Rapid Increase in Ownership and Use of Long-Lasting Insecticidal Nets and Decrease in Prevalence of Malaria in Three Regional States of Ethiopia (2006-2007)
Following recent large scale-up of malaria control interventions in Ethiopia, this study aimed to compare ownership and use of long-lasting insecticidal nets (LLIN), and the change in malaria prevalence using two population-based household surveys in three regions of the country. Each survey used multistage cluster random sampling with 25 households per cluster. Household net ownership tripled from 19.6% in 2006 to 68.4% in 2007, with mean LLIN per household increasing from 0.3 to 1.2. Net use overall more than doubled from 15.3% to 34.5%, but in households owning LLIN, use declined from 71.7% to 48.3%. Parasitemia declined from 4.1% to 0.4%. Large scale-up of net ownership over a short period of time was possible. However, a large increase in net ownership was not necessarily mirrored directly by increased net use. Better targeting of nets to malaria-risk areas and sustained behavioural change communication are needed to increase and maintain net use. 1. Introduction Selective vector control with insecticide treated mosquito nets (ITNs) and indoor residual household spraying (IRS) continues to play a key role in malaria control. As a way to achieving the United Nations Millennium Development Goals (MDGs), the World Health Organization (WHO) recommends rapid scale up of three primary interventions: ITNs, more specifically long-lasting insecticidal nets (LLINs), IRS and early detection and effective treatment of malaria cases [1, 2]. In addition, intermittent preventive treatment for pregnant women (IPTp) is recommended in areas with moderate to high transmission. The three primary interventions (LLIN, IRS and early diagnosis and treatment) form the core approach to malaria control in Ethiopia, where malaria transmission is unstable and seasonal, characterized by frequent and widespread focal epidemics. Malaria transmission mainly occurs in areas below 2,000 meters above sea level, which account for 75% of the country’s total landmass and in which approximately two-thirds of the population reside. Recognizing the low coverage and use of ITNs in the country, the Government of Ethiopia developed the National ITN Strategy in 2004 [3]. One year later, the Ethiopian Federal Ministry of Health (FMOH) set an ambitious national goal of full population coverage in malarious areas with a mean of two LLINs per household through distribution of about 20 million LLINs by the end of 2007. In addition, IRS as vector control tool was also to be scaled-up, particularly in epidemic-prone districts throughout the country. This effort also included the rapid scale-up of
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