Using schoolchildren's reports of bed net use monitored by schoolteachers as a proxy of community coverage in malaria endemic areas of Uganda.

OBJECTIVE: Community-based information on the delivery and use of health interventions is important to monitor the effectiveness of the Roll Back Malaria programme. However, community surveys to determine coverage for insecticide-treated bed nets are time-consuming and costly. We wanted to assess whether schoolchildren's reports of household ownership of a bed net and coverage among high-risk groups monitored by schoolteachers through a questionnaire could be used as a proxy of household ownership of bed net and coverage at community level, for routine monitoring of malaria control programmes.
METHOD: 3602 schoolchildren in 39 randomly selected schools and 2798 heads of households in 39 villages were interviewed about their use of either insecticide-treated or untreated bed nets.
RESULTS: The overall household ownership of any kind of bed net was 35% in school surveys and 31% in household surveys (P < 0.001). Household ownership of insecticide-treated nets was 23% and 22%, respectively (P = 0.4); household ownership of untreated nets was 15% and 9%, respectively (P < 0.001). There was significant correlation between estimates of any bed net and treated net ownership based on household surveys and estimates based on school surveys (P < 0.01 for both).
CONCLUSIONS: In areas with high school attendance rates, schoolchildren's report of bed net use monitored by schoolteachers through a questionnaire could give a good approximation of household ownership of bed net at community level with about +/-5% difference between community and school surveys. However, further operational research is required to investigate how the feasibility of large-scale implementation might be, by sending the questionnaire to the schools through routine channels and by independent handling by the school administration and teachers.