Which family members use the best nets? An analysis of the condition of mosquito nets and their distribution within households in Tanzania

Data from the 2006 TNVS household survey were analysed to assess within-household distribution of net use. The associations between net characteristics and net user were also evaluated. Multivariate analysis was applied to the relationship between the number of holes per net and user characteristics while adjusting for confounders.In households with a net:person ratio better than 1:4 (one net for every four household members), more than 80% of the people in such households reported using a net the previous night. ITNs were most likely to be used by infants, young children (1-4 y), and women of childbearing age; they were least likely to be used by older women (≥50 y), older children (5-14 y), and adult men. The nets used by infants and women of childbearing age were in better-than-average physical condition; the nets used by older women and older children were in worse-than-average condition; while young children and adult men used nets in intermediate (average) condition. When adjusted for confounders, the nets used by young and older children had more holes than nets used by infants.Infants and other vulnerable groups were most likely to sleep under the most protective nets. Nevertheless, more communication efforts are needed to increase use of intact ITNs within households for children. Further research is necessary to fully understand motivations influencing within-household net distribution.Malaria poses a serious threat to pregnant women, infants, and children [1,2], and these groups are at particular risk in high transmission settings. Insecticide-treated bed nets (ITN) have been proven to be highly effective against mosquito bites and therefore preventing the transmission of malaria [3]. Substantial progress has been made in increasing ITN use by those who are at greatest risk [4], and more recently the UN Secretary-General has called for "universal coverage, by the end of 2010 . . . to all people at risk of malaria, especially women and children in Africa"