NetMark is an eight-year project funded by the United States Agency for International Development (USAID) to prevent malaria by increasing access to and appropriate use of ITNs in sub-Saharan Africa. NetMark addresses all three components of the Roll Back Malaria Strategic Framework for Scaling-up of ITNs: commercial expansion, short-term targeted subsidies or market priming activities, and long-term targeted subsidies to vulnerable groups in order to achieve equity. NetMark aims both to develop a sustainable commercial market and to ensure that vulnerable groups have access to affordable ITNs. In addition to increasing the proportion of households that own ITNs, the project also seeks to increase nightly use of treated nets, especially by children under five years of age and pregnant women; and increase the proportion of net owners who (if not using a long-lasting ITN) regularly treat their nets with insecticide. NetMark is managed by the Academy for Educational Development (AED); its partners include over 40 national and international insecticide and net manufacturers, product distributors, and advertising companies. NetMark has programs in Ethiopia, Cameroon, Ghana, Mali, Nigeria, Senegal, Uganda, and Zambia.
As part of a comprehensive research agenda that includes both market and behavioral research, NetMark conducts periodic household surveys on ITN-related topics in selected countries. The survey provides quantitative information useful to the public health community as well as to the commercial sector. It covers:
- Awareness and ownership of mosquito nets and ITNs
- Use of nets and treated nets by vulnerable groups
- Net treatment practices
- Characteristics of nets owned
- Knowledge and beliefs about mosquitoes and malaria; exposure to information about ITNs
- Perceptions of treated and untreated mosquito nets
- Consumer preferences regarding mosquito nets
- Use of other mosquito control products
Kind of Data
Sample survey data [ssd]
Unit of Analysis
The survey examined the extent as well as pattern of net and ITN ownership and use, in terms of household location and socio-economic status (SES). A series of questions was asked to determine whether each net owned was ever treated and whether it was currently treated - thereby qualifying it as an ITN. Baby nets were asked about separately. Because there has not been a tradition of net use in Ethiopia, a question was added to the Ethiopia survey that was not included in other countries asking whether the respondent had heard of nets, before asking about net ownership and use.
The survey conducted in the following areas/ regions of the country: Bahir Dar, Nazret, Dire Dawa, Dessie and Awassal.
Producers and sponsors
Academy for Educational Development
US Agency for International Development
Funding the study
Plan abd Procedure
The sample was composed of 1000 Ethiopian households. Respondents were women of reproductive age (15-49) who were mothers or guardians of children under five years of age.
In the interest of comparability, the same procedure was used in all countries surveyed. A multistage sampling procedure was used to select respondents, as follows.
1- Selection of primary sampling units: Purposive sampling was used to select the five primary sites: Bahir Dar, Nazret, Dire Dawa, Dessie and Awassa. Only sites in malarious areas were selected. In all other countries surveyed, the capital city was included; however, since malaria is not a significant problem in Addis Ababa, the capital was not included for the Ethiopia survey. Further criteria included geo-ethnic diversity and the potential for NetMark to be active in product distribution and/or programs to provide targeted subsidies for vulnerable groups. In each site, the target sample was 200: 80 respondents from the urban center, and 120 households from up to 200 kilometers from the urban center. Therefore, the sample has an urban-rural ratio of 40:60. The sample is proportionately more urban than that of the country as a whole. The 1994 census was 14% urban and the Demographic and Health Survey of 2000 was 26% urban.
2- Selection of sampling points: Within each of the five sites, 20 sampling points (villages or urban neighborhoods) were randomly selected from electoral lists using quota sampling: 8 from within the city (urban) and 12 from within 200 kilometer radius from the city (rural). Ten households per sampling point were selected for inclusion. This stratification scheme was designed to meet the purposes of the evaluation. Since a key objective of NetMark is to increase ownership of ITNs across the socio-economic spectrum, it was essential to include urban centers with the potential to be reached by product distribution systems, as well as include households located at varying distances from the urban center where lower socio-economic status (SES) individuals typically reside.
3- Selection of households: Ten interviews were conducted per sampling point, each in a different household. For each sampling point, a starting point (a fixed landmark or address) and the direction from which to start the data collection were chosen. Interviewers were instructed to go to the starting point and walk in the chosen direction until they located a residence with a qualified respondent. After a successful interview, interviewers were instructed to skip five residences (or less if residences were far apart) and seek another qualified respondent.
4- Selection of eligible respondents: An eligible respondent for the evaluation was a female 15-49 years old who was the parent or guardian of a child less than five years old, i.e., aged 0-4. Females aged 15-49 were selected to maximize the sample size for calculating the proportion of females of reproductive age sleeping under a net. Similarly, only those women who had a child under five were included, to maximize the sample size for calculating the proportion of children under five sleeping under a net.
Dates of Data Collection
Data Collection Mode
Data Collection Notes
The data were collected from August 20 to September 13, 2004, during the rainy season and just prior to the period of peak malaria transmission. The Ethiopia questionnaire was based on that used in initial surveys conducted during the year 2000. Most of the questions are the same as those used in other countries, in order to enable comparability of data. However, the questionnaire was pre-tested in Ethiopia, and minor adjustments made as a result.
The research was designed and carried out by NetMark, which contracted with Research International South Africa to organize and manage the fieldwork, and to enter the data and produce preliminary tables. NetMark staff conducted further analyses and wrote the report.