title: How many mosquito nets are needed to achieve universal coverage? Recommendations for the quantification and allocation of long-lasting insecticidal nets for mass campaigns.
abstract: BACKGROUND
  Long-lasting insecticidal nets are an effective tool for malaria prevention, and "universal coverage" with such nets is increasingly the goal of national malaria control programmes. However, national level campaigns in several countries have run out of nets in the course of distribution, indicating a problem in the method used to estimate the quantity needed.
  
  
  OBJECTIVE
  A major reason for the shortfall in estimation is the mismatch between the quantification factor used to plan procurement and the allocation algorithm used at community level, in particular the effect of needing to add an additional net to households with an odd number of inhabitants. To solve this problem a revised quantification factor is suggested.
  Based on data from a broad range of household surveys across Africa, the effect of odd-numbered households on numbers of nets distributed is estimated via two frequently used allocation methods. The impact of these algorithms on the proportion of households reaching a person to net ratio of 2:1, a frequently used marker of universal coverage is then calculated.
  
  
  CONCLUSIONS
  In order to avoid stock-outs of nets during national coverage campaigns, it is recommended to use a quantification factor of 1.78 people per net, with an additional allocation factor suggested to account for other common problems at the community level resulting in a final recommended ratio of 1.60 people per net. It is also recommend that community level allocation procedures be aligned with procurement estimates to reduce shortages of nets during campaign distributions. These analyses should enable programme managers to make evidence-based decisions and support a more efficient and effective use of LLIN distribution campaign resources.
authors.affiliation: Malaria Consortium, Development House, London EC2A 4LT, UK. a.kilian@malariaconsortium.org
authors.forename: Albert
authors.initials: A
authors.lastname: Kilian
authors.forename: Marc
authors.initials: M
authors.lastname: Boulay
authors.forename: Hannah
authors.initials: H
authors.lastname: Koenker
authors.forename: Matthew
authors.initials: M
authors.lastname: Lynch
mesh_terms: D000349:Africa; D006293:Health Promotion; D006801:Humans; D057148:Insecticide-Treated Bednets; D007306:Insecticides / Q000600:supply & distribution*; D008288:Malaria / Q000517:prevention & control*; D009032:Mosquito Control / Q000379:methods*
chemical_list: D007306:Insecticides