This study analyzed equity in malaria control interventions in Malawi from 2000 to 2012. It found that equity in insecticide-treated net ownership and use among households and children under five improved over this period. Equity in intermittent preventive treatment in pregnancy coverage among women also increased. However, differences in equity may exist for various interventions. Further analysis of other interventions and socioeconomic factors is needed.

1. American Society for Tropical Medicine and Hygiene
Scientific Session 138; November 5, 2014
Increased Equity in Malaria
Control Interventions in Malawi
from 2000 to 2012
Jui Shah, Lia Florey, Cameron Taylor, Rebecca Winter, Ana Claudia Franca-Koh, Samantha Herrera, Yazoume Ye

2. BACKGROUND & METHODS

3. History
Increased resources for malaria control
Milestones in Malawi
1993: Policy on intermittent preventive treatment in pregnancy
2003: Subsidized insecticide-treated nets available nationwide

4. ITN coverage

5. IPTp coverage

6. Methods
Data sources
Demographic & Health Surveys (2000, 2004, 2010)
Malaria Indicator Survey (2012)
Assessing equity over time
Lorenz concentration curves
Concentration Index (C-Index)

7. RESULTS

8. Equity in ITN ownership
0
10
20
30
40
50
60
70
80
90
100
0 10 20 30 40 50 60 70 80 90 100
Cumulative%ofhouseholdspossessingat
leastoneITN
Cumulative % of households, ranked by wealth
Equity line Lorenz Concentration curve-2004
Lorenz Concentration curve-2010 Lorenz Concentration curve-2012

9. Equity in ITN use (children)
0
10
20
30
40
50
60
70
80
90
100
0 10 20 30 40 50 60 70 80 90 100
Cumulative%ofchildrenunderfivesleeping
underanITN
Cumulative % of children under five, ranked by wealth
Equity line Lorenz Concentration curve-2000 Lorenz Concentration curve-2004
Lorenz concentration curve-2010 Lorenz Concentration curve-2012

10. Equity in ITN use (pregnant women)
0
10
20
30
40
50
60
70
80
90
100
0 10 20 30 40 50 60 70 80 90 100
Cumulative%ofpregnantwomensleeping
underanITN
Cumulative % of pregnant women, ranked by wealth
Equity line Lorenz Concentration curve-2000 Lorenz Concentration curve-2004
Lorenz concentration curve-2010 Lorenz Concentration curve-2012

11. Equity in IPTp
0
10
20
30
40
50
60
70
80
90
100
0 10 20 30 40 50 60 70 80 90 100
Cumulative%ofwomenwhoreceivedat
leasttwodosesofSP
Cumulative % of women with live birth in previous two years, ranked by wealth
Equity line Lorenz Concentration curve-2000 Lorenz Concentration curve-2004
Lorenz concentration curve-2010 Lorenz Concentration curve-2012

12. Conclusions
Equity in malaria interventions is improving in Malawi
Equity may differ for various interventions
Further analyses
Other interventions
Socioeconomic factors
Cross-country study

13. Related presentations
Improving socioeconomic equity in ITN access, ownership
and use in Rwanda from 2000-2010
Oral #1249
Worsening Socio-economic Disparities in ITN Ownership,
Access and Use from 2006 to 2011 in Angola
Poster #1228
Reduction in Disparity of Insecticide-Treated Nets
Ownership and Use among Socioeconomic Groups after
Scale up in Uganda
Poster #1617
Scaling up of ITN ownership and use in Mozambique:
Has the scale-up been equitable?
Poster #1623

14. MEASURE Evaluation is funded by the U.S. Agency for International
Development (USAID) and implemented by the Carolina Population
Center at the University of North Carolina at Chapel Hill in partnership
with Futures Group International, ICF International, John Snow, Inc.,
Management Sciences for Health, and Tulane University. Views
expressed in this presentation do not necessarily reflect the views of
USAID or the U.S. government.
MEASURE Evaluation is the USAID Global Health Bureau's primary
vehicle for supporting improvements in monitoring and evaluation in
population, health and nutrition worldwide.