Abstract:
Background: In Tanzania, the distribution and coverage of insecticide-treated nets (ITNs) is inequitable. Arguments
about the most effective and equitable approach to distributing ITNs centre around whether to provide ITNs free
of charge or continue with existing social marketing strategies. The Government has decided to provide free ITNs
to all children under five in the country. It is still uncertain whether this strategy will achieve equitable coverage
and use. This study examined the equity implications of ownership and use of ITNs in households from different
socioeconomic quintiles in a district with free ITNs and a district without free ITN distribution.
Methods: A cross-sectional comparative household survey was conducted in two districts: Mpanda in Rukwa
Region (with free ITN roll out) and Kisarawe in Coast region (without free ITNs). Heads of 314 households were
interviewed in Mpanda and Kisarawe. The concentration index was estimated and regression analysis was
performed to compare socioeconomic inequalities in ownership and use of ITNs.
Results: Ownership of ITNs increased from 29% in the 2007/08 national survey to 90% after the roll out of free
ITNs in Mpanda, and use increased from 13% to 77%. Inequality was considerably lower in Mpanda, with nearly
perfect equality in use (concentration index 0.009) and ownership (concentration index 0.010). In Kisarawe,
ownership of ITNs increased from 48% in the 2007/08 national survey to 53%, with a marked inequality
concentration index 0.132. ITN use in Kisarawe district was 42% with a pro rich concentration index of 0.027.
Conclusions: The results shed some light on the possibilities of reducing inequality in ownership and use of ITNs
and attaining Roll Back Malaria and Millennium Development Goals through the provision of free ITNs to all. This
has the potential to decrease the burden of disease and reduce disparity in disease outcome.
