Irene Nabusoba
23 November 2008
Kampala — Mosquito net use increases faster in countries that distribute them freely compared to those where people have to buy them.
NOAH Maina, 30, has four children, but numerous malaria attacks forced him to sell his goat to buy them insecticide-treated mosquito nets.
"My kids get an average of four bouts of malaria each a year," the boda-boda cyclist from Kawempe, a Kampala suburb says.
"The malady peaks at the age when we stop sharing a bed with them," Maina says. "I realised this after watching the Good Life Show (an advocacy programme by AFFORD, a private health marketing initiative) on TV."
He says they had one mosquito net which his wife got when she was pregnant. "But I did not consider buying one for the children," Maina says.
Dr. Myers Lugemwa of the Ministry of Health's Malaria Control Programme says Maina is not alone. "Many parents use mosquito nets while their children do not."
He adds that the Government distributes free mosquito nets, especially to pregnant mothers, children under five years, people living with HIV/AIDS and populations in emergencies like flood victims.
"These are the most vulnerable."
"However, some parents do not want their babies to sleep under the nets saying: 'if they can kill the mosquitoes, what about the baby? Then there are those who use the mosquito nets to make wedding gowns, catch fish, filter malwa (local brew), ."
Recent study findings in Africa show that the use of insecticide-treated nets to protect children from malaria has risen six-fold in the past seven years, yet 90 million children still do not have access to the nets and remain at risk of malaria.
The 2000-2007 research conducted by Dr Abdisalan Noor, from the Kenyan Medical Research Institute in Nairobi and Professor Bob Snow from the University of Oxford, UK shows that mosquito net use increases faster in countries that distribute them freely compared to those where people have to buy them.
The study also shows that the fastest yearly growth in nets usage estimates was in Eritrea, Madagascar, Ghana, Togo, Kenya, Gambia, Guinea Bissau, Zambia, Ethiopia and Burundi-all are countries that were distributing free nets between survey periods.
National nets coverage was less than 15% in 13 countries among them Nigeria, Democratic Republic of Congo, Sudan, Mozambique, Côte d'Ivoire, Cameroon and Uganda.
These combine free national distribution and private health initiatives.
"The analysis shows that countries that provide free nets have achieved the highest levels of coverage in Africa in 2007. Making poor people pay for treated nets doesn't increase coverage," he adds.
According to the study authors, an analysis of donor funding in relation to vulnerable populations shows huge disparities in malaria funding across Africa which may be contributing to inabilities to scale up coverage.
"Although donor funding for malaria control in Africa has increased since 2002, funding remains inadequate. A focus of attention on these areas in Africa must be seen as a priority if health effects at the continental level are to be realised by 2015.
Insecticide-treated nets are one of the most important methods for achievement of the Millennium Development Goals on combating HIV, malaria and other diseases.
When African presidents met in 2000, the Abuja Declaration stated that they would work towards protecting 60% of their vulnerable populations with treated nets by 2015.
However, the study, from 40 African countries shows that as par 2007, 90 million children have not yet received the nets.
"At the time of the Abuja meeting in 2000 just over 3% of Africa's young children were protected by a mosquito net. Seven years later this increased to only 18.5%," the study says.
"Most of these children live in only seven African countries; one country in particular stands out - a quarter of all African children living without nets are Nigerian," it adds.
The researchers argue that the success of nets coverage in a few countries, including Kenya, where coverage of bed nets in children under five is 44% shows what can be achieved in a few short years, with adequate funding, political will, and a good distribution network.
"Despite 20 years of scientific evidence, the challenge for donors and governments to protect children with a bed net is a battle only just beginning.
Donor money must be targeted to areas where needs are greatest," says Snow.
One of the UN's Millennium Development Goals aims to ensure that at least 80% of vulnerable children sleep under nets within six years.
"Given that our progress on extending net coverage so far has been modest, this target appears unimaginable for much of Africa," he argues.
According to the World Health Organisation, 3.3 billion people, or nearly half of the world's population, live at risk of contracting malaria.
In Africa, malaria kills about a million people every year, most of them children and pregnant mothers. In fact, of all malaria deaths reported by WHO, nearly 85% were in children five years of age and under.
In Uganda, malaria is the leading cause of mortality. It is endemic in 95% of the country, and forms 30-50% of the outpatient department attendance, 20% of in-patient admissions, and 9-14% of the deaths of admitted cases.
"It kills 320 Ugandans every day, mostly pregnant women and children below five years. We estimate that the malady causes between 70,000 to 110,00 deaths per year in Uganda," Lugemwa says.
He says just like Maina's case shows, malaria impacts negatively on the impoverished society where an estimated 25% of household income is spent treating the disease.
"That is why we are advocating preventive measures like the use of treated mosquito nets," he says.
Uganda's fight against malaria
Government has switched to artemisinin combination therapies (ACTs) or coartem as first line treatment of malaria. However, they are expensive. A dose costs sh15,000 and sh25,000.
Government is emphasising preventive measures like indoor spraying and use of insecticide-treated mosquito nets. The six million nets distributed so far translate to about one net to five people.
We applied for the Global Fund Round Seven to cater for mosquito nets. If it is successful, it will enable the purchase of 17million nets to reduce the ratio to one net for every two people.
Dr. John Rwakimari, of the National Malaria Control Programme says malaria prevalence rates are down because of increases in net coverage. "We had the highest malaria rates in 2005 (16m cases).
We have noted a 40% reduction to about 10m cases in 2007 because of mosquito nets, ACTs and indoor spraying. "In 2004, we only had 10% coverage of nets but we are now at 42%.
Well, the number is still low. We need about 85% of the whole population using nets to significantly decrease the burden of malaria," Rwakimari says.
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