Insecticide-treated net ownership and usage in Niger after a nationwide integrated campaign

OBJECTIVES In December 2005 and March 2006, Niger conducted nationwide integrated campaigns to distribute polio vaccine and long lasting insecticide-treated nets (LLINs) to children < 5 years of age. We evaluated the campaign effectiveness, net retention, insecticide-treated net (ITN) ownership, and usage. METHODS Two nationwide cross-sectional surveys in January 2006 (dry season) and September 2006 (rainy season), using a stratified two-stage cluster sampling design. We mapped selected communities, selected households by simple random sampling, and administered questionnaires by interviewers using personal digital assistants. RESULTS The first survey showed that ITN ownership in all households was 6.3% prior to the campaign, increasing to 65.1% after the campaign in the second survey. The second survey also showed that 73.4% of households with children < 5 received an LLIN and that 97.7% of households that received >= one LLIN retained it. The wealth equity ratio for ITN ownership in households with children < 5 increased from 0.17 prior to the campaign to 0.79 afterward. During the dry season, 15.4% of all children < 5 and 11.3% of pregnant women slept under an ITN, while during rainy season, 55.5% of children < 5 and 48.2% of pregnant women slept under an ITN. CONCLUSIONS Free distribution during the integrated campaign rapidly increased ITN ownership and decreased inequities between those in the highest and lowest wealth quintiles. Retention of ITNs was very high, and usage was high during malaria transmission season. However, ITN ownership and usage by vulnerable groups continues to fall short of RBM targets, and additional strategies are needed to increase ownership and usage.