Percent of pregnant women who report having slept under an ITN the previous night

Percent of pregnant women who report having slept under an ITN the previous night

Percent of pregnant women who report having slept under an ITN the previous night

This indicator measures the level of use of insecticide-treated mosquito net (ITNs) by pregnant women at risk for malaria at the population level. An ITN is:

  • a factory treated net that does not require any re-treatment, called a long-lasting insecticide net (LLIN)
  • a net that has been soaked with insecticide within the past 12

This indicator is calculated as:

(Number of pregnant women at risk for malaria who reported having slept under an ITN the night preceding the survey / Total number of pregnant women at risk for malaria who reside within surveyed households) x 100

Data Requirement(s):

Number of pregnant women residing in survey population and a household listing of those women who slept under an ITN the previous night

Household surveys including malaria indicator surveys, multiple indicator cluster surveys, demographic and health surveys (DHS) and other nationally representative surveys

Information on use of ITNs by pregnant women is best collected through household surveys, because data from health facilities are not representative of the population at large, including women who do not attend antenatal clinics. In countries where only part of the population is at endemic risk, ITNs are relevant only for households in high risk areas. Therefore, surveys should be conducted to take a representative sample of the area at risk, and the report should clearly describe the sampling design and definition of population-at-risk used. Alternatively, in such countries, areas without endemic malaria must be identified so that they can be excluded from this indicator during analysis of data collected through nationally representative household surveys.

In areas of stable endemic malaria, where most malaria infections in adults are asymptomatic, use of ITNs by pregnant women has been shown to reduce malaria-related maternal morbidity significantly and improve birth outcomes, including the incidence of low birth weight. A study in an area of high malaria transmission in Kenya revealed that women protected by ITNs every night during their first four pregnancies produced 25% fewer underweight or premature babies (Roll Back Malaria Partnership, 2006).

Including all pregnant women in a household survey is difficult because many women either do not know that they are pregnant or do not want to divulge the information. Thus, there may be some bias if reluctance to discuss pregnancy is also associated with first birth, adolescence and other demographic factors.

Even if the woman reports having slept under her mosquito net the previous night, she may not be able to recall if it has been properly treated within the past 12 months and therefore, reliable estimates of net re-treatment status might not be obtained.

The results might be biased by the seasonality of survey data collection, which is usually done during the dry season when net use is likely to be at its lowest.

Lastly, in countries in which only part of the population is at risk for malaria, national coverage might give an underestimate of effective coverage of populations at risk.

newborn (NB), malaria, behavior, safe motherhood (SM)

WHO. Malaria in Pregnancy: Guidelines for measuring key monitoring and evaluation indicators. 2007.

Roll Back Malaria Partnership. A Guide to Gender and Malaria Resources. 2006.

Roll Back Malaria Partnership. Guidelines for Core Population-Based Indicators. MEASURE Evaluation: Calverton, MD. 2011.