An adjusted bed net coverage indicator with estimations for 23 African countries.

Area of Science:

• Public Health
• Epidemiology
• Malariology

Background:

• Bed net coverage varies significantly across populations, but studies often overlook malaria endemicity when prioritizing interventions.
• Ignoring malaria endemicity can lead to misallocation of resources, prioritizing areas with low risk or overlooking high-risk areas with seemingly adequate coverage.

Purpose of the Study:

• To introduce the Adjusted Bed net Coverage (ABC) statistic, a novel measure that integrates malaria endemicity with bed net coverage.
• To demonstrate how the ABC statistic can improve the prioritization of populations for malaria interventions.

Main Methods:

• Developed a mathematical formulation for the ABC statistic, weighted by malaria epidemiology models.
• Utilized data on bed net coverage and malaria endemicity for under-five-year-olds across 23 Sub-Saharan African countries.
• Compared prioritization based on ABC with prioritization based solely on bed net coverage at national, sub-national, and wealth quintile levels.

Main Results:

• The ABC statistic identified different priority areas for intervention compared to bed net coverage alone at national and sub-national levels.
• Assessing inequality in bed net access across wealth quintiles is significantly influenced by local malaria endemicity.

Conclusions:

• Malaria endemicity is a critical factor that must be incorporated into assessments of bed net coverage and intervention prioritization.
• The ABC statistic offers a straightforward method, derived from established epidemiological models, to refine resource allocation for malaria control efforts.