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• W74607599 abstract "Introduction: The burden of malaria remains huge particularly in low-income settings. Although effective malaria control measures such as insecticide-treated nets (ITNs) have been promoted, relatively little is known about their equity dimension. Understanding variations in their use in low-income settings is important for scaling up malaria control programmes. This paper addresses this gap by analysing the nature and magnitude of inequalities in utilisation and expenditure on bednets by socioeconomic status (SES) in Tanga district, north-eastern Tanzania. Methods: Data were collected in a household survey conducted between 2003 and 2005 for 1603 respondents drawn from rural and urban clusters. Inequalities were analysed using bivariate inequality measures and multivariate regression models across socioeconomic groups (SEGs) based on an asset-based wealth index, the education level of the household head, and by location. Focus group discussions (FGD) were conducted to explore the barriers to utilisation of bednets from a community perspective, and subjected to manual content analysis. Results: Utilisation of at least one bednet within the household was much higher in the urban (90%) compared to the rural areas (50%). Use of at least one ITN was also higher within the urban areas (48%) compared to rural areas (9%). However, these figures show that many nets are not treated. Use of any net across wealth quintiles varied from 39% within the poorest SEG to 94% for the least poor and from 7% to 58% for ITNs respectively. There were pro-rich inequalities in the utilisation of ITNs, and these were larger within the rural areas Concentration index based on wealth was 0.368 (t=3.67) in rural areas compared to 0.093 (t=1.95) in urban areas.. Per capita expenditure on nets over the previous six months for households within the top wealth quintile was about 3 times that for the lowest quintile. Utilisation of ITNs by age group marginally favoured the under5s within the rural areas but not in urban areas. Regression analysis showed that SES, living within the urban areas, being under5 and having a small family size were positively associated with bednet utilisation. FGD results showed that lack of financial resources was the major barrier to bednet use. There was also some evidence of negative perceptions regarding use of ITNs. Conclusion: The results reveal a number of key policy implications. There is need for a community-wide programme to treat all nets currently not treated, and to promote greater utilisation of ITNs by reducing their price. Interventions such as discounted voucher schemes and free mass distribution of nets should be considered to increase coverage and promote equity. A public campaign to encourage ITN use and mitigate negative perceptions about net treatment should be promoted. The problems surrounding net treatment could also be addressed by encouraging use of long-lasting insecticidal nets or longer-lasting treatment of nets. The findings also highlight the importance of including equity issues in malaria control interventions to ensure that the most vulnerable groups benefit from highly effective malaria control measures." @default.
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• W74607599 date "2007-06-01" @default.
• W74607599 modified "2023-09-28" @default.
• W74607599 title "Inequities in Prevention of Malaria: Experiences With Bednet Utilisation from a Low-Income Setting in Tanzania" @default.
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