The United Nations health agency has issued new global guidance on the use of ITNs against malaria, for the first time recommending that they be long-lasting, distributed either free or highly subsidized, and used by all community members to fight a disease that kills more than one million people each year. Until now, the WHO guidelines focused primarily on providing nets for children under five and pregnant women, but recent studies from Kenya show that expanding use of the nets to all people in targeted areas increases coverage and enhances protection of vulnerable groups, while protecting all community members . LLINs were distributed to various communities in Nigeria amongst which were those in Niger Delta states and Sahel Sahara states. Results from our study show that the Immunization-plus days (IPD) campaign, integrating distribution of TMNs with immunization, was successfully carried out in all the six geo-political zones of the country. Measles immunization rates did not appear to be adversely affected by the addition of TMNs into the IPD campaign, and as in Togo, the campaign rapidly increased levels of TMN ownership. Given the most important role that TMNs play in malaria control strategies, one of the primary implications of this campaign was to increase rates of TMN ownership in households and especially among the major at-risk groups including under-fives and pregnant women.
Certain aspects of the Nigerian IPD campaign were unique and deserve particular attention. First, in such a large and populous country with diverse topography ranging from coastal to mangrove, guinea Savannah and Sahel Savannah, this is the first planned integrated campaign covering such an extensive area. Within the first three months of 2006, close to one million TMNs were effectively distributed.
A second aspect unique to immunization-plus days in Nigeria was the one-net-per-mother strategy. This was in contrast to the national campaign in Togo in 2004, which used a one-net-per-child strategy. Because of the large numbers of under-fives in Nigeria, the one-net-per-mother allocation scheme may have been a factor in the campaign's achieving high coverage.
One major finding in this report is the very low educational status of women in the reproductive age in the Sahel Savannah region of Nigeria. This is expected to have influences low usage of TMNs in this region. According to UNICEF, " Education saves and improves the lives of girls and women. It allows women greater control of their lives and provides them with skills to contribute to their societies. It enables them to make decisions for themselves and influence their families. It is the power that produces all the other developmental and social benefits " 
In this study, there were marked differences in household possession and use of treated mosquito nets between Niger Delta Region and Sahel Savannah Region. This corresponds to the finding in another study in Zambia that reports high possession and low usage of treated mosquito nets . The majority of community members in Sahel Savannah Region are predominantly nomadic cattle rarers. Possibly, in traversing the country, finding grazing grounds for their cattle, nomads in the SSR took their treated mosquito nets with them. This might be the reason why only few households in SSR were observed to have nets in comparison to households in NDR. A study of use of mosquito nets among nomads in Sahel Savannah will clearly answer this dilemma. The Sahel Sahara Region in Nigeria closely shares the same border with Niger Republic where a similar study was conducted in 2005 . Contrary to the findings in Niger Republic, this study found high usage of treated (seen hanging 44/49 or 89.8%) or untreated (seen hanging 16/19 or 84.2%) mosquito nets SSR. In terms of absolute numbers, only 49 out of 110 (22.4%) of households in SSR, compared with 115 (70.1%) in NDR possessed TMNs. Low socio-economic status found in the SSR might have compelled some households to sell the finely-packaged and attractive TMNs to cross-border traders thus depriving themselves of this vital instrument of malaria control. Due to low educational status, households in SSR may not fully appreciate why they have to use the TMNs, or how to unfold, hang and set up these commodities. Some TMNs were reportedly seen within the household, kept as a souvenir.
Although the proportion of mosquito nets seen hanging in SSR was insignificantly higher compared to NDR, few of the at-risk groups, that is, under-fives, women in reproductive age and pregnant women, slept under TMNs the night before the survey. This result varied significantly from Niger Republic  study that indicated that 15.4% of under-fives included in their survey reported to have slept under ITNs the preceding night, while in SSR and in NDR, 27.5% and 61.3% of children included in this survey slept under TMNs the preceding night. This was still less than the percentage reported by another study in Zambia . Use of treated mosquito nets by pregnant women is very essential but coverage is still nowhere near the 60% target. According to World Malaria Report , Malawi had achieved about 32% coverage of her pregnant women using TMNs, while Nigeria achieved just about 2%. This study however, indicated that 20% of pregnant women in SSR and about 29% in NDR slept under TMN the preceding night and this percentage increased to 30 and 61 respectively when "any net" – treated or untreated was considered. Data from this study also showed 13.5% and 36.5% respectively of women in reproductive age (WRA) sleeping under TMNs the preceding night in SSR and NDR.
Reports from our study showed 52.5% of household in NDR and 42.9% in SSR possessed at least one TMN, which is still slightly lower than data from Zambia  that reported 61.3% post-intervention possession in their rural setting. An increased quantity of TMNs in the household to about three or four will most likely bring about herd protection. The effect of increased household possession of TMN means that even though at-risk groups, such as children under the age of five and pregnant women may not sleep under TMNs, as long as lots of these commodities are nearby at night, mosquitoes are likely to be repelled, thus reducing morbidity and mortality due to malaria and saving household money for other essentials of living.
The immunization-plus days campaign delivered key child health interventions (measles vaccine, vitamin A, and treated mosquito nets) to about 80% of children in the target age groups, including a substantial number of children that had not received these interventions before the campaign. Before or during the immunization-plus days campaign, communities to benefit from the distribution of TMNs should receive quality education on proper use of this commodity and its importance to the health and wealth of the households. Beyond this, the Federal Ministry of Health should collaborate very closely with two other vital Ministries – those of Women Affairs and Information – to ensure social mobilization encompasses qualitative education at grass-root. Demonstration of the use of TMNs in the home should be anchored by the Ministry of Information and such demonstrations should take place at market places, town halls and where people mostly gather. Social structure of each community should be taken into consideration as women are not allowed to sit in the same place as men in some communities. In this regards, wide-screen films of use of mosquito nets and dramatization will go a long way in empowering women. Policy makers, traditional heads and religious leader should be mobilized to play vital roles in the distribution and use of TMNs.
A follow-up survey during the rainy season might indicate higher usage rates, as was the case in Togo. In addition, community outreach is advisable to encourage increased TMN usage before the rainy seasons, without any delay.