Gaps in long lasting insecticide-treated net coverage 2 years after a mass distribution campaign in central Côte d’Ivoire

Abstract

Background To reduce malaria burden in Côte d'Ivoire, the Ministry of Health aims for 90% of its population to possess one long-lasting insecticidal net (LLIN) for every two persons by 2025. Furthermore, some studies recommend measuring LLIN access within sleeping units to improve the accuracy of coverage indicators. This study evaluated LLIN coverage two years after a mass distribution in central Côte d'Ivoire. Methods A census was conducted in 43 villages. Data were collected on household geo-position, composition, number of sleeping units and LLINs owned. LLIN coverage was assessed using: 1/ ownership; proportion of household with at least one LLIN; 2/household access; households with sufficient nets for every two persons and for every sleeping unit; and 3/ population access; proportion of population with access to LLIN within households and sleeping units. Results 10,630 households (89.6% response rate) and 46,619 inhabitants were recruited. Household LLIN ownership was 63.8% (95%CI: 58.7–68.8). Household LLIN access was 37.6% (95%CI: 33.2–42.0) based on 1 LLIN per 2 persons and 37.1% (95%CI: 33.0-41.2) based on 1 net per sleeping unit. Population LLIN access based on 1 LLIN per 2 persons and 1 net per sleeping space was 53.3% (95%CI: 48.6–58.1) and 49.4% (95%CI: 45.1–53.6) respectively. Approximately 17% of households with access for every 2 persons did not have access by every sleeping unit and 9.7% of households with access by sleeping unit did not have access for every 2 persons. Households with adequate access by sleeping unit but not for every 2 persons tend to be larger with fewer sleeping units, and have children under five years old and female members. The largest households (> 7 members) and households with at least one under-five member had the lowest access (20.8% and 27.3% respectively). Conclusion LLIN access was low in this area of intense indoor malaria transmission, 2 years after the last mass distribution campaign. Strategies are needed to improve LLINs coverage.