Insecticide-treated nets are the cornerstone of malaria control efforts worldwide. Over 2 billion ITNs have been distributed to people at risk of malaria over the past two decades. While most ITNs are used for malaria prevention, some gaps in use remain. Anecdotal reports and qualitative observations have indicated that in some areas, households may prefer softer polyester ITNs to ITNs made of polyethylene, which can have a ‘harder’ feel.
As a result, National Malaria Control Programs have expressed a desire to procure only ITNs of a specific textile for upcoming mass distribution campaigns. While the Global Fund procurement system allows for these types of requests, they are unable to guarantee that nets of a particular textile will be available for a specific campaign, due to global supply chain issues, ITN production timelines, and other manufacturing variables.
The Global Fund and WHO have advised countries wishing to procure nets of a single textile that this decision must be justified with data that support a significant increase in overall ITN use for one textile over another.
This document aims to provide an analysis framework for use by National Malaria Control Programs and their partners wishing to demonstrate differential use of ITNs due to the textile of the net, in order to justify procurement of ITNs of a specific textile (polyester or polyethylene).
Download datasets for the most recent MIS or DHS or MICS from dhsprogram.com or mics.unicef.org
If using an MIS or DHS, the ITN roster data are contained within the household file (files ending with HR). This file must be reshaped to long format, generating a dataset with one row for each net in the household. MICS datasets have a separate ITN file (TN).
The outcome variable will be whether the ITN was used the previous night.
Many household-level factors influence ITN use, and must be controlled for in the analysis. These variables are nearly always standard within MIS/DHS/MICS:
region
time of year (month of the survey)
urban/rural setting
socioeconomic status
age of the net
the number of nets and people within the household - frequently categorized as household owning
Let us first review overall net use patterns across these covariates, to get a sense of what is happening in Ghana 2022.