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Abstract
Insecticide-treated bednets (ITNs) provide a means to improve child survival across
Africa. Sales figures of these nets and survey coverage data presented nationally
mask inequities in populations at biological and economic risk, and do not allow for
precision in the estimation of unmet commodity needs. We gathered subnational ITN
coverage sample survey data from 40 malaria-endemic countries in Africa between 2000
and 2007.
We computed the projected ITN coverage among children aged less than 5 years for age-adjusted
population data that were stratified according to malaria transmission risks, proximate
determinants of poverty, and methods of ITN delivery.
In 2000, only 1.7 million (1.8%) African children living in stable malaria-endemic
conditions were protected by an ITN and the number increased to 20.3 million (18.5%)
by 2007 leaving 89.6 million children unprotected. Of these, 30 million were living
in some of the poorest areas of Africa: 54% were living in only seven countries and
25% in Nigeria alone. Overall, 33 (83%) countries were estimated to have ITN coverage
of less than 40% in 2007. On average, we noted a greater increase in ITN coverage
in areas where free distribution had operated between survey periods.
By mapping the distribution of populations in relation to malaria risk and intervention
coverage, we provide a means to track the future requirements for scaling up essential
disease-prevention strategies. The present coverage of ITN in Africa remains inadequate
and a focused effort to improve distribution in selected areas would have a substantial
effect on the continent's malaria burden.