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John M. Miller, MPH; Eline L. Korenromp, PhD; Bernard L. Nahlen, MD; Richard W. Steketee, MD

JAMA. 2007;297(20):2241-2250.

Context  African countries are scaling up malaria interventions, especially insecticide-treated nets (ITNs), for which ambitious coverage targets have been set.

Objective  To estimate how many ITNs are available in African households that are at risk of malaria and how many ITNs are needed to reach targets for use by children younger than 5 years and pregnant women.

Data Sources  Primary sources of data were the Multiple Indicator Cluster Surveys II, the Demographic and Health Surveys, or other nationally representative or large-scale household surveys that measured household possession and use of nets or ITNs among children younger than 5 years.

Data Extraction  Data from 42 household surveys between 1999 and 2006 on net and ITN coverage (either household possession or use) and average numbers of nets and ITNs per household were compared with populations and households at risk. Data are included for 43 sub-Saharan African countries.

Data Synthesis  For the median survey year 2003, the population-weighted mean proportion of households possessing at least 1 ITN was 6.7% (range among countries, 0.1%-71.0%) and was 23.8% (range, 5.0%-91.2%) for any type of net. Based on an average of 0.13 ITNs per household, we estimated that 53.6 million nets, of which 16.7 million were ITNs, were available in households at risk of malaria. Between 130 million and 264 million ITNs are required in 2007 to reach the 80% coverage target for about 133 million children younger than 5 years and pregnant women living in 123 million households in risk areas; the exact number depends on usage patterns (best estimate, assuming 55% of owned ITNs are used by the target groups, 192 million ITNs).

Conclusion  To achieve the targeted ITN usage rates, numbers of ITNs available to African households must be dramatically increased.

Author Affiliations: PATH Malaria Control and Evaluation Partnership in Africa (MACEPA), National Malaria Control Centre, Lusaka, Zambia (Mr Miller); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, La (Mr Miller); The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland (Drs Korenromp and Nahlen); Erasmus MC, University Medical Centre Rotterdam, Department of Public Health, Rotterdam, the Netherlands (Dr Korenromp); and PATH MACEPA, Batiment Avant Centre, Ferney-Voltaire, France (Dr Steketee).

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