Background:
Recent expansion in insecticide-treated net (ITN) distribution strategies range from targeting
pregnant women and children under five and distributing ITN at antenatal care and immunization programmes, to
providing free distribution campaigns to cover an entire population. These changes in strategy raise issues of
disparities, such as equity of access and equality in ITN use among different groups, including females and males.
Analysis is needed to assess the effects of gender on uptake of key malaria control interventions. A recent post-
universal free ITN distribution campaign survey in Kano State, Nigeria offered an opportunity to look at gender
effects on ITN use.
Methods:
A post-campaign survey was conducted three to five months after the campaign in Kano State, Nigeria from
19 October to 4 November, 2009, on a random sample of 4,602 individuals. The survey was carried out using a
questionnaire adapted from the Malaria Indicator Survey. Using binary logistic regression, controlling for several
covariates, the authors assessed gender effects on ITN use among individuals living in households with at least one ITN.
Results:
The survey showed that household ITN ownership increased more than 10-fold, from 6% before to 71% after
the campaign. There was no significant difference between the proportion of females and males living in households
with at least one ITN. However, a higher percentage of females used ITNs compared to males (57.2%
vs
48.8%). After
controlling for several covariates, females remained more likely to use ITNs compared to males (OR: 1.5, 95% CI: 1.3-1.7).
Adolescent boys remained the least likely group to use an ITN.
Conclusions:
This study reveals gender disparity in ITN use, with males less likely to use ITNs particularly among ages
15
–
25 years. The uptake of the intervention among the most at-risk group (females) is higher than males, which may
be reflective of earlier strategies for malaria interventions. Further research is needed to identify whether gender
disparities in ITN use are related to traditional targeting of pregnant women and children with malaria interventions;
however, results provide evidence to design gender-sensitive messaging for universal ITN distribution campaigns to
ensure that males benefit equally from such communications and activities.