There is robust evidence of the efficacy of insecticide-treated mosquito nets (ITNs) in reducing malaria parasite prevalence, incidence, and all-cause child mortality from carefully conducted trials in sub-Saharan Africa across a range of transmission settings. Trials have shown ITNs to both significantly reduce Plasmodium falciparum prevalence among children under 5 years old by 13% and post-neonatal (1–59 months) all-cause mortality by 18% in areas of stable malaria transmission in Africa. However, there have been limited data on the effectiveness of ITNs under routine program conditions at preventing malaria morbidity and child mortality, especially at the national level. This has of course raised serious concerns abou how likely the efficacy of ITNs from trials is translating into real-world effectiveness on the ground. There are certainly examples where a proven effective intervention achieved disappointing results when programs ran into constraints with deployment at wide-scale implementation