title: Sustaining fragile gains: the need to maintain coverage with long-lasting insecticidal nets for malaria control and likely implications of not doing so.
abstract: Global commitment to malaria control has greatly increased over the last decade. Long-lasting insecticidal nets (LLINs) have become a core intervention of national malaria control strategies and over 450 million nets were distributed in sub-Saharan Africa between 2008 and 2012. Despite the impressive gains made as a result of increased investment in to malaria control, such gains remain fragile. Existing funding commitments for LLINs in the pipeline to 2016 were collated for 40 sub-Saharan African countries. The population-based model NetCALC was used to estimate the potential LLIN coverage achievable with these commitments and identify remaining gaps, and the Lives Saved Tool (LiST) was used to estimate likely consequences for mortality impact if these gaps remain unfilled. Overall, countries calculated a total need of 806 million LLINs for 2013-16. Current funding commitments meet just over half of this need, leaving approximately 374 million LLINs unfunded, most of which are needed to maintain coverage in 2015 and 2016. An estimated additional 938,500 child lives (uncertainty range: 559,400-1,364,200) could be saved from 2013 through 2016 with existing funding (relative to 2009 LLIN coverage taken as the 'baseline' for this analysis); if the funding gap were closed this would increase to 1,180,500 lives saved (uncertainty range: 707,000-1,718,900). Overall, the funding gap equates to approximately 242,000 avoidable malaria-attributable deaths amongst under-fives. Substantial additional resources will need to be mobilized to meet the full LLIN need of sub-Saharan countries to maintain universal coverage. Unless these resources are mobilized, the impressive gains made to date will not be sustained and tens of thousands of avoidable child deaths will occur.
authors.affiliation: Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Lucy Smith
authors.initials: LS
authors.lastname: Paintain
authors.affiliation: Strategy, Investment and Impact Division, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Kolaczinski
authors.affiliation: African Leaders Malaria Alliance, Geneva, Switzerland.
authors.forename: Melanie
authors.initials: M
authors.lastname: Renshaw
authors.affiliation: Strategy, Investment and Impact Division, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland.
authors.forename: Scott
authors.initials: S
authors.lastname: Filler
authors.affiliation: Tropical Health LLP, Montagut, Girona, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Kilian
authors.affiliation: Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Jayne
authors.initials: J
authors.lastname: Webster
authors.affiliation: Center for Communication Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Kojo
authors.initials: K
authors.lastname: Lokko
authors.affiliation: Center for Communication Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Matthew
authors.initials: M
authors.lastname: Lynch
mesh_terms: D017954:Africa South of the Sahara; D002648:Child; D005260:Female; D006801:Humans; D057148:Insecticide-Treated Bednets / Q000191:economics* / Q000600:supply & distribution; D008288:Malaria / Q000191:economics* / Q000517:prevention & control*; D015397:Program Evaluation / Q000191:economics*; D013997:Time Factors; D019472:Universal Health Insurance / Q000706:statistics & numerical data*