Universal coverage of vector control in low- and middle-income countries: Evidence from demographic and health survey data.

OBJECTIVE: To the best of our knowledge, no previous study has estimated the pooled proportion estimate of universal vector control coverage in low- and middle-income countries. Therefore, this study aimed to determine the proportion of universal coverage of vector control in low- and middle-income countries via demographic health survey data. METHODS: We used demographic and health survey data from 31 LMICs from 2015-2024, comprising a weighted sample of 1,830,422 individuals. Pooled estimates were performed via the random effects meta-pro command. Data analysis was performed via STATA version 17. RESULTS: The estimated pooled survey proportion of at least one LLIN for every two persons in households across 31 malaria-endemic LMICs from 2015-2024 was 29% (95% CI: 26-32). There was between-country variation among the included countries, with the proportion ranging from 8% (95% CI: 8-9) in Mauritania to 61% (95% CI: 60-61) in Benin. The sensitivity analysis revealed 33% (95% CI: 28-38) and 12% (95% CI: 10-14) sensitivity in high- and low-malaria transmission countries, respectively. The pooled prevalence of IRS in the 12 months prior to the survey in 10 countries was 11% (95% CI 8-14). CONCLUSIONS: Nearly one in three households had at least one LLIN for every two persons. Despite the limited IRS, only approximately one in nine households had been sprayed in the 12 months prior to the survey; these households are far below the WHO target, leaving the majority vulnerable to malaria. However, we acknowledge that the universal coverage access to and use of LLINs and IRSs among at-risk populations was operationalized in this study, as households with ≥1 ITN per 2 persons or IRS in the last 12 months are a proxy for household-level access, not a true measure of universal coverage.