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This study uses data from Demographic and Health Surveys (DHS) and Malaria Indicator Surveys (MIS) conducted in Mali from 2006 to 2018 to assess regional trends in two key areas of malaria prevention: the provision and use of insecticide-treated nets (ITNs), and protection against malaria in pregnancy. Trends during the study period reflect the increased investment in these two areas. While comparison of national trends is limited by the exclusion of the northern regions in 2012-13 and 2015, and the security concerns that affected sampling in Kidal in 2006, 2010, and 2018, the regional trends between surveys support an overall positive and significant improvement in the coverage of ITNs and intermittent preventive treatment in pregnancy (IPTp) throughout the country.
Trend analysis shows positive changes between the 2006 and 2018 surveys in ITN indicators, in response to ITN distribution through mass campaigns, routine antenatal care (ANC) and childhood immunizations, and sales of ITNs at shops and markets. The use of ITN by pregnant women and children under age 5 has consistently been at least 70% since 2010, and population ITN use is nearly equal to population access to an ITN, which reflects a strong culture of ITN use. Although the percentage of women who received at least three doses of sulfadoxine-pyrimethamine (SP)/Fansidar (IPTp3) coverage has significantly increased since 2006, and has continued to increase with each survey, overall rates of IPTp3 remain below 30%, with significant gains from 2015 to 2018 limited to the Bamako and Koulikoro regions. In 2018, fewer than half of women who made at least four ANC visits received at least three doses of sulfadoxine-pyrimethamine (SP). This reflects significant missed opportunities to provide IPTp. However, since 2012-13, nationwide gains in IPTp3 appear to be due primarily to an increase in IPTp provision, rather than increased ANC attendance. The rates of ANC4 have not changed significantly since 2012-13 in any region. This suggests that the increased investments in provider in-service training, refresher training, and supply chain management for SP are likely responsible for the progress in IPTp3 rates.
There are clear disparities in ITN and IPTp coverage between the central/southern and the northern regions. Since 2012, insecurity in the northern areas has impeded implementation of malaria prevention activities. In 2018, Tombouctou and Gao lagged behind the other regions in all coverage indicators, although net use indicators were as strong as in the rest of the country.