There has been a huge increase in the numbers of children protected from malaria by insecticide-treated bednets (ITNS) from 2000 to 2007, now at around 20 million. However, some 90 million children are still unprotected, with 25% of these in Nigeria alone. Mapping ITN coverage can help in the scale-up of disease-prevention strategies. These are the conclusions of an Article published Online first and in an upcoming edition of The Lancet, written by Dr Abdisalan Noor, KEMRI-University of Oxford-Welcome Trust Collaborative Programme, Nairobi, Kenya, and colleagues.
The authors computed the projected ITN coverage among children less than 5 years for age-adjusted population data that were stratified according to malaria transmission risks, proximate determinants of poverty, and methods of ITN delivery. They found that in 2000, only 1.7 million (1.8%) of African children living in stable malaria-endemic conditions were protected by an ITN and the number increased to 20.3 million (18.5%) by 2007, leaving 89.6 million children unprotected. Of these, 30 million were living in some of the poorest areas of Africa; 54% were living in only seven countries and 25% in Nigeria alone. Overall, 33 (83%) of countries were estimated to have an ITN coverage of less than 40% in 2007. On average, a greater increase in ITN coverage was noted in areas where free distribution had operated between survey periods.
The authors conclude: "Definition of vulnerability and unmet need is central to effective investment strategies by the donor community. Mapping risks, target populations, vulnerability, and coverage provides a means to redress deficiencies in the international calls for 80% coverage of ITN by 2015.These targets remain elusive across vast areas of Africa. Increased funding and more informed use of this funding is desperately needed to protect more children in the most vulnerable and most populated areas of Africa."
In an accompanying Comment, Dr Lawrence Slutsker and Dr Robert D Newman, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA, say: "Focus must be maintained on improving and sustaining scale-up in high burden countries. At the same time, the strategies and planning for strengthening surveillance, health systems, human-resource capacity, and regional coordination mechanisms must proceed. Lessons learned over the next 5-10 years in pursuing elimination in areas with lower transmission rates will help to guide future approaches in countries with currently intolerable malaria burdens."
Dr Abdisalan Noor, KEMRI-University of Oxford-Welcome Trust Collaborative Programme, Nairobi, Kenya T) +254 20 2715160 / 2720163 / 2719936 E) anoor@nairobi.kemri-wellcome.org
Dr Lawrence Slutsker, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA T) +1 678 469 9728 E) lms5@cdc.gov
For full Article and Comment: : http://press.thelancet.com/bednetprogressfinal.pdf
Journal
The Lancet