{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T07:04:08Z","timestamp":1789369448049,"version":"build-2803163510"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100004417","name":"Global Fund to Fight AIDS, Tuberculosis and Malaria","doi-asserted-by":"publisher","award":["TO 2023-005892"],"award-info":[{"award-number":["TO 2023-005892"]}],"id":[{"id":"10.13039\/100004417","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infect Dis Poverty"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Papua New Guinea (PNG) completed five nation-wide mass distributions of insecticide-treated nets (ITNs) in the last 15\u00a0years. Despite this considerable achievement, malaria cases in PNG are rising. Recent national-level surveys indicate unusually low ITN coverage and usage indicators, raising concerns about the continued effectiveness of this core intervention. Significant knowledge gaps remain around factors impacting ITN effectiveness in PNG, limiting interpretation of the role of ITNs in the context of rising malaria cases. This study assessed how ITN ownership and usage indicators in three of the highest burden provinces changed after the most recent mass distribution in 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Cross-sectional surveys involving a target of 60 randomly selected households per village were conducted in 12 villages in East Sepik, West Sepik and Madang province and collected data on 5671 individuals belonging to 815 households. The surveys were conducted within 1\u20134\u00a0months before (September\u2013December 2023), and 5\u20137\u00a0months after (May\u2013October 2024) programmatic ITN mass distribution. Data were collected through household questionnaires, visual inspection of all ITNs present in households, and matching of ITNs to individual users. Household-level and person-level indicators of ITN ownership and use were evaluated using generalised linear mixed effects models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Distribution targets were achieved in two provinces but were missed by 38\u201342% in the third province. Overall, 94.8% of houses owned at least one ITN, before, and 99.4% after distribution (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). The mean number of ITNs per person rose from 0.55 to 0.64 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), and universal coverage increased from 60.0% before to 69.9% after distribution (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.002). ITN distribution resulted in 61.1% of new ITNs in use and 55.5% of old ITNs lost to follow-up at the post distribution survey. Distribution increased ITN usage evenly across genders and ages and did not change existing overall age- or gender-related usage and sharing patterns.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ITN ownership and use are high and sustained by 3-yearly distributions in the three provinces. ITN use was primarily driven by availability, with no further increases observed beyond universal coverage. Results also highlight the importance of post-distribution surveillance to confirm that programme targets are achieved.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40249-026-01494-x","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T06:16:50Z","timestamp":1789366610000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of mass distribution on insecticide-treated net coverage and usage in three high burden malaria provinces of Papua New Guinea"],"prefix":"10.1186","volume":"15","author":[{"given":"John B.","family":"Keven","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Koinari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Pombreaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micah","family":"Muri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celine","family":"Figa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Are","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Solomon","family":"Lagur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Cowan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice R.","family":"Egid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Kisomb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petrina","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Ome-Kaius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lincoln","family":"Timinao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leanne J.","family":"Robinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moses","family":"Laman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Karl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"1494_CR1","unstructured":"National Health Information System. Papua New Guinea National Department of Health, Port Moresby. 2026. http:\/\/www.healthpng.com. Accessed 17 Nov 2025."},{"key":"1494_CR2","unstructured":"World Malaria Report 2024. World Health Organization, Geneva. 2024. https:\/\/www.who.int\/teams\/global-malaria-programme\/reports\/world-malaria-report-2024. Accessed 17 Nov 2025."},{"key":"1494_CR3","unstructured":"Chairman's Statement of the 9th East Asia Summit. https:\/\/www.dfat.gov.au\/international-relations\/regional-architecture\/eas\/Pages\/chairmans-statement-of-the-9th-east-asia-summit. Accessed 17 Nov 2025."},{"key":"1494_CR4","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-020-17456-2","volume":"11","author":"R Vinit","year":"2020","unstructured":"Vinit R, Timinao L, Bubun N, Katusele M, Robinson LJ, Kaman P, et al. Decreased bioefficacy of long-lasting insecticidal nets and the resurgence of malaria in Papua New Guinea. Nat Commun. 2020;11:3646.","journal-title":"Nat Commun"},{"key":"1494_CR5","unstructured":"The alliance for malaria prevention net mapping project. https:\/\/netmappingproject.allianceformalariaprevention.com\/. Accessed 17 Nov 2025."},{"key":"1494_CR6","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0000747","volume":"2","author":"O Seidahmed","year":"2022","unstructured":"Seidahmed O, Jamea S, Kurumop S, Timbi D, Makita L, Ahmed M, et al. Stratification of malaria incidence in Papua New Guinea (2011\u20132019): contribution towards a sub-national control policy. PLoS Glob Public Health. 2022;2:e0000747.","journal-title":"PLoS Glob Public Health"},{"key":"1494_CR7","doi-asserted-by":"publisher","first-page":"695","DOI":"10.2471\/BLT.16.189902","volume":"95","author":"MW Hetzel","year":"2017","unstructured":"Hetzel MW, Pulford J, Ura Y, Jamea-Maiasa S, Tandrapah A, Tarongka N, et al. Insecticide-treated nets and malaria prevalence, Papua New Guinea, 2008\u20132014. Bull World Health Organ. 2017;95:695\u2013705b.","journal-title":"Bull World Health Organ"},{"key":"1494_CR8","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1186\/s12936-024-05005-x","volume":"23","author":"N Bubun","year":"2024","unstructured":"Bubun N, Anetul E, Koinari M, Johnson PH, Makita LS, Freeman TW, et al. Insufficient duration of insecticidal efficacy of Yahe((R)) insecticide-treated nets in Papua New Guinea. Malar J. 2024;23:175.","journal-title":"Malar J"},{"key":"1494_CR9","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-022-04217-3","volume":"21","author":"SG Mbwambo","year":"2022","unstructured":"Mbwambo SG, Bubun N, Mbuba E, Moore J, Mbina K, Kamande D, et al. Comparison of cone bioassay estimates at two laboratories with different Anopheles mosquitoes for quality assurance of pyrethroid insecticide-treated nets. Malar J. 2022;21:214.","journal-title":"Malar J"},{"key":"1494_CR10","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1016\/j.pt.2021.03.004","volume":"37","author":"S Karl","year":"2021","unstructured":"Karl S, Katusele M, Freeman TW, Moore SJ. Quality control of long-lasting insecticidal nets: are we neglecting it? Trends Parasitol. 2021;37:610\u201321.","journal-title":"Trends Parasitol"},{"key":"1494_CR11","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-022-04392-3","volume":"21","author":"N Bubun","year":"2022","unstructured":"Bubun N, Anetul E, Koinari M, Freeman TW, Karl S. Coating formulation change leads to inferior performance of long-lasting insecticidal nets in Papua New Guinea. Malar J. 2022;21:349.","journal-title":"Malar J"},{"key":"1494_CR12","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2875-13-242","volume":"13","author":"MW Hetzel","year":"2014","unstructured":"Hetzel MW, Choudhury AA, Pulford J, Ura Y, Whittaker M, Siba PM, et al. Progress in mosquito net coverage in Papua New Guinea. Malar J. 2014;13:242.","journal-title":"Malar J"},{"key":"1494_CR13","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1186\/1475-2875-11-192","volume":"11","author":"MW Hetzel","year":"2012","unstructured":"Hetzel MW, Gideon G, Lote N, Makita L, Siba PM, Mueller I. Ownership and usage of mosquito nets after four years of large-scale free distribution in Papua New Guinea. Malar J. 2012;11:192.","journal-title":"Malar J"},{"key":"1494_CR14","doi-asserted-by":"publisher","DOI":"10.3389\/fepid.2022.980795","author":"E Cleary","year":"1900","unstructured":"Cleary E, Hetzel MW, Clements ACA. A review of malaria epidemiology and control in Papua New Guinea 1900\u20132021: progress made and future directions. Front Epidemiol. 1900. https:\/\/doi.org\/10.3389\/fepid.2022.980795.","journal-title":"Front Epidemiol"},{"key":"1494_CR15","doi-asserted-by":"publisher","DOI":"10.5281\/zenodo.10630065","author":"JG Giduthuri","year":"2024","unstructured":"Giduthuri, JG., Timbi, D., Kualawi, M., Are, C., Muri, M., & Goi, P. et al. Papua New Guinea malaria indicator survey 2022\u20132023: final report on malaria prevention, infection prevalence and treatment-seeking, Papua New Guinea Inst Med Res, https:\/\/doi.org\/10.5281\/zenodo.10630065 (2024)."},{"key":"1494_CR16","doi-asserted-by":"publisher","first-page":"S111","DOI":"10.1093\/infdis\/jiab004","volume":"223","author":"J Hii","year":"2021","unstructured":"Hii J, Hustedt J, Bangs MJ. Residual malaria transmission in select countries of Asia-Pacific region: old wine in a new barrel. J Infect Dis. 2021;223:S111-s142.","journal-title":"J Infect Dis"},{"key":"1494_CR17","doi-asserted-by":"publisher","first-page":"S171","DOI":"10.1093\/infdis\/jiaa402","volume":"223","author":"D Rodriguez-Rodriguez","year":"2021","unstructured":"Rodriguez-Rodriguez D, Katusele M, Auwun A, Marem M, Robinson LJ, Laman M, et al. Human behavior, livelihood, and malaria transmission in two sites of Papua New Guinea. J Infect Dis. 2021;223:S171\u201386.","journal-title":"J Infect Dis"},{"key":"1494_CR18","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/s12936-015-1067-7","volume":"15","author":"LJ Reimer","year":"2016","unstructured":"Reimer LJ, Thomsen EK, Koimbu G, Keven JB, Mueller I, Siba PM, et al. Malaria transmission dynamics surrounding the first nationwide long-lasting insecticidal net distribution in Papua New Guinea. Malar J. 2016;15:25.","journal-title":"Malar J"},{"key":"1494_CR19","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-021-03867-z","author":"P Millat\u2013Mart\u00ednez","year":"2021","unstructured":"Millat-Mart\u00ednez P, Gabong R, Balanza N, Luana S, Sanz S, Raulo S, et al. Coverage, determinants of use and repurposing of long-lasting insecticidal nets two years after a mass distribution in Lihir Islands, Papua New Guinea: a cross-sectional study. Malar J. 2021. https:\/\/doi.org\/10.1186\/s12936-021-03867-z.","journal-title":"Malar J"},{"key":"1494_CR20","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-021-23707-7","volume":"12","author":"A Bertozzi\u2013Villa","year":"2000","unstructured":"Bertozzi-Villa A, Bever CA, Koenker H, Weiss DJ, Vargas-Ruiz C, Nandi AK, et al. Maps and metrics of insecticide-treated net access, use, and nets-per-capita in Africa from 2000\u20132020. Nat Commun. 2000;12:3589.","journal-title":"Nat Commun"},{"key":"1494_CR21","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0161417","volume":"11","author":"H Koenker","year":"2016","unstructured":"Koenker H, Kilian A. Correction: recalculating the net use gap: a multi-country comparison of ITN use versus ITN access. PLoS ONE. 2016;11:e0161417.","journal-title":"PLoS ONE"},{"key":"1494_CR22","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-023-04609-z","volume":"22","author":"H Koenker","year":"2023","unstructured":"Koenker H, Yukich J, Erskine M, Opoku R, Sternberg E, Kilian A. How many mosquito nets are needed to maintain universal coverage: an update. Malar J. 2023;22:200.","journal-title":"Malar J"},{"key":"1494_CR23","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1186\/1471-2334-14-69","volume":"14","author":"V Gnanguenon","year":"2014","unstructured":"Gnanguenon V, Azondekon R, Oke-Agbo F, Beach R, Akogbeto M. Durability assessment results suggest a serviceable life of two, rather than three, years for the current long-lasting insecticidal (mosquito) net (LLIN) intervention in Benin. BMC Infect Dis. 2014;14:69.","journal-title":"BMC Infect Dis"},{"key":"1494_CR24","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-021-03604-6","volume":"20","author":"EL Villalta","year":"2021","unstructured":"Villalta EL, Soto Bravo AM, Vizcaino L, Dzuris N, Delgado M, Green M, et al. Evaluation of the durability and use of long\u2010lasting insecticidal nets in Nicaragua. Malar J. 2021;20:106.","journal-title":"Malar J"},{"key":"1494_CR25","doi-asserted-by":"publisher","first-page":"1747","DOI":"10.4269\/ajtmh.21-0210","volume":"105","author":"JB Keven","year":"2021","unstructured":"Keven JB, Katusele M, Vinit R, Rodr\u00edguez-Rodr\u00edguez D, Hetzel MW, Robinson LJ, et al. Nonrandom selection and multiple blood feeding of human hosts by Anopheles vectors: implications for malaria transmission in Papua New Guinea. Am J Trop Med Hyg. 2021;105:1747.","journal-title":"Am J Trop Med Hyg"},{"key":"1494_CR26","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2875-12-119","volume":"12","author":"AE Garley","year":"2013","unstructured":"Garley AE, Ivanovich E, Eckert E, Negroustoueva S, Ye Y. Gender differences in the use of insecticide-treated nets after a universal free distribution campaign in Kano State, Nigeria: post-campaign survey results. Malar J. 2013;12:119.","journal-title":"Malar J"},{"key":"1494_CR27","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-018-2575-z","volume":"17","author":"B Olapeju","year":"2018","unstructured":"Olapeju B, Choiriyyah I, Lynch M, Acosta A, Blaufuss S, Filemyr E, et al. Age and gender trends in insecticide-treated net use in sub-Saharan Africa: a multi-country analysis. Malar J. 2018;17:423.","journal-title":"Malar J"},{"key":"1494_CR28","doi-asserted-by":"publisher","first-page":"e1805","DOI":"10.1016\/S2214-109X(23)00415-1","volume":"11","author":"HW Unger","year":"2023","unstructured":"Unger HW, Acharya S, Arnold L, Wu C, van Eijk AM, Gore-Langton GR, et al. The effect and control of malaria in pregnancy and lactating women in the Asia-Pacific region. Lancet Glob Health. 2023;11:e1805\u201318.","journal-title":"Lancet Glob Health"},{"key":"1494_CR29","doi-asserted-by":"publisher","first-page":"2283","DOI":"10.1016\/j.socscimed.2012.08.030","volume":"75","author":"J Pulford","year":"2012","unstructured":"Pulford J, Oakiva T, Angwin A, Bryant M, Mueller I, Hetzel MW. Indifferent to disease: a qualitative investigation of the reasons why some Papua New Guineans who own mosquito nets choose not to use them. Soc Sci Med. 2012;75:2283\u201390.","journal-title":"Soc Sci Med"}],"container-title":["Infectious Diseases of Poverty"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40249-026-01494-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40249-026-01494-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40249-026-01494-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T06:16:54Z","timestamp":1789366614000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s40249-026-01494-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,14]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["1494"],"URL":"https:\/\/doi.org\/10.1186\/s40249-026-01494-x","relation":{"references":[{"id-type":"doi","id":"10.5281\/zenodo.10630065","asserted-by":"subject"}]},"ISSN":["2049-9957"],"issn-type":[{"value":"2049-9957","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,14]]},"assertion":[{"value":"21 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This research was approved by the PNG Institutional Review Board (IRB, #2402 and IRB, #1901) and received ethics approval from the PNG Medical Research Advisory Committee (MRAC, #23.03 and MRAC, 19.12). All participants interviewed in this study provided verbal and written consent before participating in the interview.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publications","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"103"}}