Title: Deciding the number of ITNs per household
Course: Communicable Diseases Part 1 - Ethiopia (Full)

Deciding the number of ITNs per household

The first step in ITN programmes is making the nets available to the community. Several methods have been tried to make ITNs available to a large number of people in malaria-risk areas. They included encouraging people to buy nets from the market at full price, making nets available at subsidised or reduced prices, and credit schemes.

However, none of these methods was effective in scaling up coverage of nets in poor communities like those in rural Ethiopia. Therefore the current policy of the malaria programme in Ethiopia is to distribute nets free of charge to all population groups, using the methods described in Section 11.5 of this study session.

The objective is to ensure that communities living in malaria-risk villages have enough nets to cover all sleeping sites in the household. In Ethiopia, the strategy since 2005 has been to provide, on average, two ITNs per household in all malaria-risk areas. Between 2005 and 2007 this strategy provided access to ITNs to an estimated 10 million households, or approximately 50 million people, living in malaria-risk areas.

Approximately how many ITNs were distributed in Ethiopia between 2005 and 2007?

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10 million households received ITNs. Households received on average two ITNs per family; so around 20 million ITNs were distributed.

Although an average of two ITNs per household is used for logistical or planning purposes, it does not mean that every household will get two nets. The number of ITNs a household will receive depends on family size, and is based on the general principles shown in Table 11.1.

Table 11.1 General guide to determine the number of nets per household based on family size.

Family size | Number of ITNs to be supplied
1 to 2 | 1
3 to 5 | 2
6 to 7 | 3
More than or equal to 8 | 4

The number of sleeping sites in the household must also be taken into account during distribution of the nets. For example, even if there are only two people in the household, if they sleep separately in two different sleeping sites, the household needs two nets — not just one as indicated in Table 11.1. You must also make sure that pregnant mothers and children under five years old always get priority access to ITNs, even if this means supplying extra ITNs to the household.

Why should children and pregnant mothers get special attention during ITN distribution?

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Because children and pregnant mothers are at higher risk of getting ill and dying of malaria (Study Session 6).