Insecticide-treated net coverage in Africa: mapping progress in 2000-07.

Area of Science:

• Public Health
• Tropical Medicine
• Epidemiology

Background:

• Insecticide-treated bednets (ITNs) are vital for child survival in malaria-endemic African regions.
• National sales and coverage data obscure critical inequities in access and unmet needs.
• Subnational ITN coverage data from 40 African countries (2000-2007) were analyzed.

Purpose of the Study:

• To map ITN coverage at a subnational level, identifying populations at risk.
• To estimate unmet needs for ITNs among children under five.
• To inform strategies for scaling up malaria prevention.

Main Methods:

• Projected ITN coverage for children under five using age-adjusted population data.
• Stratified analysis by malaria transmission intensity, poverty indicators, and distribution methods.
• Geospatial mapping of population distribution against malaria risk and intervention coverage.

Main Results:

• ITN protection increased from 1.7 million (1.8%) in 2000 to 20.3 million (18.5%) in 2007, leaving 89.6 million children unprotected.
• 30 million unprotected children resided in impoverished areas, with 54% concentrated in seven countries (25% in Nigeria).
• 83% of countries had ITN coverage below 40% in 2007; free distribution correlated with greater coverage increases.

Conclusions:

• Mapping population distribution relative to malaria risk and ITN coverage aids in planning future interventions.
• Current ITN coverage in Africa is insufficient to significantly impact the malaria burden.
• Focused distribution efforts in high-need areas can substantially reduce malaria incidence.