Who buys insecticide-treated nets? Implications for increasing coverage in Nigeria.

OBJECTIVES: To investigate the determinants of purchase of insecticide-treated nets (ITNs) and explore the policy implications of the findings for ITN programmes. METHODS: Two surveys were conducted 1 month apart in three villages. The first survey was used to determine stated willingness to pay (WTP) and respondent practices regarding untreated nets and ITNs. The second survey was accompanied by actual sales of ITNs. Pre-tested interviewer-administered questionnaires using three contingent valuation method (CVM) question formats, namely the bidding game (BG), binary with follow up (BWFU) and a structured haggling technique (SH), were administered to different sub-samples of the respondents. The nets were sold at a price of 350 Naira (US dollars 1 = 110 Naira). Bivariate analysis and logistic regression were used to investigate the factors that explain actual WTP. FINDINGS: While 15/158 (9.5%), 21/166 (12.7%) and 35/144 (24.3%) of the respondents in the BG, BWFU and SH stated WTP amounts that were equal to or greater than the price of the net, 19.6%, 24.7% and 24.3% of respondents actually purchased the nets in the three groups respectively. Lower socioeconomic groups were less likely to purchase the nets, while households with a recent attack of malaria and those that stated higher WTP amounts were more likely to purchase nets. Stated WTP was positively associated with actual WTP (p < 0.01). Increased distance of the respondents to the ITNs sales point decreased net purchases (p < 0.05). CONCLUSIONS: Stated WTP was a good predictor of actual WTP. ITNs distribution strategies that will decrease time and travel costs to households are needed to increase net coverage. Also, ITNs financing mechanisms are needed that will ensure that lower socioeconomic groups and those at greater risk of malaria are protected. Governments and donors should take the lead to ensure that ITNs programmes are equitable.