6.7 Proportion of children under 5 sleeping under insecticide-treated bednets

Modified on 2012/11/05 14:32 by MDG Wiki Handbook — Categorized as: Goal 6



Goal 6. Combat HIV/AIDS, malaria and other diseases
Target 6.C. Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases


This indicator is defined as the proportion of children aged 0–59 months who slept under an insecticide-treated mosquito net the night prior to the survey.

This indicator is expressed as a percentage.

An insecticide-treated mosquito net, or bednet, is a net that has been treated with insecticide within the previous 12 months or has been permanently treated. In permanently treated nets the insecticide lasts for the useful life of the mosquito net, defined as at least 20 washes and at least three years of use under field conditions.

Method of computation
The indicator is calculated by dividing the number of children aged 0–59 months who slept under an insecticide-treated mosquito net the night prior to the survey by the total number of children aged 0–59 months included in the survey and multiplying by 100.


In areas of sub-Saharan Africa with high levels of malaria transmission, regular use of an insecticide-treated net has been shown to reduce mortality in children under-five by as much as 20 per cent. This indicator will allow countries to monitor progress towards widespread use of insecticide-treated nets in efforts to limit contact between humans and mosquitoes. It is important to note, however, that malaria control programmes now advise monitoring the proportion of total population (regardless of age) sleeping under an ITN.


This indicator is calculated with data from national-level household surveys, including Multiple Indicator Cluster Surveys (MICS), Demographic Health Surveys (DHS), and Malaria Indicator Surveys (MIS). In addition, malaria modules have been added to other ongoing household surveys.

Data from sample surveys are subject to sampling errors and are generally available only every three to five years. Malaria Indicator Surveys are implemented during interim years between DHS and MICS in order to increase the frequency of malaria data collection.

The lag between the survey reference year and the actual production of data series differs among surveys. For household surveys, such as DHS and MICS, the results tend to be published within a year of field data collection.


The indicator should be disaggregated by sex, mother’s level of education, area of residence and wealth index quintiles. Estimates should be disaggregated by urban and rural areas and by sub-national populations living in areas with malaria transmission (see below).


In some countries, significant proportions of the population live in areas where malaria is not transmitted. Therefore, estimates of bed net use at the national level may underestimate use among subpopulations living in areas where malaria is transmitted. However, for many countries it is difficult to accurately define at-risk areas, and to identify households surveyed within those areas since surveys do not always geo-code households or villages where survey interviews occur. In addition, survey sample sizes are not always large enough to offer meaningful results for sub-national areas.

Another limitation is that recall bias during interviews can lead to inaccurate date reports of the last insecticide impregnation of nets. Also, information is not typically collected on whether insecticide used to treat nets was “approved” insecticide; nor is information collected on whether nets were washed after treatment, which can reduce the net’s effectiveness.

The seasonality of the surveys can also cause under-estimation of coverage as data collection is often carried out during the dry season when net use is likely at its lowest.


Gender bias could influence a child’s access to an ITN. For example, if there are not enough ITNs for everyone in the household, it is possible that preference could be shown to a boy child over a girl child in terms of who sleeps under a bed net.


The United Nations Children’s Fund (UNICEF) is the agency responsible for compiling these data and for reporting on this MDG indicator at the international level. Data are compiled in the UNICEF global malaria databases. Data incorporated in these databases are derived from national-level household surveys, including MICS, DHS and MIS. No adjustments are made to the data compiled from DHS, MICS, MIS or other surveys that are statistically sound and nationally representative.

The data are reviewed in collaboration with the Roll Back Malaria (RBM) partnership, which was launched in 1998 by the World Health Organization (WHO), UNICEF, the United Nations Development Programme (UNDP) and the World Bank (WB).

Regional and global estimates are based on population-weighted averages weighted by the total number of children under five years of age. These estimates are presented only if available data cover at least 50 per cent of total children under five years of age in the regional or global groupings.

Because nationally-representative data on insecticide treated mosquito net use are collected through large-scale household surveys, and these figures are not modified, there would normally not be discrepancies between global and national figures. However, there could be discrepancies if national figures are calculated based only on those geographic areas with malaria transmission, or if national figures do not fit the standard indicator definition used for global reporting.




ROLL BACK MALARIA PARTNERSHIP (2008). Global Malaria Action Plan. Geneva. Available from http://www.rollbackmalaria.org/gmap/.

UNITED NATIONS CHILDREN’S FUND and ROLL BACK MALARIA PARTNERSHIP (2007). Malaria and Children: Progress in Intervention Coverage. New York. Available from http://www.childinfo.org/files/malaria_and_children.pdf.

WORLD HEALTH ORGANIZATION (2009). World Malaria Report 2009. Geneva. Available from http://www.who.int/malaria/publications/atoz/9789241563901/en/index.html.

WORLD HEALTH ORGANIZATION (2010). World Malaria Report 2010. Geneva. Available from http://www.who.int/malaria/publications/atoz/9789241564106/en/index.html.

WORLD HEALTH ORGANIZATION (2011). World Malaria Report 2011. Geneva. Available from http://www.who.int/malaria/world_malaria_report_2011/en/.

WORLD HEALTH ORGANIZATION, ROLL BACK MALARIA PARTNERSHIP and UNITED NATIONS CHILDREN’S FUND (2005). World Malaria Report 2005. Geneva. Available from http://www.who.int/malaria/publications/atoz/9241593199/en/index.html.

WORLD HEALTH ORGANIZATION and UNITED NATIONS CHILDREN’S FUND (2003). Africa Malaria Report 2003. Geneva. Available from http://www.who.int/malaria/publications/atoz/whocdsmal20031093/en/index.html.