Presented at the 2015 American Society of Tropical Medicine and Hygiene (ASTMH) Annual Meeting.

1. Samantha Herrera1
, Lia Florey2
, Ana Claudia Franca-Koh1
, Jui Shah1
, Cameron Taylor2
, Yazoume Ye1
1
MEASURE Evaluation, ICF International, 2
The DHS Program, ICF International
Background
Scaling up of ITN ownership and use in Mozambique:
Has the scale-up been equitable?
Methods
Results
• Mozambique 2007 Malaria Indicator Survey (MIS) and 2011 Demographic
and Health Survey (DHS).
• Lorenz Concentration Curves and the Lorenz Concentration Index (C-Index) were used to assess equity in
household ITN ownership, ITN access, and ITN use among children under five and pregnant women across
household wealth quintiles. Separate analyses were run for the 2007 MIS and 2011 DHS surveys.
• The C-Curve graphically presents the gap in relation to an equity line and the C-Index, which is directly related
to the Lorenz Concentration Curve, quantifies the degree of socio-economic related inequality in a health
variable. C-Index values range between -1 to 1. A value of 0 suggests no difference in ownership and use
among different socioeconomic groups. C-Index is greater than 0 (<0) if the outcome is disproportionately
concentrated on population from the highest (lowest) wealth quintile.
Summary Acknowledgments
This study was made possible by support from the U.S. Agency for
International Development (USAID) under the terms of Cooperative
Agreement GPO-A-00-03-00003-00. The opinions expressed are those
of the authors and do not necessarily reflect the views of USAID, or the
United States Government.
Data Sources Analysis
Figure 2: Equity of household ownership of ITNs
Source: Mozambique MIS 2007 and DHS 2011
Figure 4: Equity of children under five using an
ITN the previous night
Figure 3: Equity of household access to ITNs Figure 5: Equity of pregnant women using an ITN
the previous night
1623
Insecticide-treated nets (ITNs) are an effective tool for malaria prevention and can significantly reduce morbidity and mortality due to malaria,
especially among children under five in endemic areas. ITN ownership and use have rapidly increased in Mozambique, due to scaling up of ITN
distribution efforts within the country over the seven years. The percent of households that owned at least one ITN rose by more than three-fold from
15.7% in 2007 to 51.4% in 2011. ITN access, defined as one ITN for every two people in the household also rose significantly, from 9.4% in 2007 to
37.0% in 2011. Similarly during this time, ITN use among children under five and pregnant women increased significantly, from 6.7% to 35.7% and
from 7.3% to 34.3%, respectively. With the recent programmatic shift of distribution of ITNs from target groups to universal coverage, it is important
to assess the distribution across subgroups, particularly groups from different socio-economic status to ensure equal access to and use of ITNs. This
study assessed the equity of ITN household ownership, access, and use among different socioeconomic groups in Mozambique between 2007 and
2011.
© Jon Warren
ITN Ownership and Use Indicators
• Proportion of households that own at least one ITN
• Proportion of households with at least one ITN for every two people
• Proportion of children under 5 years old who slept under an ITN the previous night
• Proportion of pregnant women who slept under an ITN the previous night
From 2007 to 2011, equity in household ownership of at least one ITN (C-Index: 0.06 in 2007 and 0.04 in 2011), ITN
household access (C-Index: 0.12 in 2007 and 0.09 in 2011), and ITN use among children under five (C-Index: -0.04 in 2007 and
0.03 in 2011) showed slight improvements in equity, while ITN use among pregnant women remained the same (C-Index:
0.06 for both years). It is important to highlight that while improvements were shown, equity in ITN household ownership,
access and use among children under five, all were fairly equitable in 2007. The results suggest that ITN scale-up efforts have
been successful, as well as equitable across the population. Despite the gains observed in coverage of ITN ownership and use
over the past years, further improvements are still needed to reach targets.