Blanket bednet coverage best, say researchers

A mother and child under an ITN, Kilifi district, Kenya Copyright: WHO/TDR/Crump

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[NAIROBI] Children sleeping under insecticide-treated nets (ITNs) are less likely to die from malaria and nets should be distributed free to all who need them, according to research from Kenya.

Increased ITN coverage in Kenya has resulted in 44 per cent fewer deaths in children, and increases in the birth weight of babies, according to preliminary data from the Malaria Control Department of the Kenyan Ministry of Health, announced at a meeting in Nairobi last week (16 August).

And research published in PLoS Medicine this week (20 August) shows that making ITNs available for free — rather than selling them commercially or heavily subsiding them — achieves the highest overall usage in children.

Researchers from the Kenya Medical Research Institute analysed children aged 0–4 years old in four districts of Kenya. They carried out annual checks on ITN coverage and introduced different methods of distributing ITNs.

They found that if ITNs were sold, only 7.1 per cent of children were using one. Usage rose to 23.5 per cent when nets were heavily subsidised, but was highest — 67.3 per cent — when they were free.

Scaling up the use of ITNs has been slow in many countries, partly due to a lack of consensus among the international community on how to best distribute ITNs to maintain high coverage.

Prompted by the Kenyan studies, the World Health Organization (WHO) last week (16 August) announced a radical shift in its malaria control strategy. Previous policy focused on young children and pregnant women but it now advocates mass distribution of ITNs for free or at highly subsidised prices to protect entire communities, with young children and pregnant mothers a priority.

James Nyikal, Kenya’s Director of Medical Services, said the government was in the process of revising its malaria control policy to focus on killing mosquitoes at breeding sites and emphasising proper vector management techniques, including the use of ITNs.

Guillet Pierre, WHO coordinator for vector control and prevention, said the study is significant in rallying donors to support Africa’s efforts to combat malaria, which  could be done through technology transfer and enabling the manufacturing of the long-lasting mosquito nets locally.

Link to full paper in PLoS Medicine

Reference: PLoS Medicine doi:10.1371/journal.pmed.0040255 (2007)