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Where did the nets go? Tracing long-lasting insecticidal net migration on Bioko Island
Thomas C Stabler1,2,3, Liyu A Teklemichael1, Jeremias Nzamio Mba Eyono4
1MCD Global Health, Hallowell, ME, USA.
Malaria Journal
|June 26, 2026
Summary
Mass distribution campaigns for long-lasting insecticidal nets (LLINs) result in significant net loss and mobility. LLIN redistribution impacts malaria risk, necessitating a shift to demand-driven distribution points.
Area of Science:
- Public Health
- Entomology
- Epidemiology
Background:
- Long-lasting insecticidal nets (LLINs) are crucial for malaria control, typically distributed via mass distribution campaigns (MDCs).
- MDCs often lead to substantial LLIN loss and reduced coverage, impacting their effectiveness.
- Understanding LLIN mobility post-distribution is vital for optimizing malaria prevention strategies.
Purpose of the Study:
- To characterize the mobility and loss of LLINs following a mass distribution campaign on Bioko Island.
- To identify factors associated with LLINs being in households different from their original distribution community.
- To assess the impact of LLIN migration on malaria transmission risk across different areas.
Main Methods:
- A mass distribution campaign (MDC) was conducted, marking LLINs with unique community codes.
- A malaria indicator survey (MIS) tracked LLIN presence, code registration, and code mismatches.
- Multivariate models and source-sink analysis were used to determine LLIN mobility patterns and associated factors.
Main Results:
- Over 37% of LLINs distributed were lost post-MDC; only 46.9% of surviving nets had registered codes.
- 16.1% of registered nets showed mismatched codes, with open eaves significantly associated with this phenomenon.
- LLINs predominantly migrated from lower to higher malaria risk areas (62.3%), but a substantial portion moved in the opposite direction (37.7%).
Conclusions:
- LLIN redistribution following MDCs has mixed impacts, with some high-risk areas losing nets to lower-risk areas.
- Significant LLIN loss and inefficient redistribution highlight critical gaps in current distribution strategies.
- A shift from mass distribution campaigns to demand-driven fixed distribution points is recommended to improve LLIN coverage and impact.
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