This study assessed changes in disparities in insecticide-treated net (ITN) ownership and use among socioeconomic groups in Uganda between 2006 and 2011. It found significant increases in household ITN ownership (from 16% to 60%) and children under 5 sleeping under an ITN (from 10% to 43%). Disparities between wealth quintiles were reduced, as shown by a decrease in the concentration index from 0.11 to 0.02 for household ownership and from 0.04 to 0.01 for children's use. This achievement is likely due to Uganda's shift to universal coverage and free mass distribution campaigns of long-lasting insecticidal nets from 2009. However, further efforts are needed to increase overall coverage and reduce

1. Background
Reduction in Disparity of Insecticide-Treated Nets Ownership and Use among
Socioeconomic Groups after Scale-up from 2006 to 2011 in Uganda
Methods
The increase in funding for malaria control in the past decade resulted in an increase in Insecticide-Treated Net (ITN) ownership
and use in many countries in sub-Saharan Africa, particularly in Uganda. However, with the shift in programmatic focus from target
groups to universal coverage there is a need to ensure equal access and use of ITNs for all sub-populations regardless of their
socioeconomic status. This study assessed change in disparity in ITN ownership and use among different socioeconomic groups in
Uganda between 2006 and 2011.
Results
• 2006 and 2011 Uganda Demographic and Health Surveys (DHS)
•DHS 2006 (Fieldwork: May–October 2006)
•DHS 2011 (Fieldwork: End of June–December 2011)
• Proportion of households with at least one ITN
• Proportion of children under 5 years old who slept under an ITN the
night before the interview
• Lorenz Concentration Curves and the Lorenz Concentration Index (C-Index) were used to
assess equity in household ITN ownership and ITN use among children under five across
household wealth quintiles. Separate analyses were run for the 2006 and 2011 DHS surveys.
• While the C-Curve graphically presents the gap in relation to an equity line, the C-Index,
which is directly related to the Lorenz Concentration Curve, quantifies the degree of socio-
economic related inequality in a health variable. C-Index values range between -1 to 1. A
value of 0 suggests no difference in ownership and use among different socioeconomic
groups. C-Index is greater than 0 (<0) if the outcome is disproportionately concentrated on
population from the highest (lowest) wealth quintile.
Conclusion
Household ownership of at least one ITN rose significantly from 16% (2006) to 60% (2011) (Figure 1). Similarly, ITN use among
children under five was very low (10%) in 2006 and increased substantially to 43% in 2011 (Figure 2). The increase in ITN ownership
between 2006 and 2011 was associated with significant reduction in inequity between wealth quintiles from C-Index 0.11 (95% CI:
0.08;0.34) in 2006 to C-Index 0.02, (95% CI: 0.01;0.04) in 2011 (Figure 3). Similarly the disparity in ITN use among children under five
from different wealth quintiles greatly declined from 2006 (C-Index: 0.04, 95% CI:-0.10;0.19) to 2011 (C-Index: 0.01, 95% CI:-
0.04;0.06) (Figure 4). This achievement is probably due to the shift from targeted ITN distribution to universal coverage in 2009 which
led to free mass distribution campaigns of Long-lasting Insecticidal Nets (LLINs), with 7.2 million LLINs distributed by 2010. This
achievement in parity between wealth quintiles should be sustained; however, efforts are needed to further increase overall ITN
ownership coverage and use in Uganda. This is achievable through additional free mass campaign distribution combined with
traditional distribution channels.
Acknowledgments
This study was made possible by support
from the U.S. Agency for International
Development (USAID) under the terms of
Cooperative Agreement GPO-A-00-03-00003-
00. The opinions expressed are those of the
authors and do not necessarily reflect the
views of USAID, or the United States
Government.
Data Sources
Analysis
Cameron Taylor1, Ana Claudia Franca- Koh2, Samantha Herrera2, Jui Shah2, Lia Florey1, Yazoume Ye2
1DHS Program, ICF International 2MEASURE Evaluation, ICF International
Figure 1: Household ownership of ITNs
© Bonnie Gillespie, courtesy of Photoshare
Indicators
16
60
2006 2011
% of households that owns ≥ 1 ITN
0
10
20
30
40
50
60
70
80
90
100
0 10 20 30 40 50 60 70 80 90 100
Cumulativepercentageofwealthquintiles
amonghouseholdsowningatleast1ITN
Cumulative percentage of wealth quintiles in sample
Equity line 2006 2011
10
43
2006 2011
% children <5 used ITN
Source: Demographic Health Surveys (DHS)
0
10
20
30
40
50
60
70
80
90
100
0 10 20 30 40 50 60 70 80 90 100
Cumulativepercentageofwealthquintiles
amongchildrenunder-fiveusingITNs
Cumulative percentage of wealth quintiles in sample
Equity Line 2006 2011
Figure 3: Equity of household ownership of ITNs Figure 4: Equity of children under five using ITNs
Figure 2: ITN use among children under five
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