Evaluation of household coverage with long-lasting insecticidal nets in central Côte d'Ivoire.

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. 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 5 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.