title: Coverage and system efficiencies of insecticide-treated nets in Africa from 2000 to 2017.
abstract: Insecticide-treated nets (ITNs) for malaria control are widespread but coverage remains inadequate. We developed a Bayesian model using data from 102 national surveys, triangulated against delivery data and distribution reports, to generate year-by-year estimates of four ITN coverage indicators. We explored the impact of two potential 'inefficiencies': uneven net distribution among households and rapid rates of net loss from households. We estimated that, in 2013, 21% (17%-26%) of ITNs were over-allocated and this has worsened over time as overall net provision has increased. We estimated that rates of ITN loss from households are more rapid than previously thought, with 50% lost after 23 (20-28) months. We predict that the current estimate of 920 million additional ITNs required to achieve universal coverage would in reality yield a lower level of coverage (77% population access). By improving efficiency, however, the 920 million ITNs could yield population access as high as 95%.
authors.affiliation: Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom.
authors.forename: Samir
authors.initials: S
authors.lastname: Bhatt
authors.affiliation: Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weiss
authors.affiliation: Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom.
authors.forename: Bonnie
authors.identifier: http://orcid.org/0000-0002-1205-719X
authors.initials: B
authors.lastname: Mappin
authors.affiliation: Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom.
authors.forename: Ursula
authors.initials: U
authors.lastname: Dalrymple
authors.affiliation: Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom.
authors.forename: Ewan
authors.initials: E
authors.lastname: Cameron
authors.affiliation: Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom.
authors.forename: Donal
authors.initials: D
authors.lastname: Bisanzio
authors.affiliation: Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom.|Sanaria Institute of Global Health and Tropical Medicine, Rockville, United States.|Fogarty International Center, National Institutes of Health, Bethesda, United States.
authors.forename: David L
authors.identifier: http://orcid.org/0000-0003-4367-3849
authors.initials: DL
authors.lastname: Smith
authors.affiliation: Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom.
authors.forename: Catherine L
authors.identifier: http://orcid.org/0000-0002-8028-4079
authors.initials: CL
authors.lastname: Moyes
authors.affiliation: Fogarty International Center, National Institutes of Health, Bethesda, United States.|Flowminder Foundation, Stockholm, Sweden.|Department of Geography and the Environment, University of Southampton, Southampton, United Kingdom.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Tatem
authors.affiliation: Global Malaria Programme, World Health Organization, Geneva, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Lynch
authors.affiliation: Global Malaria Programme, World Health Organization, Geneva, Switzerland.
authors.forename: Cristin A
authors.initials: CA
authors.lastname: Fergus
authors.affiliation: Center for Applied Malaria Research and Evaluation, Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, United States.
authors.forename: Joshua
authors.initials: J
authors.lastname: Yukich
authors.affiliation: Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, San Francisco, United States.
authors.forename: Adam
authors.initials: A
authors.lastname: Bennett
authors.affiliation: Center for Applied Malaria Research and Evaluation, Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, United States.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Eisele
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: Global Malaria Programme, World Health Organization, Geneva, Switzerland.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Cibulskis
authors.affiliation: Fogarty International Center, National Institutes of Health, Bethesda, United States.|Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom.|Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States.
authors.forename: Simon I
authors.identifier: http://orcid.org/0000-0002-0611-7272
authors.initials: SI
authors.lastname: Hay
authors.affiliation: Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Gething
mesh_terms: D000349:Africa; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D006302:Health Services Research; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control*; D009032:Mosquito Control / Q000379:methods*
keywords: Bayesian compatment model; ITN; LLIN; Malaria; epidemiology; global health; human