Monitoring mosquito net coverage for malaria control in Africa: possession vs. use by children under 5 years

doi:10.1046/j.1365-3156.2003.01084.x

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Wiley InterScience

Tropical Medicine & International Health

Volume 8 Issue 8, Pages 693 - 703

Published Online: 18 Jul 2003

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Monitoring mosquito net coverage for malaria control in Africa: possession vs. use by children under 5 years

Eline L. Korenromp ¹ , John Miller ¹ , Richard E. Cibulskis ¹ , M. Kabir Cham ¹ , David Alnwick ¹ and Christopher Dye ²

1World Health Organization, Roll Back Malaria Monitoring and Evaluation, Geneva, Switzerland 2World Health Organization, StopTB, Tuberculosis Monitoring and Evaluation, Geneva, Switzerland

Authors
All authors at WHO, Communicable Diseases, 1211 Geneva 27, Switzerland. Dr Eline L. Korenromp, Tel.: +41 22 791 1378/1329; Fax: +41 22 791 4824; E-mail: korenrompe@who.int (corresponding author).
John Miller, Tel.: +41 22 791 3620; Fax: +41 22 791 4824; E-mail: millerj@who.int
Dr Richard E. Cibulskis, Tel.: +41 22 791 2731; Fax: +41 22 791 4824; E-mail: cibulskisr@who.int; current address: DFID (Malawi), British High Commission, P.O. Box 30042, Lilongwe 3, Malawi, Tel.: +265 01 772 400 ext. 2240; E-mail: r_cibulskis@dfid.gov.uk
Dr M. Kabir Cham, Tel.: +41 22 791 384]2; Fax: +41 22 791 4824; E-mail chamm@who.int
Dr David Alnwick, Tel.: +41 22 791 2769; Fax: +41 22 791 4824; E-mail alnwickd@who.int
Dr Christopher Dye, Tel.: +41 22 791 2904/4566, Fax: +41 22 791 4268; E-mail: dyec@who.int

KEYWORDS

malaria – prevention and control • measurement • demographic and health surveys • monitoring • insecticide-treated mosquito nets

Summary

ObjectivesTo investigate the strengths and weaknesses of the indicators 'proportion of households possessing mosquito net(s)' and 'proportion of children under 5 years of age who slept under a net the preceding night' for monitoring malaria control.

MethodsReview of data from household surveys including demographic and health surveys in sub-Saharan African countries.

ResultsNet possession ranged among 14 surveyed regions from 0.1% to 28.5% for insecticide-treated nets (ITNs) and among 69 regions from 3.6% to 79.7% for any net. Reported use during the preceding night by children under 5 years of age was between 0% and 16% for ITNs and between 0.7% and 74.5% for any net. On average, in households owning ITN(s), 55% of children slept under it (R² = 0.97, P < 0.001). For any net, use was −4.2% + 0.875 × possession (R² = 0.89, P < 0.001); the use of nets, however, also varied somewhat among the surveyed countries (P = 0.003). In-depth surveys suggested that use was lower than possession because: (i) nets were scarce (mean 1.8 per possessing household); (ii) nets were not always used for children and (iii) use was lower during hot, dry months than during cool rainy months, and many surveys had been conducted in the dry season.

ConclusionsNot all mosquito nets owned by African households are being used for young children. Household education on the consistent use of nets for this vulnerable group is called for in malaria control programmes. Regular, district-level rapid assessments of household possession of nets should complement ongoing in-depth surveys. Data on 'use during the preceding night' must be interpreted taking the survey season into account.

DIGITAL OBJECT IDENTIFIER (DOI)

10.1046/j.1365-3156.2003.01084.x About DOI