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Intra-household Mosquito Net Use in Ethiopia, Ghana, Mali, Nigeria, Senegal, and Zambia: Are Nets Being Used? Who in the Household Uses Them?

Mosquito net ownership is rising in sub-Saharan Africa but will substantially reduce malaria only if nets are used and the most vulnerable household members sleep under them. We used data from 9 large-scale household surveys conducted in 6 African countries from 2000 to 2004 that enumerated all household members and nets owned, analyzing only net-owning households. Across countries, women of reproductive age and children under 5 (without gender bias) were most likely to use the net; least likely were children of age 5–14 and adult males. Nets commonly covered 2–3 people. If a baby net was used, fewer people used the family net. Pregnant women were more likely to use a net in 2004 than in 2000. In several countries, a sizable minority of nets owned were not used. Understanding intra-household net-use patterns helps malaria control programs more effectively direct their efforts to increase their public health impact.

Received March 29, 2007. Accepted for publication August 9, 2007.

Acknowledgments: The authors thank the United States Agency for International Development for funding the NetMark project, including the collection of the data used for these analyses. We also thank AED’s Global Health, Population, and Nutrition Group for allocating Leadership Funds to cover staff time for writing this article. Special appreciation goes to Ms. Roshelle Payes who assisted with data analysis of all surveys and with preparation of the document. We also thank those who reviewed the manuscript: Martin Alilio, Lawrence Barat, Mr. David McGuire, Ms. Lonna Shafritz, and Susan Zimicki. We also thank Mr. Joseph Boniaszczuk of Research International (RI), South Africa, who gave valuable input on various aspects of the survey and worked with local RI personnel and local field teams to collect the data. Finally, we thank the mothers who gave their time to provide us with the information for this research.

^* Address correspondence to Carol Baume, Academy for Educational Development, 1825 Connecticut Avenue NW, Washington, DC 20009-5721. E-mail: cbaume{at}aed.org

Authors’ addresses: Carol Baume and Celeste Marin, Academy for Educational Development, 1825 Connecticut Avenue NW, Washington, DC 20009, Telephone: +1 (202) 884-8980, Fax: +1 (202) 884-8844, E-mails: cbaume{at}aed.org and cmarin{at}aed.org.