Abstract
BackgroundA key to making insecticide-treated nets (ITNs) a long-term, sustainable solution to the spread of malaria is understanding what drives their purchase and use. Few studies have analysed the determinants of demand for bed nets for malaria prevention at the household level, and in particular, how demand for nets compares with demand for other mosquito prevention methods.MethodsThis study uses a household survey to assess the determinants of demand for bed nets in an area of endemic malaria transmission in rural, southern Mozambique. The study looks at willingness to pay (WTP) for bed nets, net ownership, usage, and past purchase behaviour, alongside expenditure and frequency of use of alternate methods for malaria prevention.ResultsWhile overall net ownership in the sample is low, the evidence fails to suggest that poorer households are less likely to own bed nets, when controlling for covariates, nor does the likelihood of receiving a free net depend on socioeconomic status (SES). Formal schooling and market knowledge seem to indicate higher average willingness to pay, while use of alternate methods for malaria prevention, and receipt of Indoor Residual Spraying (IRS) are found to decrease demand for bed nets.ConclusionFor long-term sustainability of ITNs to be realized, results suggest that either full or partial subsidies may be necessary in some contexts to encourage households to obtain and use nets. Given the possible substitution effects of combined malaria control interventions, and the danger of not taking into consideration household preferences for malaria prevention, successful malaria control campaigns should invest a portion of their funds towards educating recipients of IRS and users of other preventive methods on the importance of net use even in the absence of mosquitoes.
Highlights
A key to making insecticide-treated nets (ITNs) a long-term, sustainable solution to the spread of malaria is understanding what drives their purchase and use
The findings presented here indicate that willingness to pay (WTP) for bed nets in an area of rural, southern Mozambique is highly dependent on formal schooling, market knowledge of bed nets, and use of alternate malaria prevention methods, including Indoor Residual Spraying (IRS)
This study uses a household survey to assess the determinants of demand for bed nets in a rural area of southern Mozambique
Summary
A key to making insecticide-treated nets (ITNs) a long-term, sustainable solution to the spread of malaria is understanding what drives their purchase and use. Insecticide-treated nets (ITNs) are regarded as one of the most effective prevention methods available to decrease this burden, yet they continue to remain under-utilized despite widespread efforts to introduce and sustain their use. ITNs have failed to achieve their full public health impact [2]. Handing out millions of nets for free is both time and cost-prohibitive, and while it has been shown to achieve the greatest coverage rates [5], free distribution may not necessarily translate into higher usage, leading to inefficiencies as well. Cost-sharing programmes are often criticized for generating inequities in distribution and net use [3,8]. Cost-sharing programmes ignore the potential community benefits of ITNs [2,9,10], which make public subsidies designed to encourage public consumption more appealing [11]
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