Can mosquito Insecticide Treated Net campaigns achieve equity in coverage and use? Case of northern Nigeria

Insecticide-treated nets (ITN) are an effective tool for malaria prevention and can significantly reduce severe disease and mortality due to malaria, especially among under-five children in endemic areas. However, ITN coverage and use remain low and inequitable among different socioeconomic groups in sub-Saharan Africa particularly in Nigeria. To increase coverage and use and reduce inequity several strategies have been proposed; including free distribution campaigns recently adopted by the Nigerian federal government. To assess the impact of the campaigns in addressing equity across different socioeconomic groups a post-campaign survey was undertaken in November 2009 in northern Nigeria. The survey included 987 households randomly selected from 60 clusters in Kano state. Using logistic regression we assessed equity in ITN coverage and use using wealth quintile as predictors and controlling for potential confounders. ITN coverage increased from 13% before the campaigns to 71% -a more than fivefold increase. The campaigns reduced the ownership coverage gap by 75%, effectively reaching parity among quintiles. Although ownership was high, and 74% of households also reported having used a net the previous night, this pattern varied across quintiles. Households in the highest quintile were more likely to have used a net compared to their counterparts in the lowest quintile. The campaign had a significant impact by increasing ITN coverage and reducing inequity in ownership, though inequity in use remained. Bed net campaigns should be sustained to increase coverage but should be supplemented with effective behavior change communication strategies to increase use across the different socioeconomic strata.