Malaria is still responsible for over a million deaths every year, even though it has been known for some years that sleeping under an insecticide-treated net (ITN) greatly reduces the chance of being bitten by the mosquitoes which carry the disease. There have been heated arguments as to how best to increase the use of such nets, particularly for children and pregnant women. Now research in Kenya, published in the latest issue of PLoS Medicine, has shown that a free mass distribution programme has raised the rate of ITN use to an impressive 66%. Further good news from this research is that this high rate is more or less the same whatever the family income level.
Back in 2004 almost all ITNs available in Kenya were sold commercially and only 7% of children slept under nets, according to a survey conducted by Abdisalan Noor and colleagues at the Kenya Medical Research Institute (KEMRI). Their survey, involving 3,700 children in four parts of Kenya, also found that, in the poorest families, who are most at risk of malaria, only 3% slept under nets.
During 2005 ITNs became increasingly available, heavily subsidised in clinics, and the researchers found an increase in the overall level of use to 24%. Free mass distribution began in 2006 and by the end of that year two-thirds of children were sleeping under nets. Rates of use need to be improved still further so that every child sleeps under a net, but the result is still impressive after just one year of free distribution.
The researchers argue that their findings show that ITNs must be available free if high levels of use are to be achieved. This will cost money but will save many lives. There will also be savings to the health services; if there are fewer cases of malaria, less will be spent on treatment. The findings of the study will be used by the Government of Kenya as a powerful argument for more international support for its ITN distribution programme. The study has also identified other factors which will be important in the continuing efforts to increase ITN use
Note: The insecticide used in ITNs is of extremely low toxicity to humans. It must be reapplied at intervals but long-lasting nets are now available which remain effective for 3-5 years.
Citation: Noor AM, Amin AA, Akhwale WS, Snow RW (2007) Increasing coverage and decreasing inequity in insecticide-treated bed net use among rural Kenyan children. PLoS Med 4(8): e255.
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Professor Bob Snow
Malaria Epidemiology & Public Health Group,
Kenya Medical Research Institute /University of Oxford
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Kenya
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