title: Monitoring mosquito net coverage for malaria control in Africa: possession vs. use by children under 5 years.
abstract: OBJECTIVE
  To investigate the strengths and weaknesses of the indicators 'proportion of households possessing mosquito net(s)' and 'proportion of children under 5 years of age who slept under a net the preceding night' for monitoring malaria control.
  
  
  METHODS
  Review of data from household surveys including demographic and health surveys in sub-Saharan African countries.
  
  
  RESULTS
  Net possession ranged among 14 surveyed regions from 0.1% to 28.5% for insecticide-treated nets (ITNs) and among 69 regions from 3.6% to 79.7% for any net. Reported use during the preceding night by children under 5 years of age was between 0% and 16% for ITNs and between 0.7% and 74.5% for any net. On average, in households owning ITN(s), 55% of children slept under it (R2 = 0.97, P < 0.001). For any net, use was -4.2% + 0.875 x possession (R2 = 0.89, P < 0.001); the use of nets, however, also varied somewhat among the surveyed countries (P = 0.003). In-depth surveys suggested that use was lower than possession because: (i). nets were scarce (mean 1.8 per possessing household); (ii). nets were not always used for children and (iii). use was lower during hot, dry months than during cool rainy months, and many surveys had been conducted in the dry season.
  
  
  CONCLUSIONS
  Not all mosquito nets owned by African households are being used for young children. Household education on the consistent use of nets for this vulnerable group is called for in malaria control programmes. Regular, district-level rapid assessments of household possession of nets should complement ongoing in-depth surveys. Data on 'use during the preceding night' must be interpreted taking the survey season into account.
authors.affiliation: World Health Organization, Roll Back Malaria Monitoring and Evaluation, Geneva, Switzerland. koremrompe@who.int
authors.forename: Eline L
authors.initials: EL
authors.lastname: Korenromp
authors.forename: John
authors.initials: J
authors.lastname: Miller
authors.forename: Richard E
authors.initials: RE
authors.lastname: Cibulskis
authors.forename: M
authors.initials: M
authors.lastname: Kabir Cham
authors.forename: David
authors.initials: D
authors.lastname: Alnwick
authors.forename: Christopher
authors.initials: C
authors.lastname: Dye
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D000818:Animals; D001512:Bedding and Linens / Q000706:statistics & numerical data / Q000600:supply & distribution*; D002675:Child, Preschool; D015438:Health Behavior; D006306:Health Surveys; D006801:Humans; D007303:Insect Vectors; D007306:Insecticides / Q000008:administration & dosage; D016014:Linear Models; D008288:Malaria / Q000517:prevention & control* / Q000635:transmission; D009032:Mosquito Control / Q000379:methods*; D012621:Seasons
chemical_list: D007306:Insecticides