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Additional file 2: Table S1. Coverage of nets in Musoma district by net source.

Additional file 1.

BACKGROUND: The Government of Tanzania is the main source of long-lasting insecticidal nets (LLINs) for its population. Mosquito nets (treated and untreated) are also available in the commercial market. To sustain investments and health gains in the fight against malaria, it is important for the National Malaria Control Programme to monitor LLIN coverage especially in the years between mass distributions and to understand what households do if their free nets are deemed unusable. The aim of this paper was to assess standard LLIN indicators by wealth status in Tanzania in 2013, 2 years after the last mass campaign in 2011, and extend the analysis to untreated nets (UTNs) to investigate how households adapt when nets are not continuously distributed. METHODS: Between October-December 2013, a household survey was conducted in 3398 households in eight districts in Tanzania. Using the Roll Back Malaria indicators, the study analysed: (1) household net ownership; (2) access to nets; (3) population net use and (4) net use:access ratio. Outcomes were calculated for LLINs and UTNs. Results were analysed by socio-economic quintiles and by district. RESULTS: Only three of the eight districts had household LLIN ownership of more than 80%. In 2013, less than a quarter of the households had one LLIN for every two people and only half of the population had access to an LLIN. Only the wealthier quintiles increased their net ownership and access to levels above 80% through the addition of UTNs. Overall net use of the population was low (LLINs: 32.8%; UTNs: 9.5%) and net use:access ratio was below target level (LLINs: 0.66; UTN: 0.50). Both measures varied significantly by district. CONCLUSIONS: Two years after the last mass campaign, the percentage of households or population with access to LLINs was low. These findings indicate the average rate at which households in Tanzania lose their nets is higher than the rate at which they acquire new nets. The wealthiest households topped up their household net ownership with UTNs. Efforts to make LLINs available through commercial markets should be promoted, so those who can afford to buy nets purchase LLINs rather than UTNs. Net use was low around 40% and mostly explained by lack of access to nets. However, the use:access ratio was poor in Mbozi and Kahama districts warranting further investigations to understand other barriers to net use.

Microsporidian parasites are being considered as alternatives to conventional insecticides for malaria control. They should reduce malaria transmission by shortening the lifespan of female mosquitoes and thus killing them before they transmit malaria. As the parasite replicates throughout the mosquito's life, it should have little detrimental effects on young mosquitoes, thus putting less selection pressure on the hosts to evolve resistance. Here, we examined these expectations for the microsporidian Vavraia culicis on Anopheles gambiae Giles sensu stricto mosquitoes under varying environmental conditions. Infection by the microsporidian delayed pupation by 10%, decreased fecundity by 23% and reduced adult lifespan by 27%, with higher infectious doses causing greater effects. The decrease of lifespan was mostly because of an increase of the mortality rate with age. Similarly, the parasite's effect on mosquito fecundity increased with the mosquitoes’ age. Neither infection nor food availability affected juvenile survival. Thus, as V. culicis reduced the longevity of A. gambiae (s.s.), yet affected mortality and fecundity of the young mosquitoes only slightly, the microsporidian is a promising alternative to insecticides for effective malaria control that will impose little evolutionary pressure for resistance.