Bed Nets: Are They Working to Fight Malaria?

Bed Nets: Are They Working to Fight Malaria?

Diane Donchak

Malaria is a common, but deadly tropical disease transmitted through the bites of infected mosquitoes.  It kills almost one million people every year – the vast majority being children under five years old. Each year there are 247 million new cases of malaria with ninety percent of all malaria deaths occurring in sub-Sahara Africa. Malaria costs an estimated $12 billion in lost productivity in Africa.  With these staggering figures it is no wonder that combating malaria has been the focus of many government and private organizations. One strategy that has been successful in fighting malaria, but not without impediment, is the use of insecticide-treated bed nets (ITNs) and long lasting insecticide-treated bed nets (LLINs).

Few control methods can be considered as clinically effective and as cost effective in fighting malaria mortality and morbidity as these bed nets. They act as a barrier protecting the skin of those sleeping beneath them and as well as killing infected mosquitoes that try to get past the net.  A bed net which can typically cover two people costs about five dollars.  Even though many countries and organizations have praised the use of bed nets as an inexpensive and practical way to fight malaria, the method has not been without controversy and adversity.

According to the Huff Post, health groups have spent more than a billion dollars buying millions of bed nets to fight malaria. Twenty African countries have increased their bed net coverage at least fivefold. If the bed nets are reaching people at risk, this fivefold increase puts some countries on target to reach a U.N. goal of providing a bed net to all 350 million people at risk of malaria by the end of this year. But some experts say the figures are an artificial symbol of success against the disease. Philip Stevens, a health-policy expert at the London International Policy Network, states “These are meaningless input measures that tell us only (the UN) is effective at spending other people’s money,” showing little regard for the use of bed nets.  We know that bed nets can work, and that people have them. However, there is limited data supporting the fact that people are actually sleeping under these bed nets. According to UNICEF and its partners, the percentage of children sleeping under bed nets ranges from 4 percent in Cameroon, Swaziland, and Guinea to 62 percent in Zambia. Richard Tren, director of Africa Fighting Malaria, said UN policies have skewed towards bed nets when they should really focus on other proven tools like pesticides as well as access to malaria medications.

Although bed nets are an excellent prevention against malaria, there are apparent issues surrounding their implementation. Education is a major factor surrounding their use. Throughout Africa there are areas that look upon bed nets with suspicion. Community engagement, instruction, and the monitoring of their use are vital. Even though churches, often the only functioning institution in many communities, are utilized as a trusted delivery system, proper distribution remains a big concern. In Tanzania and Malawi, more bed nets go to the rich than to the poor even though the poor are more susceptible to the disease. The wealthier households were also more likely to repair nets that have been damaged, which plays an important role in their effectiveness. A large part of the distribution of bed nets is controlled by antenatal programs that provide these nets for pregnant women and children. However, many elderly and those without children are being missed. It has been noted that some of the poor who received bed nets have sold them to obtain provisions such as food and water. Compliance in the use of bed nets has been a significant concern. In Kenya, 71% of the people own bed nets but compliance and the actual use of the nets was noted to be 56%.  Door to door visits, as demonstrated by workers for Nets for Life, is needed to access the utilization of bed nets.  Tewolde Gebremeskel, head of the national malaria control unit in the health ministry in Asmara, notes that distribution of mosquito nets and raising public awareness regarding the methods to prevent malaria are imperative factors in controlling the epidemic. He also stated that distribution should be increased in high malaria zones noting mosquito breeding spots and heavy rainfall, which can affect the number of infected mosquitoes. The whole picture surrounding malaria continues to be thoroughly examined.

Bed nets can prove to be a valuable tool in the fight against malaria. However, it is only when combined with education regarding their use, proper distribution, and follow-up visits that bed nets can be fully utilized.  Bed nets, as well as education, research, political and economic stability, and access to anti-malaria drugs are all major factors needed to put an end to this devastating disease.

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