Estimating the number of insecticide-treated nets required by African households to reach continent-wide malaria coverage targets.
BACKGROUND
African countries are scaling up malaria interventions, especially insecticide-treated nets (ITNs), for which ambitious coverage targets have been set.


OBJECTIVE
To estimate how many ITNs are available in African households that are at risk of malaria and how many ITNs are needed to reach targets for use by children younger than 5 years and pregnant women.


METHODS
Primary sources of data were the Multiple Indicator Cluster Surveys II, the Demographic and Health Surveys, or other nationally representative or large-scale household surveys that measured household possession and use of nets or ITNs among children younger than 5 years.


METHODS
Data from 42 household surveys between 1999 and 2006 on net and ITN coverage (either household possession or use) and average numbers of nets and ITNs per household were compared with populations and households at risk. Data are included for 43 sub-Saharan African countries.


RESULTS
For the median survey year 2003, the population-weighted mean proportion of households possessing at least 1 ITN was 6.7% (range among countries, 0.1%-71.0%) and was 23.8% (range, 5.0%-91.2%) for any type of net. Based on an average of 0.13 ITNs per household, we estimated that 53.6 million nets, of which 16.7 million were ITNs, were available in households at risk of malaria. Between 130 million and 264 million ITNs are required in 2007 to reach the 80% coverage target for about 133 million children younger than 5 years and pregnant women living in 123 million households in risk areas; the exact number depends on usage patterns (best estimate, assuming 55% of owned ITNs are used by the target groups, 192 million ITNs).


CONCLUSIONS
To achieve the targeted ITN usage rates, numbers of ITNs available to African households must be dramatically increased.
Miller
John M
JM
PATH Malaria Control and Evaluation Partnership in Africa (MACEPA), National Malaria Control Centre, Lusaka, Zambia. jmiller@path.org
Korenromp
Eline L
EL
Nahlen
Bernard L
BL
W Steketee
Richard
R
D017954:Africa South of the Sahara / Q000453:epidemiology; D001512:Bedding and Linens; D002675:Child, Preschool; D005191:Family Characteristics; D005260:Female; D005544:Forecasting; D006801:Humans; D007223:Infant; D007306:Insecticides / Q000008:administration & dosage; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control*; D020380:Needs Assessment; D011247:Pregnancy; D012306:Risk
D007306:Insecticides