The online version of this article (doi:10.1186/1475-2875-11-32) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
All authors contributed to the design of the study. YY performed the analysis and wrote the first draft of the manuscript. EE, EP, SD, AK contributed to the write up and reviewed the final draft. All authors read and approved the final manuscript.
Insecticide-treated nets (ITNs) are effective tools for malaria prevention and can significantly reduce severe disease and mortality due to malaria, especially among children under five in endemic areas. However, ITN coverage and use remain low and inequitable among different socio-economic groups in sub-Saharan Africa, particularly in Nigeria. Several strategies have been proposed to increase coverage and use and reduce inequity in Nigeria, including free distribution campaigns recently conducted by the Nigerian federal government. Using data from the first post-campaign survey, the authors investigated the effect of the mass free distribution campaigns in achieving equity in household ownership and use of ITNs.
A post-campaign survey was undertaken in November 2009 in northern Nigeria to assess the effect of the campaigns in addressing equity across different socio-economic groups. The survey included 987 households randomly selected from 60 clusters in Kano state. Using logistic regression and the Lorenz concentration curve and index, the authors assessed equity in ITN coverage and use.
ITN ownership coverage increased from 10% before the campaigns to 70%-a more than fivefold increase. The campaigns reduced the ownership coverage gap by 75%, effectively reaching parity among wealth quintiles (Concentration index 0.02, 95% CI (-0.02 ; 0.05) versus 0.21 95%CI (0.08 ; 0.34) before the campaigns). ITN use (individuals reporting having slept under an ITN the night before the survey visit) among individuals from households owning at least one ITN, was 53.1% with no statistically significant difference between the lowest, second, third and fourth wealth quintiles and the highest wealth quintile (lowest: odds ratio (OR) 0.87, 95% confidence interval (CI) (0.67 ; 1.13); second: OR 0.85, 95% CI (0.66 ; 1.24); third: OR 1.10 95% CI (0.86 ; 1.4) and fourth OR 0.91 95% CI (0.72 ; 1.15).
The campaign had a significant impact by increasing ITN coverage and reducing inequity in ownership and use. Free ITN distribution campaigns should be sustained to increase equitable coverage. These campaigns should be supplemented with other ITN distribution strategies to cover newborns and replace aging nets.
Lengeler C: Insecticide-treated bed nets and curtains for preventing malaria. Cochrane Database Syst Rev. 2004, CD000363-2
Blackburn BG, Eigege A, Gotau H, Gerlong G, Miri E, Hawley WA, Mathieu E, Richards F: Successful integration of insecticide-treated bed net distribution with mass drug administration in Central Nigeria. AmJTrop Med Hyg. 2006, 75: 650-655.
Gerstl S, Dunkley S, Mukhtar A, Maes P, De Smet M, Baker S, Maikere J: Long-lasting insecticide-treated net usage in eastern Sierra Leone-the success of free distribution. Trop Med Int Health. 2010, 15: 480-488. PubMed
Grabowsky M, Farrell N, Hawley W, Chimumbwa J, Hoyer S, Wolkon A, Selanikio J: Integrating insecticide-treated bednets into a measles vaccination campaign achieves high, rapid and equitable coverage with direct and voucher-based methods. Trop Med Int Health. 2010, 10: 1151-1160. CrossRef
Wolkon A, Vanden Eng JL, Morgah K, Eliades MJ, Thwing J, Terlouw DJ, Takp V, Dare A, Sodahlon YK, Doumanou Y, Hightower AW, Lama M, Thawani N, Slutsker L, Hawley WA: Rapid scale-up of long-lasting insecticide-treated bed nets through integration into the national immunization program during child health week in Togo, 2004. AmJTrop Med Hyg. 2010, 83: 1014-1019. CrossRef
Federal Ministry of Health and National Malaria Control Programme: Nigeria strategic plan 2009-2013. Abuja, Nigeria, [ http://nmcpnigeria.org/f/STRATEGIC%20PLAN%202009-2013.pdf?PHPSESSID=9af62a6bf2a27f1e47ba845abc0b0c35]
SuNMaP, Malaria Consortium, MEASURE Evaluation, USAID Nigeria: Retention, Use and Acheivement of "Universal Access" Following the Distribution of Long-Lasting Insecticidal-Treated Nets in Kano State, Nigeria. 2009, ICF International, Calverton, MD, 1-48.
Roll Back Malaria Monitoring and Evaluation Reference Group: Malaria Indicator Survey: Household Questionnaire. 2005, Calverton, MD: MEASURE Evaluation
Lorenz MO: Methods of measuring the concentration of wealth. Am Stat Assoc. 1905, 9: 209-219.
MEASURE DHS: Nigeria Demographic and Health Survey. 2009, Calverton: MEASURE DHS
Terlouw DJ, Morgah K, Wolkon A, Dare A, Dorkenoo A, Eliades MJ, Vanden Eng J, Sodahlon YK, ter Kuile FO, Hawley WA: Impact of mass distribution of free long-lasting insecticidal nets on childhood malaria morbidity: the Togo National Integrated Child Health Campaign. Malar J. 2010, 9: 199-10.1186/1475-2875-9-199. PubMedCentralCrossRefPubMed
Thwing J, Hochberg N, Vanden Eng J, Issifi S, Eliades MJ, Minkoulou E, Wolkon A, Gado H, Ibrahim O, Newman RD, Lama M: Insecticide-treated net ownership and usage in Niger after a nationwide integrated campaign. Trop Med Int Health. 2008, 13: 827-834. 10.1111/j.1365-3156.2008.02070.x. CrossRefPubMed
Lengeler C, Grabowsky M, McGuire D, de Savigny D: Quick wins versus sustainability: options for the upscaling of insecticide-treated nets. AmJTrop Med Hyg. 2007, 77: 222-226.
Kulkarni MA, Vanden Eng J, Desrochers RE, Cotte AH, Goodson JL, Johnston A, Wolkon A, Erskine M, Berti P, Rakotoarisoa , Ranaivo L, Peat J: Contribution of integrated campaign distribution of long-lasting insecticidal nets to coverage of target groups and total populations in malaria-endemic areas in Madagascar. AmJTrop Med Hyg. 2010, 82: 420-425. CrossRef
Larson D, Keating J, Miller J, Bennett A, Changufu C, Katebe C, Eisele T: Barriers to insecticide-treated mosquito net possession 2 years after a mass free distribution campaign in Luangwa District. Zambia PLoS ONE. 2010, 5: e13129. CrossRef
- Can universal insecticide-treated net campaigns achieve equity in coverage and use? the case of northern Nigeria
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