Mosquito nets and the poor: can social marketing redress inequities in access?


Rose Nathan (corresponding author), Hassan Mshinda and Honorati Masanja, Ifakara Health Research and Development Centre, PO Box 53, Ifakara, Tanzania. E-mail:,,
Joanna R.M. Armstrong Schellenberg, London School of Hygiene and Tropical Medicine, Keppel Street, London WC 1E 7HT, UK. E-mail:
Don de Savigny, Christian Lengeler and Marcel Tanner, Swiss Tropical Institute, Postfach. 4200 Basel, Switzerland. E-mail:,,
Cesar G. Victora, Federal University of Pelotas, CP 464, 96001–970, RS, Brazil. E-mail:


Treated mosquito nets are a practical malaria control tool. However, implementation of efficient delivery mechanisms remains a challenge. We investigated whether social marketing of treated mosquito nets results in decreased equity in rural Tanzania, through household surveys before the start of a social marketing programme and 3 years later. About 12 000 household heads were asked about ownership of nets and other assets including a tin roof, radio, or bicycle. A socio-economic status score was developed for each household. Net ownership was calculated for households in each quintile of this score, from poorest to least poor. In 1997, about 20% of the poorest households and over 60% of the least poor households owned a mosquito net. Three years later, more than half of the poorest households owned a net, as did over 90% of the least poor: the ratio of net ownership among the poorest to least poor increased from 0.3 in 1997 to 0.6 in 2000. Social marketing in the presence of an active private sector for nets was associated with increased equity.