Casting the Net Wide
East African ( Nairobi)
By Zachary Ochien
INSECTICIDE TREATED NETS (ITNS) - one of the most inexpensive and efficacious means to avert childhood deaths in sub-Saharan Africa - have reached about 67.3 per cent coverage among the poorest rural sectors, a new study shows.
The study, published in PLoS Medicine, a medical journal of the American Public Library of Science, says that free mass distribution of ITNs favoured the least poor.
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The study presents repeat observations of ITN coverage among rural Kenyan homesteads exposed at different times to a range of delivery models, and assesses changes in coverage across socioeconomic groups.
The researchers undertook a study of annual changes in ITN coverage among 3,700 children aged up to four years in four districts of Kenya - Bondo, Greater Kisii, Kwale and Makueni - annually between 2004 and 2006.
Cross-sectional surveys of ITN coverage were undertaken coincidentally with the incremental availability of commercial sector nets (2004), the introduction of heavily subsidised nets through clinics (2005), and the introduction of free mass distributed ITNs (2006).
The changing prevalence of ITN coverage was examined with special reference to the degree of equity in each delivery approach.
ITN coverage was only 7.1 per cent in 2004 when the predominant source of nets was the commercial retail sector. By the end of 2005, following the expansion of heavily subsidised clinic distribution system, ITN coverage rose to 23.5 per cent. In 2006, a large-scale mass distribution of ITNs was mounted, providing nets free of charge to children, resulting in a dramatic increase in ITN coverage to 67.3 per cent.
With each subsequent survey, socioeconomic inequity in net coverage sequentially decreased.
The researchers conducted surveys and then calculated the rates of net use in 2004, 2005, and 2006. In the first survey, when nets were available to most people only through the commercial sector, only 7 per cent of children were sleeping under ITNs, with only 3 per cent among the poorest families, compared with 16 per cent among the least poor.
By the end of 2005, the year in which subsidised nets became increasingly available in clinics, the overall rate of use rose to 24 per cent. By the end of 2006, following the free distribution campaign, the rate rose 66 per cent, with the 2006 figure being about the same for the poorest and the least poor.
According to the researchers, the findings mean that the rate of net use in the districts in the survey is much higher than expected, even though one-third of children were still not protected by ITNs.
Among key findings of the study was that rapid scaling up of ITN coverage among Africa's poorest rural children can be achieved through mass distribution campaigns.
THESE EFFORTS MUST FORM an important adjunct to regular, routine access to ITNs through clinics, and each complimentary approach should aim to make this intervention free to clients to ensure equitable access among those least able to afford even the cost of a heavily subsidised net.
The study was funded by the Wellcome Trust, UK, the British Department for International Development (Kenya Programme), Population Services International, the Roll Back Malaria Initiative, Kenya's Ministry of Health and Kemri.
Malaria is one of the world's biggest killer diseases in the world, with over a million people succumbing to the fever every year. Frequent attacks of the disease have severe consequences for the health of many millions more.
A high level of protection from the disease is obtained by sleeping under a mosquito net that has been impregnated with insecticide. The insecticides used are of extremely low toxicity for humans. The nets must also be re-impregnated regularly, although long-lasting ones that remain effective for three to five years (or 21 washes) are now widely distributed.
Governments and health agencies are keen to increase the use of nets, particularly for children and pregnant women. The main approach used has been that of "social marketing," in which advertising campaigns promote the use of nets, and their local manufacture is encouraged. The nets are then sold on the open market, sometimes with government subsidies. This approach has been controversial as many people say that ways must be found to make nets available free to all who need them.
In Kenya, where malaria is common, a programme to increase net use began in 2002, using the social marketing approach. In 2004, most of the nets available in Kenya were those on sale commercially.
However, in October 2004, health clinics started to distribute more heavily subsidised ITNs for children and pregnant women and, in 2006, there was a mass distribution programme for children.
NEWS
2 October 2007
Posted to the web 2 October 2007
