The 31% decline in malaria incidence and 49% drop in numbers of malaria deaths in the period 2000–2012 has been largely due to the expanded use of insecticide-treated nets (ITNs). This is a highly cost–effective intervention, with nets usually provided free or at a heavily subsidized price.
Scale up of ITN use in the Region was deployed in two steps.
Between 2005 and 2008, a mortality reduction objective was pursued through targeting ITN distribution to the two most vulnerable populations – pregnant women and children less than 5 years of age. As a result, ITN distribution was linked with other effective interventions such as antenatal care services and routine immunization.
By 2009, the strategy of universal access was introduced to better scale up ITN ownership and use. Thus nationwide distribution of ITN to all populations at risk was adopted. Therefore by the end of 2012, all countries had adopted a policy on universal coverage with ITNs defined as two ITNs for two people at risk of malaria.
This better scale-up strategy resulted in ITNs being distributed free in 39 of the 44 malaria-endemic countries of the Region, including distribution through antenatal clinics in 34 countries and through Expanded Programme on Immunization clinics in 26 countries.
The percentage of households owning at least one ITN was estimated to be 53% at the end of 2012, while the population sleeping under an ITN was estimated as 36% in 2012. The proportion of the population sleeping under an ITN remained an estimated 36% in 2013. However, the percentage of children and pregnant women using nets still remains significantly below the 80% target set by the World Health Assembly.