Maps and metrics of insecticide-treated net access, use, and nets-per-capita in Africa from 2000-2020

Amelia Bertozzi‐Villa ,Harry S Gibson,Hannah Koenker,Ewan Cameron,Suzanne H Keddie ,Susan F Rumisha,Katherine E Battle,Jennifer Rozier,Punam Amratia,Daniel J Weiss,A Nandi ,Tasmin L Symons ,Swapnil Mishra,Rohan Arambepola,Elisabeth G Chestnutt,Camilo Vargas-Ruiz,Katherine A Twohig,Emma Collins ,Peter W Gething,Jonathan Harris ,T Déirdre Hollingsworth ,Caitlin A Bever,Justin Millar,Samir Bhatt

doi:10.1038/s41467-021-23707-7

Abstract

Insecticide-treated nets (ITNs) are one of the most widespread and impactful malaria interventions in Africa, yet a spatially-resolved time series of ITN coverage has never been published. Using data from multiple sources, we generate high-resolution maps of ITN access, use, and nets-per-capita annually from 2000 to 2020 across the 40 highest-burden African countries. Our findings support several existing hypotheses: that use is high among those with access, that nets are discarded more quickly than official policy presumes, and that effectively distributing nets grows more difficult as coverage increases. The primary driving factors behind these findings are most likely strong cultural and social messaging around the importance of net use, low physical net durability, and a mixture of inherent commodity distribution challenges and less-than-optimal net allocation policies, respectively. These results can inform both policy decisions and downstream malaria analyses.

Highlights

Insecticide-treated nets (ITNs) are one of the most widespread and impactful malaria interventions in Africa, yet a spatially-resolved time series of ITN coverage has never been published
All results in this analysis are reported among the population at risk of malaria, defined here as anyone living in a zone with stable Plasmodium falciparum malaria transmission[7]
Targets for ITN coverage have since expanded to include the entire population at risk[9], though “universal coverage” targets are commonly set to 80% for both access and use[5,10]

Summary

Introduction

Insecticide-treated nets (ITNs) are one of the most widespread and impactful malaria interventions in Africa, yet a spatially-resolved time series of ITN coverage has never been published. The primary driving factors behind these findings are most likely strong cultural and social messaging around the importance of net use, low physical net durability, and a mixture of inherent commodity distribution challenges and less-than-optimal net allocation policies, respectively. These results can inform both policy decisions and downstream malaria analyses. Throughout this paper, we will refer to metrics by name, or use the term “coverage” to indicate any combination of metrics All results in this analysis are reported among the population at risk of malaria, defined here as anyone living in a zone with stable Plasmodium falciparum malaria transmission[7]. Language around coverage targets has softened to acknowledge the heterogeneous intervention needs of different settings, though universal coverage remains the official policy[11]

Methods

Results

Conclusion