increase long-run adoption through experience and social learning effects . We find no evidence that people anchor around subsidized prices Background Since 2002/03 , an estimated 4.7 million nets have been distributed in the Southern Nations , Nationalities and Peoples Region ( SNNPR ) among an at risk population of approximately 10 million people . Evidence from the region suggests that large-scale net ownership rapidly increased over a relatively short period of time . However , little is known about how coverage is being maintained given that the last mass distribution was in 2006/2007 . This study sought to determine the status of current net ownership , utilization and rate of long lasting insecticide-treated nets ( LLIN ) loss in the previous three years in the context of planning for future net distribution to try to achieve sustainable universal coverage . Methods A total of 750 household respondents were interviewed across malarious , rural kebeles of SNNPR . Households were r and omly selected following a two-stage cluster sampling design where kebeles were defined as clusters . Kebeles were chosen using proportional population sampling ( PPS ) , and 25 households within 30 kebeles r and omly chosen . Results Approximately 67.5 % ( 95%CI : 64.1–70.8 ) of households currently owned at least one net . An estimated 31.0 % ( 95%CI 27.9–34.4 ) of all nets owned in the previous three years had been discarded by owners , the majority of whom considered the nets too torn , old or dirty ( 79.9 % : 95%CI 75.8–84.0 ) . Households reported that one-third of nets ( 33.7 % ) were less than one year old when they were discarded . The majority ( 58.8 % ) of currently owned nets had ‘ good ’ structural integrity according to a proportionate Hole Index . Nearly two-thirds of households ( 60.6 % ) reported using their nets the previous night . The overriding reason for not using nets was that they were too torn ( 45.7 % , 95 % CI 39.1–50.7 ) . Yet , few households are making repairs to their nets ( 3.7 % , 95 % CI : 2.4–5.1 ) . Conclusions Results suggest that the life span of nets may be shorter than previously thought , with little maintenance by their owners . With the global move towards malaria elimination it makes sense to aim for sustained high coverage of LLINs . However , in the current economic climate , it also makes sense to hark back to simple tools and messages on the importance of careful net maintenance , which could increase their lifespans Background Insecticide-treated bed nets ( ITNs ) have been shown to reduce morbidity and mortality due to malaria in sub-Saharan Africa . Strategies using incentives to increase ITN use could be more efficient than traditional distribution campaigns . To date , behavioural incentives have been studied mostly in developed countries . No study has yet looked at the effect of incentives on the use of ITNs . Reported here are the results of a cluster r and omized controlled trial testing household-level incentives for ITN use following a free ITN distribution campaign in Madagascar . Methods The study took place from July 2007 until February 2008 . Twenty-one villages were r and omized to either intervention or control clusters . Households in both clusters received a coupon redeemable for one ITN . After one month , intervention households received a bonus for ITN use , determined by visual confirmation of a mounted ITN . Data were collected at baseline , one month and six months . Both unadjusted and adjusted results , using cluster specific methods , are presented . Results At baseline , 8.5 % of households owned an ITN and 6 % were observed to have a net mounted over a bed in the household . At one month , there were no differences in ownership between the intervention and control groups ( 99.5 % vs. 99.4 % ) , but net use was substantially higher in the intervention group ( 99 % vs. 78 % ) , with an adjusted risk ratio of 1.24 ( 95 % CI : 1.10 to 1.40 ; p < 0.001 ) . After six months , net ownership had decreased in the intervention compared to the control group ( 96.7 % vs. 99.7 % ) , with an adjusted risk ratio of 0.97 ( p < 0.01 ) . There was no difference between the groups in terms of ITN use at six months ; however , intervention households were more likely to use a net that they owned ( 96 % vs. 90 % ; p < 0.001 ) . Conclusions Household-level incentives have the potential to significantly increase the use of ITNs in target households in the immediate-term , but , over time , the use of ITNs is similar to households that did not receive incentives . Providing incentives for behaviour change is a promising tool that can complement traditional ITN distribution programmes and improve the effectiveness of ITN programmes in protecting vulnerable population s , especially in the short-term Long-lasting insecticidal nets ( LLINs ) have been advocated as an effective tool against malaria transmission . However , success of this community based intervention largely depends on the knowledge and practice regarding malaria and its prevention . According to the national strategy plan on evaluation of LLINs ( Olyset nets ) , this study was conducted to determine the perceptions and practice s about malaria and to improve use of LLINs in Bashagard district , one of the important foci of malaria in southeast Iran . The study area comprised 14 villages that were r and omized in two clusters and design ated as LLINs and untreated nets . Each of households in both clusters received two bed nets by the free distribution and delivery . After one month quantitative data collection method was used to collect information regarding the objectives of the study . On the basis of this information , an educational program was carried out in both areas to increase motivation for use of bed nets . Community knowledge and practice regarding malaria and LLIN use assessed pre- and post-educational program . The data were analyzed using SPSS ver.16 software . At baseline , 77.5 % of respondents in intervention and 69.4 % in control area mentioned mosquito bite as the cause of malaria , this awareness increased significantly in intervention ( 90.3 % ) and control areas ( 87.9 % ) , following the educational program . A significant increase also was seen in the proportion of households who used LLINs the previous night ( 92.5 % ) compared with untreated nets ( 87.1 % ) . Educational status was an important predictor of LLINs use . Regular use of LLIN was considerably higher than the targeted coverage ( 80 % ) which recommended by World Heaths Organization . About 81.1 % and 85.3 % of respondents from LLIN and control areas reported that mosquito nuisance and subsequent malaria transmission were the main determinants of bed net use . These findings highlight a need for educational intervention in implementation of long-lasting insecticidal nets ; this should be considered in planning and decision-making in the national malaria control program during the next campaigns of LLINs in Iran A group-r and omized controlled trial of insecticide (permethrin)-treated bed nets ( ITNs ) was conducted in an area of high perennial malaria transmission in western Kenya to test the effect of ITNs on  all-cause mortality in children 1 - 59 months of age . Child deaths were monitored over a two-year period by biannual household census in Asembo ( 1997 - 1998 ) and in Gem ( 1998 - 1999 ) . Overall , 1,722 deaths occurred in children 1 - 59 months followed for 35,932 child-years .  Crude mortality rates/1,000  child-years were 51.9 versus 43.9 in control and ITN villages in children 1 - 59 months old . The protective efficacy ( PE ) ( 95 % confidence interval ) adjusted for age , study year , study site , and season was 16 % ( 6 - 25 % ) . Corresponding figures in 1 - 11- and 12 - 59-month-old children in control and ITN villages were 133.3 versus 102.3 , PE = 23 % ( 11 - 34 % ) and 31.1 versus 28.7 , PE = 7 % ( -6 - 19 % ) . The numbers of lives saved/1,000 child-years were 8 , 31 , and 2 for the groups 1 - 59 , 1 - 11 , and 12 - 59 months old , respectively . Stratified analysis by time to insecticide re-treatment showed that the PE of  ITNs  re-treated per study protocol ( every six months ) was 20 % ( 10 - 29 % ) , overall and 26 % ( 12 - 37 % ) and 14 % ( -1 - 26 % ) in 1 - 11- and 12 - 59-month-old children , respectively . ITNs prevent approximately one in four infant deaths in areas of intense perennial malaria transmission , but their efficacy is compromised if re-treatment is delayed beyond six months Insecticide-treated nets ( ITNs ) are effective in substantially reducing malaria transmission . Still , ITN coverage in sub-Saharan Africa ( SSA ) remains extremely low . Policy makers are concerned with identifying the most suitable delivery mechanism to achieve rapid yet sustainable increases in ITN coverage . Little is known , however , on the comparative costs of alternative ITN distribution strategies . This paper aim ed to fill this gap in knowledge by developing such a comparative cost analysis , looking at the cost per ITN distributed for two alternative interventions : subsidized sales supported by social marketing and free distribution to pregnant women through antenatal care ( ANC ) . The study was conducted in rural Burkina Faso , where the two interventions were carried out alongside one another in 2006/07 . Cost information was collected prospect ively to derive both a financial analysis adopting a provider 's perspective and an economic analysis adopting a societal perspective . The average financial cost per ITN distributed was US$ 8.08 and US$ 7.21 for sales supported by social marketing and free distribution through ANC , respectively . The average economic cost per ITN distributed was US$ 4.81 for both interventions . Contrary to common belief , costs did not differ substantially between the two interventions . Due to the district 's ability to rely fully on the use of existing re sources , financial costs associated with free ITN distribution through ANC were in fact even lower than those associated with the social marketing campaign . This represents an encouraging finding for SSA governments and points to the possibility to invest in programmes to favour free ITN distribution through existing health facilities . Given restricted budgets , however , free distribution programmes are unlikely to be feasible Many severe health risks in developing countries could be substantially reduced with access to appropriate preventive measures . However , the associated costs are often high enough to restrict access among poor households , and free provision through public health campaigns is often not financially feasible . We describe findings from the first large-scale cluster r and omized controlled trial in a developing country context that evaluates the uptake of a health-protecting technology , insecticide-treated bednets ( ITNs ) , through micro-consumer loans , as compared to free distribution and control conditions . Numerous studies have shown that widespread , regular use of ITNs is one the most effective preventive measures against malaria . However , ownership rates remain very low in most malarious areas , including our study areas in rural Orissa ( India ) . Despite the un-subsidized price , 52 percent of sample households purchased at least one ITN  , leading to 16 percent of individuals using a treated net the previous night , relative to only 2 percent in control areas where nets were not offered for sale . However , the increase fell significantly short of the 47 percent previous-night usage rate achieved with free distribution . Most strikingly , we find that neither micro-loans nor free distribution led to improvements in malaria and anemia prevalence , measured using blood tests . We examine and rule out several plausible explanations for this latter finding . We conjecture that insufficient ITN coverage is the most likely explanation , and discuss implication s for public health policy Background ITN use is generally poor in Nigeria among all categories of people . Although use of ITNs has been shown to reduce malarial morbidity and mortality , this measure needs to be supported by an adequate healthcare system providing ITN possibly at the household level . This study was therefore design ed to determine the effect of health education on the uptake of ITN among nursing mothers in rural communities in Nigeria . Methods The study design was a quasi-experimental study carried out in Ijebu North Local Government Area of Ogun State . A multistage r and om sampling technique was used in choosing the required sample s for this study and a semi- structured question naire was used to collect relevant information . The intervention consisted of a structured educational programme based on a course content adapted from the national malaria control programme .  A total of 400 respondents were recruited into the study with 200 each in both the experimental and control groups and were followed up for a period of 3 months when the knowledge and uptake of ITN was reassessed . Result There was no significant difference ( P > 0.05 ) observed between the experimental and control groups in terms of socio-dermographic characteristics such as 
    Output:
    
These studies suggest that providing free ITNs probably increases ITN ownership when compared to subsidized ITNs or ITNs offered at full market price .
Five studies examined the effect of price on ITN ownership and found moderate-certainty evidence that ownership was highest among the groups who received the ITN free versus those who purchased the ITN at any cost .
In economic terms , this means that dem and for ITNs is elastic with regard to price .
Educational interventions for promoting ITN use have an additional positive effect .
However , the impact of different types or intensities of education is unknown