Insecticide-treated nets (ITNs) for malaria control are widespread but coverage remains inadequate. We developed a Bayesian model using data from 102 national surveys, triangulated against delivery data and distribution reports, to generate year-by-year estimates of four ITN coverage indicators. We explored the impact of two potential 'inefficiencies': uneven net distribution among households and rapid rates of net loss from households. We estimated that, in 2013, 21% (17%–26%) of ITNs were over-allocated and this has worsened over time as overall net provision has increased. We estimated that rates of ITN loss from households are more rapid than previously thought, with 50% lost after 23 (20–28) months. We predict that the current estimate of 920 million additional ITNs required to achieve universal coverage would in reality yield a lower level of coverage (77% population access). By improving efficiency, however, the 920 million ITNs could yield population access as high as 95%.
Bhatt S, Weiss DJ, Mappin B, Dalrymple U, Cameron E, Bisanzio D, Smith DL, Moyes CL, Tatem AJ, Lynch M, Fergus CA, Yukich J, Bennett A, Eisele TP, Kolaczinski J, Cibulskis RE, Hay SI, Gething PW. Coverage and System Efficiencies of Insecticide-Treated Nets in Africa from 2000 to 2017. ELife. 29 Dec 2015:4:e09672. doi: 10.7554/eLife.09672