Maps and metrics of insecticide-treated net access, use, and nets-per-capita in Africa from 2000-2020
Amelia Bertozzi-Villa, Caitlin Bever, Hannah Koenker, Daniel J. Weiss, Camilo Vargas-Ruiz, A. Nandi, Harry S. Gibson, Joseph Harris, Katherine E. Battle, Susan F. Rumisha, Suzanne Keddie, Punam Amratia, Rohan Arambepola, Ewan Cameron, Elisabeth G. Chestnutt, Emma L. Collins, Justin Millar, Swapnil Mishra, Jennifer Rozier, Tasmin L. Symons, Katherine A. Twohig, T. Déirdre Hollingsworth, Peter W. Gething, Samir Bhatt
Abstract
Insecticide-treated nets (ITNs) are one of the most widespread and impactful malaria interventions in Africa, yet a spatially-resolved time series of ITN coverage has never been published. Using data from multiple sources, we generate high-resolution maps of ITN access, use, and nets-per-capita annually from 2000 to 2020 across the 40 highest-burden African countries. Our findings support several existing hypotheses: that use is high among those with access, that nets are discarded more quickly than official policy presumes, and that effectively distributing nets grows more difficult as coverage increases. The primary driving factors behind these findings are most likely strong cultural and social messaging around the importance of net use, low physical net durability, and a mixture of inherent commodity distribution challenges and less-than-optimal net allocation policies, respectively. These results can inform both policy decisions and downstream malaria analyses.