Abstract: Of the 3032 records identified, 10 studies were included in this review. Effect of ITN cost on ownership: Four studies including 4566 households and another study comprising 424 participants evaluated the effect of ITN price on ownership. These studies suggest that providing free ITNs probably increases ITN ownership when compared to subsidized ITNs or ITNs offered at full market price. Effect of ITN Cost on appropriate use of ITNs: Three studies including 9968 households and another study comprising 259 individuals found that there is probably little or no difference in the use of ITNs when they are provided free, compared to providing subsidized ITNs or ITNs offered at full market price. Education: Five studies, including 12,637 households, assessed educational interventions regarding ITN use and concluded that education may increase the number of adults and children using ITNs (sleeping under ITNs) compared to no education. One study, including 519 households, assessed the effects of providing an incentive (an undisclosed prize) to promote ITN ownership and use, and found that incentives probably lead to little or no difference in ownership or use of ITNs, compared to not receiving an incentive. None of the included studies reported on adverse effects. Five studies examined the effect of price on ITN ownership and found moderate-certainty evidence that ownership was highest among the groups who received the ITN free versus those who purchased the ITN at any cost. In economic terms, this means that demand for ITNs is elastic with regard to price. However, once the ITN is supplied, the price paid for the ITN probably has little to no effect on its use; the four studies addressing this outcome failed to confirm the hypothesis that people who purchase nets will use them more than those who receive them at no cost. Educational interventions for promoting ITN use have an additional positive effect. However, the impact of different types or intensities of education is unknown.

Plain-language summary: The studies included in this review took place in Africa and India. In five of the studies, people were either given insecticide-treated bednets free, or could buy them at a subsidized price or full market price. In the other five studies, people were educated about how to use the bednets properly, for instance through visits at home or through information on the radio, on television and in the community. The included studies show the following: Providing free insecticide-treated bednets: - Probably increases the number of people who own bednets compared to providing subsidized bednets or bednets offered at full market price. - Probably leads to little or no difference in the use of bednets compared to providing subsidized bednets or bednets offered at full market price. Providing education for the appropriate use of insecticide- treated bednets: - May increase the number of adults and children under five using bednets (sleeping under bednets). Providing incentives to encourage use of insecticide-treated bednets: - Probably leads to little or no difference in ownership or use of bednets compared to those who did not receive an incentive. A possible side effect when providing free or subsidized insecticide-treated bednets may be that the governments and institutions who pay for the bednets take this money from other priority issues. However, none of the included studies measured whether these or any other side effects had occurred.