ArticleTropical medicine and health2026
Who uses the only mosquito net? Sex and age disparities.
Article in Tropical medicine and health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe percentage of the population sleeping under insecticide-treated nets (ITN) increased in sub-Saharan Africa from 3 to 59% between 2000 and 2023. However, achieving universal coverage remains far from realized. Because ITNs are the most effective tools for preventing malaria, it is important to identify barriers to their use and maximize their protective effects. We investigated sex and age disparities in ITN use in a region of western Kenya where Plasmodium transmission remains high.
methodsWe examined sex- and age-related disparities in ITN use under two scenarios: households with sufficient ITNs and those with insufficient ITNs, focusing specifically on households possessing only one ITN. Residents were asked whether they had slept under an ITN the previous night, as well as their age and sex. They were also tested for P. falciparum (PF) infection using a rapid diagnostic test (RDT).
resultsThe proportion of residents using ITNs was 91% in households with sufficient ITNs and 66% in households with insufficient ITNs. ITN availability averaged 1.7 persons per net (SD = 0.35; n = 1445) in households with sufficient ITNs and 4.4 persons per net in households with insufficient ITNs. A generalized additive mixed model revealed non-linear relationships between ITN use and age in households with insufficient ITNs. Adult females aged 19-40 years and infants were consistently prioritized, whereas residents aged 3-18 years exhibited lower levels of ITN use. In contrast, this pattern was not evident in households with sufficient ITNs. Among households possessing only one ITN, RDT-positive prevalence was below 15% among infants and adult females, whereas it exceeded 30% among young males and females. Overall, ITN use was associated with a 20% reduction in PF infection.
conclusionsIn households with insufficient ITNs, adult females and infants were typically prioritized for ITN use. Given that PF infection was negatively associated with ITN use, such prioritization represents an appropriate allocation strategy under conditions of limited net availability. However, the low level of ITN use and the high prevalence of PF infection among young residents remain a substantial concern.
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