title: Closing the gap between insecticide treated net ownership and use for the prevention of malaria.
abstract: BACKGROUND
  Malaria is the leading cause of morbidity and mortality in children younger than 5 years old and pregnant women in sub-Saharan Africa. Insecticide-treated nets (ITNs) reduce clinical malaria by more than 50% and all cause mortality in young children by 15% to 30%. However, use of these nets is poor across sub-Saharan Africa, limiting the potential impact of this effective tool in the fight against malaria.
  
  
  OBJECTIVE
  We sought to improve the use of ITNs using a community-created and -implemented approach, and measure the change in ITN use over the year after implementation.
  
  
  METHODS
  Using a community-based participatory research approach, we created and implemented an intervention to improve ITN use in a rural village. Our intervention involved providing hands-on instructions and assistance in hanging of nets, in-home small group education, and monthly follow-up by trained community members. ITN use was measured for all individuals in a subset of the community (61 households, 759 individuals) at baseline and at 6 months and 1 year after distribution.
  
  
  RESULTS
  Rates of individual usage increased significantly from 29% at baseline to 88.7% (p < .001) at 6 months and to 96.6% (p < .001) at 12 months. For children under age 5, usage rates increased from 46% at baseline to 95.7% (p < .001) at 6 months and 95.4% (p < .001) at 12 months.
  
  
  CONCLUSIONS
  Our study demonstrates that rapidly achieving and sustaining almost universal ITN usage rates is possible using a community-based approach. Closing the gap between ITN ownership and use will help communities to realize the full potential of ITNs in the prevention of malaria.
authors.affiliation: Department of Health Services, University of California Los Angeles, USA.
authors.forename: Diana G
authors.initials: DG
authors.lastname: Rickard
authors.forename: Rebecca N
authors.initials: RN
authors.lastname: Dudovitz
authors.forename: Mitchell D
authors.initials: MD
authors.lastname: Wong
authors.forename: Howard C
authors.initials: HC
authors.lastname: Jen
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Osborn
authors.forename: Hilda E
authors.initials: HE
authors.lastname: Fernandez
authors.forename: Clement I
authors.initials: CI
authors.lastname: Donkor
mesh_terms: D000293:Adolescent; D000328:Adult; D002675:Child, Preschool; D055812:Community-Based Participatory Research / Q000379:methods / Q000458:organization & administration*; D005260:Female; D005869:Ghana; D006293:Health Promotion / Q000379:methods / Q000458:organization & administration*; D006801:Humans; D008288:Malaria / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D057147:Mosquito Nets / Q000706:statistics & numerical data*; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000517:prevention & control; D012423:Rural Health; D055815:Young Adult