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Updated: Feb 4, 2026
06:30
Bioassays for Monitoring Insecticide Resistance
Published on: December 30, 2010
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Assessing whether universal coverage with insecticide-treated nets has been achieved: is the right indicator being
Hannah Koenker1, Fred Arnold2, Fatou Ba3
1PMI Vectorworks Project, Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, Baltimore, MD, USA. hkoenker@jhu.edu.
Malaria Journal
|October 12, 2018
Summary
Insecticide-treated nets (ITNs) are crucial for malaria control. Current household coverage indicators are misleading; population access better reflects ITN protection, especially for larger families.
Area of Science:
- Public Health
- Vector-Borne Disease Control
- Malariology
Background:
- Insecticide-treated nets (ITNs) are the primary tool for malaria vector control in sub-Saharan Africa.
- Despite widespread distribution campaigns, no country has achieved 80% of households owning 1 ITN per 2 people.
Purpose of the Study:
- To analyze ITN availability data from sub-Saharan Africa (2005-2017).
- To evaluate the effectiveness of household-level ITN indicators.
- To determine the best indicator for assessing ITN distribution program success.
Main Methods:
- Analysis of 86 public datasets from 33 sub-Saharan African countries (2005-2017).
- Exploration of causes for failure to achieve universal household ITN coverage.
- Comparison of household ownership indicators versus population access indicators.
Main Results:
- No country consistently achieved 80% household ownership of 1 ITN per 2 people.
- Population ITN access at 80% only corresponds to 60% household ownership of 1 ITN per 2 people.
- Large households (7-9 people) had low ownership (6.2%) despite moderate population access (41.0%).
Conclusions:
- Household-level ITN coverage indicators are incomplete and potentially misleading.
- Current ITN distribution strategies are unlikely to achieve the 80% household ownership target.
- Population access to ITNs is a superior indicator of universal coverage and personal protection.
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