Equity Trends in Ownership of Insecticide-Treated Nets in 19 sub-Saharan African Countries

Malaria disproportionatelyaffects poor, rural populations, with pregnant womenand young children at highest risk. The Roll Back Malaria Partnership, togetherwith the Secretary-General of the United Nations, launchedthe initiative Cover The Bed Net Gap to achieve the goal ofuniversal bed-net coverage by December 2010.

Finding that previous distribution strategies had led to inequity in insecticide-treated net (ITN) ownershipamong subgroups, particularly between socioeconomicsubgroups, the Cover the Bed Net Gap initiative shifted the distribution of ITNs fromtargeted distribution to mass distribution campaigns, whichaim to provide one ITNfor every two household members.

This study assessed the level of equity inbed net ownership before and after the widespread implementationof national ITN distribution strategies in 19 malaria-endemic countries in sub-Saharan Africa.

The study used data from Demographic and Health Surveys as well as Malaria Indicator Surveys. Surveys conducted prior to the launch of the initiative in 2009 were assigned as baseline surveys, and those conducted between 2009 and 2014 were considered endpoint surveys. The study used both 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. A calculation of the Lorenz concentration curve and concentration index (C-index) assessed changes in equity.

Out of the 19 countries this study assessed, 13 showed improved equity between the baseline and endpoint surveys, and two countries showed no change. Four countries had worsened equity, with two showing greater increases in coverage of poorer households and two showing greater increases in coverage of richer households.

Findings indicate that bed net distribution campaigns 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 a significant reduction in inequity.