Mapping of access and usage of insecticide-treated nets in Nigeria

Malaria remains a major public health challenge in Nigeria with children under five years of age and pregnant women possessing the highest risk. Preventive efforts including indoor residual spraying (IRS) and insecticide-treated nets (ITN) have been implemented over the years but issues such as limited funding, low net coverage, and cultural barriers have hindered progress. This study analyses ITN ownership and usage trends across Nigeria to assess local-level variations and differences based on household size. This study used data from the Nigeria Demographic and Health Survey (NDHS) and the Nigeria Malaria Indicators Survey (NMIS) to analyse access and usage trends over seven distinct years (2003, 2008, 2013, 2018, 2010, 2015, and 2020). A Bayesian spatio-temporal model was applied to capture variations in access and usage. The model was estimated using Integrated Nested Laplace Approximation (INLA). The results highlight significant geographic and temporal variations in access to and use of bed nets, with notable disparities between northern and southern regions. For women of reproductive age, access to bed nets increased over time, particularly in northern states; however, usage remained generally low, especially in the south. Pregnant women exhibited similar patterns, with higher access in northern states but low usage overall, particularly in the southern regions. For children under five, usage increased in some northern states but remained low in the south, creating a clear north–south divide. Additionally, bed net availability at the household level remains low overall. The study underscores the need for targeted public health interventions to address regional disparities in access and use of bed nets in Nigeria. Promoting consistent use of bed nets through tailored awareness campaigns and overcoming cultural barriers will be crucial in reducing malaria burden.