Dataset Information

The use of insecticide treated nets by age: implications for universal coverage in Africa.

ABSTRACT: The scaling of malaria control to achieve universal coverage requires a better understanding of the population sub-groups that are least protected and provide barriers to interrupted transmission. Here we examine the age pattern of use of insecticide treated nets (ITNs) in Africa in relation to biological vulnerabilities and the implications for future prospects for universal coverage.Recent national household survey data for 18 malaria endemic countries in Africa were assembled to identify information on use of ITNs by age and sex. Age-structured medium variant projected population estimates for the mid-point year of the earliest and most recent national surveys were derived to compute the population by age protected by ITNs.All surveys were undertaken between 2005 and 2009, either as demographic health surveys (n = 12) or malaria indicator surveys (n = 6). Countries were categorized into three ITN use groups: <10%; 10 to <20%; and > or =20% and projected population estimates for the mid-point year of 2007 were computed. In general, the pattern of overall ITNs use with age was similar by country and across the three country groups with ITNs use initially high among children <5 years of age, sharply declining among the population aged 5-19 years, before rising again across the ages 20-44 years and finally decreasing gradually in older ages. For all groups of countries, the highest proportion of the population not protected by ITNs (38% - 42%) was among those aged 5-19 years.In malaria-endemic Africa, school-aged children are the least protected with ITNs but represent the greatest reservoir of infections. With increasing school enrollment rates, school-delivery of ITNs should be considered as an approach to reach universal ITNs coverage and improve the likelihood of impacting upon parasite transmission.

SUBMITTER: Noor AM

PROVIDER: S-EPMC2761895 | biostudies-other | 2009 Oct

REPOSITORIES: biostudies-other

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The use of insecticide treated nets by age: implications for universal coverage in Africa.

Noor Abdisalan M AM Kirui Viola C VC Brooker Simon J SJ Snow Robert W RW

BMC public health 20091001

<h4>Background</h4>The scaling of malaria control to achieve universal coverage requires a better understanding of the population sub-groups that are least protected and provide barriers to interrupted transmission. Here we examine the age pattern of use of insecticide treated nets (ITNs) in Africa in relation to biological vulnerabilities and the implications for future prospects for universal coverage.<h4>Methods</h4>Recent national household survey data for 18 malaria endemic countries in Afr ...[more]

PMID: 19796380

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Project description: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.

Project description:Background/methodsInsecticide-treated nets (ITNs) are the primary tool for malaria vector control in sub-Saharan Africa, and have been responsible for an estimated two-thirds of the reduction in the global burden of malaria in recent years. While the ultimate goal is high levels of ITN use to confer protection against infected mosquitoes, it is widely accepted that ITN use must be understood in the context of ITN availability. However, despite nearly a decade of universal coverage campaigns, no country has achieved a measured level of 80% of households owning 1 ITN for 2 people in a national survey. Eighty-six public datasets from 33 countries in sub-Saharan Africa (2005-2017) were used to explore the causes of failure to achieve universal coverage at the household level, understand the relationships between the various ITN indicators, and further define their respective programmatic utility.ResultsThe proportion of households owning 1 ITN for 2 people did not exceed 60% at the national level in any survey, except in Uganda's 2014 Malaria Indicator Survey (MIS). At 80% population ITN access, the expected proportion of households with 1 ITN for 2 people is only 60% (p?=?0.003 R2?=?0.92), because individuals in households with some but not enough ITNs are captured as having access, but the household does not qualify as having 1 ITN for 2 people. Among households with 7-9 people, mean population ITN access was 41.0% (95% CI 36.5-45.6), whereas only 6.2% (95% CI 4.0-8.3) of these same households owned at least 1 ITN for 2 people. On average, 60% of the individual protection measured by the population access indicator is obscured when focus is put on the household "universal coverage" indicator. The practice of limiting households to a maximum number of ITNs in mass campaigns severely restricts the ability of large households to obtain enough ITNs for their entire family.ConclusionsThe two household-level indicators-one representing minimal coverage, the other only 'universal' coverage-provide an incomplete and potentially misleading picture of personal protection and the success of an ITN distribution programme. Under current ITN distribution strategies, the global malaria community cannot expect countries to reach 80% of households owning 1 ITN for 2 people at a national level. When programmes assess the success of ITN distribution activities, population access to ITNs should be considered as the better indicator of "universal coverage," because it is based on people as the unit of analysis.

Project description:Over the past decade, significant gains have been made in the implementation of malaria prevention measures in pregnancy in sub-Saharan Africa, including the distribution of insecticide-treated nets (ITNs). These have been shown to cause a reduction in the incidence of malaria and its consequences such as maternal anaemia, stillbirths and intrauterine growth restriction. Currently most nations in Africa have policies for distributing ITNs to pregnant women through various mechanisms, however coverage remains well below the targets. This review summarizes recent evidence regarding the correlation between ownership and use of ITNs and the determinants of both, in pregnancy in sub-Saharan Africa, and reviews interventions directed at improving coverage. A review of the literature using Pubmed, CINAHL and scanning of reference lists was conducted in October 2012 and 59 articles were selected for final review. The research obtained was a mixture of national and district level surveys, and a narrative synthesis of the data was undertaken. Ownership of ITNs varied from as low as 3% to greater than 80%, and the main determinants were found to be education level, knowledge of malaria, community involvement, socio-economic status and parity, although the significance of each varied between the different settings and studies reviewed. In more than half the settings where data were available, the combination of lack of availability and lack of use of an available net meant that less than half of all pregnancies received the recommended intervention. Supply and cost remain major barriers to achieving optimal coverage, but the additional important contributor to reduced efficiency of intervention was the clear discrepancy between ownership and use, with available ITN use below 60% in several settings. Cited reasons for not using an ITN, where one was available, included discomfort, problems with hanging up nets and lack of space, low awareness of need, and seasonal variations in use. These findings highlight the need for context-specific approaches and educational components to be incorporated into ITN distribution programmes to address some of the reasons why some pregnant women do not use the ITNs they own.

Dataset Information

The use of insecticide treated nets by age: implications for universal coverage in Africa.

Publications

The use of insecticide treated nets by age: implications for universal coverage in Africa.

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