title: Barriers to insecticide-treated mosquito net possession 2 years after a mass free distribution campaign in Luangwa District, Zambia.
abstract: METHODS
  Roll Back Malaria set the goal of 100% of households in malaria endemic countries in Africa owning an insecticide-treated mosquito net (ITN) by 2010. Zambia has used mass free distribution campaigns and distribution through antenatal care (ANC) clinics to achieve high coverage.
  
  
  RESULTS
  We conducted a probability survey of 801 households in 2008 to assess factors associated with households that lacked an ITN after mass distribution. Community perceptions of barriers to ITN access were also obtained from in-depth interviews with household heads that reported not owning an ITN. Nearly 74% of households in Luangwa district reported owning ≥1 ITN. Logistic regression showed households without a child <5 years old during the ITN distribution campaigns were twice as likely to not have an ITN as those with a child <5 during distribution (Adjusted odds ratio (AOR)  = 2.43; 95% confidence interval (CI): 1.67-3.55). Households without a woman who attended an ANC in the past 2 years were more likely to be without ITNs compared to households with a woman who attended an ANC in the past 2 years (AOR  = 1.52; 95% CI: 1.04-2.21). In-depth interviews with heads of households without an ITN revealed that old age was a perceived barrier to receiving an ITN during distribution, and that ITNs wore out before they could be replaced.
  
  
  CONCLUSIONS
  Delivery of a large number of ITNs does not translate directly into 100% household coverage. Due to their design, current ITN distribution strategies may miss households occupied by the elderly and those without children or ANC access. ITN distribution strategies targeting the elderly, those with limited access to distribution points, and others most likely to be missed are necessary if 100% ITN coverage of households is to be achieved.
authors.affiliation: Department of International Health and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America.
authors.forename: David A
authors.initials: DA
authors.lastname: Larsen
authors.forename: Joseph
authors.initials: J
authors.lastname: Keating
authors.forename: John
authors.initials: J
authors.lastname: Miller
authors.forename: Adam
authors.initials: A
authors.lastname: Bennett
authors.forename: Cynthia
authors.initials: C
authors.lastname: Changufu
authors.forename: Cecilia
authors.initials: C
authors.lastname: Katebe
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Eisele
mesh_terms: D000367:Age Factors; D000818:Animals; D002648:Child; D002675:Child, Preschool; D003625:Data Collection / Q000379:methods; D005191:Family Characteristics; D005260:Female; D006801:Humans; D057148:Insecticide-Treated Bednets; D016015:Logistic Models; D008288:Malaria / Q000517:prevention & control*; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012423:Rural Health / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000706:statistics & numerical data; D012923:Social Class; D013997:Time Factors; D015024:Zambia