Abstract
ObjectiveTo examine the change in equity of insecticide-treated net (ITN) ownership among 19 malaria-endemic countries in sub-Saharan Africa before and after the launch of the Cover The Bed Net Gap initiative.MethodsTo assess change in equity in ownership of at least one ITN by households from different wealth quintiles, we used data from Demographic and Health Surveys and Malaria Indicator Surveys. We assigned surveys conducted before the launch (2003–2008) as baseline surveys and surveys conducted between 2009–2014 as endpoint surveys. We did country-level and pooled multicountry analyses. Pooled analyses based on malaria transmission risk, were done by dividing geographical zones into either low- and intermediate-risk or high-risk. To assess changes in equity, we calculated the Lorenz concentration curve and concentration index (C-index).FindingsOut of the 19 countries we assessed, 13 countries showed improved equity between baseline and endpoint surveys and two countries showed no changes. Four countries displayed worsened equity, two favouring the poorer households and two favouring the richer. The multicountry pooled analysis showed an improvement in equity (baseline survey C-index: 0.11; 95% confidence interval, CI: 0.10 to 0.11; and endpoint survey C-index: 0.00; 95% CI: −0.01 to 0.00). Similar trends were seen in both low- and intermediate-risk and high-risk zones.ConclusionThe mass ITN distribution campaigns to increase coverage, linked to the launch of the Cover The Bed Net Gap initiative, have led to improvement in coverage of ITN ownership across sub-Saharan Africa with significant reduction in inequity among wealth quintiles.
Highlights
Equity in health is a major tenet of global development organizations, such as the World Health Organization (WHO) and the World Bank, whose policies are aimed to decrease the gap between poor and rich populations
In April 2008 the Roll Back Malaria Partnership, together with the Secretary-General of the United Nations, launched the initiative Cover The Bed Net Gap to achieve the goal of universal bed-net coverage by December 2010.11,12 The aim of this initiative is to have every household at risk of malaria transmission and every person within that household protected by an insecticide-treated net (ITN).[13,14]
The analysis focused on malariaendemic countries in sub-Saharan Africa that have conducted Demographic and Health Surveys (DHS) or Malaria Indicator Surveys (MIS) between 2003 and 2014
Summary
Equity in health is a major tenet of global development organizations, such as the World Health Organization (WHO) and the World Bank, whose policies are aimed to decrease the gap between poor and rich populations. WHO defines health inequity as “inequality with respect to health determinants, access to the resources needed to improve and maintain health or health outcomes”.1. Many diseases, such as malaria, are not distributed equitably among populations. Rural populations, with pregnant women and young children at highest risk of severe morbidity and mortality.[2,3,4,5,6,7,8,9,10] Addressing inequities that are actionable, such as the availability of commodities, has been the cornerstone of malaria control efforts for more than a decade.
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