Towards making efficient use of household resources for appropriate prevention of malaria: investigating households' ownership, use and expenditures on ITNs and other preventive tools in Southeast Nigeria.
BACKGROUND
Many households own, use and spend money on many malaria preventive tools, some of which are inappropriate and ineffective in preventing malaria. This is despite the promotion of use of effective preventive methods such as Insecticide treated nets (ITNs) and indoor residual house spraying (IRHS). The use of these ineffective methods imposes some economic burden on households with no resultant reduction in the risk of developing malaria. Hence, global and national targets in use of various effective malaria preventive toools are yet to be achieved in Nigeria. This paper presents new evidence on the differential use and expenditures on effective and non-effective malaria preventive methods in Nigeria.


METHODS
Semi-structured interviewer administered pre-tested questionnaire were used to collect data from 500 households from two communities in Enugu state, Nigeria. The two study communities were selected randomly while the households were selected systematically. Information was collected on demography, malaria status of children under 5 within the past month, types of malaria preventive tools used by households and how much was spent on these, the per capita household food expenditure and assets ownership of respondents to determine their socio-economic status.


RESULTS
There was high level of ownership of ITNs (73%) and utilization (71.2%), with 40% utilization by children under 5. There were also appreciable high levels of use of other malaria preventive tools such as window and door nets, indoor spray, aerosol spray and cleaning the environment. No significant inequity was found in ownership and utilization of ITNs and in use of other preventive methods across socioeconomic groups. However, households spent a lot of money on other preventive tools and average expenditures were between N0.83-N172 ($0.005-$1.2) The richest households spent the most on window and door nets (P = 0.04).


CONCLUSIONS
High levels of use and expenditure on ITNs and other malaria preventive tools exist. A programmatic challenge will involve designing ways and means of converting some of the inefficient and inappropriate expenditures on many ineffective malaria preventive tools to proven cost-effective methods such as ITNs and IRHS. This will help to achieve universal coverage with malaria preventive tools.
Obinna
O
Onwujekwe
Department of Pharmacology and Therapeutics, Health Policy Research Group, College of Medicine, University of Nigeria Enugu-Campus, Enugu, Nigeria. enyietiaba@yahoo.co.uk.
Enyi
E
Etiaba
Nkoli
N
Uguru
Benjamin
B
Uzochukwu
Alex
A
Adjagba
D000328:Adult; D002675:Child, Preschool; D005260:Female; D005102:Health Expenditures; D006794:Household Articles / Q000191:economics; D006801:Humans; D057148:Insecticide-Treated Bednets / Q000191:economics / Q000706:statistics & numerical data*; D007407:Interviews as Topic; D008288:Malaria / Q000517:prevention & control*; D008297:Male; D009549:Nigeria; D010067:Ownership / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires