Abstract
BackgroundMass distribution of insecticide-treated nets (ITNs) is a cost-effective way to achieve universal coverage, but maintaining this coverage is more difficult. In addition to commonly used indicators, evaluation of universal coverage should include coverage of effective nets and changes in coverage over time.MethodsLongitudinal and cross-sectional household ITN surveys were carried out from 2010 to 2013 in six locations representing a variety of settings across western Kenya. Five indicators were used to evaluate the current status of universal coverage: 1) ITN ownership – proportion of households that own at least one ITN, 2) access index – ratio of the number of family members over the number of ITNs owned by that household, 3) operational coverage – proportion of the at-risk population potentially covered by ITNs, assuming one ITN for every two people, 4) effective coverage – population coverage of effective ITNs, and 5) usage – proportion of the population that used ITNs the previous night.ResultsITN ownership and operational coverage increased substantially from 2010 to 2013, but this increase was mostly due to the 2011 mass distribution campaign. In 2013, household ITN ownership was on average 84.4% (95% CI [78.4, 90.5]) across the six study areas, and operational coverage was 83.2% (95% CI [72.5, 93.8]). The ITN access rate was 59.1% (95% CI [56.6, 61.7]), and 40.8% (95% CI [38.3, 43.4]) of the people at risk needed more nets to achieve universal coverage. About 88.5% (95% CI [86.1, 90.9]) of the ITNs were below three years old and 16.5% (95% CI [12.1, 20.9]) of the ITNs had hole(s). The estimated effective long-lasting insecticide-treated net (LLIN) coverage was 70.5% (95 CI [58.7, 82.3]). Approximately 18.4% (95% CI [15.5, 21.4]) of the ITNs were shared by more than three persons, and the population ITN usage rate was about 75-87%. The reason for not using ITNs was almost exclusively “net not available”.ConclusionCurrent methods of delivering ITNs, i.e., one mass campaign every five years and regular distribution of ITNs from health center can barely maintain the current effective coverage. Inaccessibility and loss of physical integrity of ITNs are major hindrances to achieving and maintaining universal coverage.Electronic supplementary materialThe online version of this article (doi:10.1186/1475-2875-13-351) contains supplementary material, which is available to authorized users.
Highlights
Mass distribution of insecticide-treated nets (ITNs) is a cost-effective way to achieve universal coverage, but maintaining this coverage is more difficult
The impact of current malaria control strategies could be short-lived given that insecticide resistance in the mosquito vectors and anti-malarial drug resistance in the malaria parasites are known to become more prevalent [10,11]
There is a need for continuous supply of new ITNs/long-lasting insecticide-treated net (LLIN) to replace those that are torn or show waning efficacy, so as to sustain high levels of coverage to effectively reduce malaria transmission in sub-Saharan Africa [16]
Summary
Mass distribution of insecticide-treated nets (ITNs) is a cost-effective way to achieve universal coverage, but maintaining this coverage is more difficult. The estimated malaria mortality rate has been dropped by 45% in all age groups and by 51% in children under five years of age between 2000 and 2012 [4]. Encouraged by such remarkable progress, WHO has recently set malaria elimination and eradication as the new goals in its malaria strategy [7,8,9]. There is a need for continuous supply of new ITNs/LLINs to replace those that are torn or show waning efficacy, so as to sustain high levels of coverage to effectively reduce malaria transmission in sub-Saharan Africa [16]
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