This document summarizes a study analyzing the equity of insecticide-treated net (ITN) access, ownership, and use in Rwanda from 2000-2010. The study found that while early ITN interventions were not equitable, distribution and use have become increasingly equitable across wealth quintiles over time. Concentration index values showed a decline in inequity for household ITN ownership, child and pregnant women ITN use, and population access to ITNs. The authors conclude that Rwanda's malaria control program has successfully reached the poorest households with ITNs.

1. Improving socioeconomic equity in ITN access,
ownership and use in Rwanda from 2000-2010
Authors: Lia Florey1
, Cameron Taylor1
, Rebecca Winter1
, Ana Claudia Franca- Koh2
,
Samantha Herrera2
, Jui Shah2
, Yazoume Ye2
1
ICF International - The DHS Program, 2
ICF International - MEASURE Evaluation
29th
Annual ASTMH Meeting
New Orleans, LA USA
November 5, 2014

2. Background
• Huge investments have been made in malaria control
– > 280 million USD from 2008-2013 in Rwanda
• This has led to major scale-up in interventions and to
subsequent improvements in coverage

3. Coverage of ITN ownership and use

4. ITN Use in target populations
Children < 5 years Pregnant Women

5. Inequity in ITN ownership
Steketee RW, Eisele TP (2009) Is the Scale Up of Malaria Intervention Coverage Also Achieving Equity?. PLoS ONE 4(12): e8409.
Scale-up has not always been equitable

6. Objectives
Determine if:
•Interventions have reached those in the poorest
households
•ITN distribution has become more equitable over time

7. Lorenz Curves
• Graphical representation of the cumulative
distribution function of the empirical probability
distribution of wealth
• Developed in 1905 by Max O. Lorenz for
representing inequalities in wealth distributions
• Concentration Index (C-Index) values
range between -1 and 1 with a value
of 0 representing perfect equality.

8. Household ITN ownership
C-Index: 0.35, 0.07 and 0.03 in 2005, 2010 and 2013, respectively

9. ITN use in children less than 5
C-Index: 0.66, 0.33, 0.05 and 0.02 in 2000, 2005, 2010, and 2013, respectively

10. ITN use by pregnant women
C-Index: 0.70, 0.25, 0.03 and 0.04 in 2000, 2005, 2010, 2013, respectively

11. Population access to ITNs
C-Index: 0.42, 0.12, 0.06, 0.04 in 2000, 2005, 2010, and 2013, respectively

12. Households with Universal Coverage
C-Index: 0.56, 0.20, 0.10 and 0.08 in 2005, 2007/8, 2010 and 2013, respectively

13. Conclusions
• ITN distribution and use have become equitable
across household wealth quintiles between 2000 and
2013.
• Rwanda’s malaria control program has successfully
implemented ITN interventions to reach the poorest
households.
• Limited additional gains have been made between
2010 and 2013.
• Useful tool for identifying gaps in coverage and for
targeting high risk populations.

14. Next Steps
Spatial and temporal patterns in risk and interventions

15. Acknowledgments
• Yazoume Ye, MEASURE Evaluation
• Staff and participants of the Rwanda DHS and MIS
• President’s Malaria Initiative

16. www.measureevaluation.org