I recently posted about some research in a small sample of countries which indicated that there had been rapid scale up of insecticide treated nets (ITNs) in sub-Saharan Africa.  I just read a related study published in the Lancet (November 18, 2008) by Noor, Mutheu, Tatem, Hay, and Snow that expands upon these findings.
In this second study, the authors collected data from 40 countries in Africa instead of just a handful.  They also find relatively large increases in coverage – from under 2% of children to nearly 20% by 2007.  I think a nearly 10 fold increase in 7 years is pretty remarkable, although clearly this is still very far from the target level to reach the MDG goal.
What I thought was really interesting in their study, is that they then go on the stratify the countries relative to the actual risk of malaria in those countries.  They find the highest coverage rates in areas that have no risk of malaria transmission, although less than 10% of children do fall into this category.  Coverage rates were the lowest in countries with the highest risk of malaria transmission, suggesting that improved targeting might be needed.
Nearly half of the children in high risk malaria countries not sleeping under nets lived in just 7 countries: Nigeria, Demographic Republic of Congo, Uganda, Sudan, Mozambique, Cote d’Ivoire, and Cameroon.  A quarter lived in  Nigeria alone.
Stepped up targeted efforts in a few countries, such as Nigeria, could go a long way to protecting the proportion of children in Africa sleeping under nets.
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