Malaria is one of the most pressing public health problems on the planet today, especially in parts of the world where the parasite is endemic. Although the advent of modern medical science and technology has brought us considerably nearer to a cure for this dreaded disease, malaria affects millions of people the world over, the majority of whom live in sub-Saharan Africa. The good news is that there is a bright light at the end of this nightmare. And like most good news, it’s simple. It’s called ITN or insecticide-treated net. This humble tool has helped make a dent in malaria prevalence, and can easily be used as an intervention tool to win the fight against this age-old scour how. Insecticide-treated nets have been a significant player in malaria prevention. We explore some exciting, and successful, stories in this article.
Understanding Malaria and Insecticide-Treated Nets
Malaria is a disease caused by parasites that are transmitted through the bites of infected female Anopheles mosquitoes. When untreated, symptoms range from life-debilitating flu-like illnesses to severe complications such as seizures, mental impairment, and death. Among the most effective prevention and control approaches to mitigate the impact of malaria are insecticide-treated nets.
Insecticide-treated nets are treated with either repellent or insecticide that will kill any mosquitoes after they contact the net. Since re-treatment is required every six months, the insecticide must be long-lasting. ITNs create a physical barrier between mosquitoes and people, which reduces malaria transmission.
Success Stories from Malaria-Prone Regions
1. The Impact in Nigeria
In Nigeria, with the highest malaria incidence in the world, ITN scale-up has been especially important. The National Malaria Elimination Program (NMEP) in Nigeria leads large-scale campaigns that distribute these protective measures to millions of households.
One example of non-specific impact involves eventually decreasing the burden of malaria. Some of the best data available about the potential reduction of malarial cases and deaths involve the northern states of Nigeria. According to data from the Nigerian Ministry of Health – including nearly 170,000 households and 15,000 healthcare facilities – the use of ITNs has substantially contributed to the drop in malaria incidence. Specifically, as ITN use went up, malaria-related hospitalizations and incidence significantly decreased. The impact was not only from the effective use of bed nets but from a seemingly strong community-based educational program that also promoted ITN use.
2. Tanzania’s Remarkable Progress
Another is Tanzania where ITNs are making a huge difference due to an intensive effort from international funders, in particular the Global Fund (an international finance organization) and the US President’s Malaria Initiative (PMI) (an initiative of the US government) who have helped the country dramatically scale up ITN distribution and uptake.
Photo by Neil BrandvoldFor example, in the Mwanza and Kagera regions in the north, where malaria was a major public health problem, a significant decrease in malaria prevalence has been accompanied by widespread ITNs. Local district health officials have reported that malaria cases and deaths have greatly diminished in areas of high ITN coverage. ITNs are effective in limiting the spread of malaria.
3. Success Stories from Ethiopia
Ethiopia has also shown impressive declines in malaria in the past decade as a result of widespread ITN usage The widespread distribution of insecticide-treated nets across Ethiopia has been carried out by the Ethiopian government in partnership with various international actors promoting malaria prevention and control.
One of their great success stories is from Ethiopia’s Oromia region where, with a coordinated mass ITN distribution and education campaign, malaria cases have plummeted, falling from a prevalence of nearly 70 percent in some areas to below the survey detection limit of 5 percent. Understandably, definitive proof of a relationship between adherence to the intervention and the favorable measured outbreak response is lacking.
4. Kenya’s Community-Based Approach
Kenya embraced a rapidly disseminated community-based implementation strategy expressly conceived to promote ITN use. Partnerships between the government, local nongovernmental organizations, and community health workers resulted in wide distribution of ITNs and increased ITN use.
That is the case in Western Kenya, for example, where both malaria transmission and its associated morbidity and mortality were historically high. Initially, residents were reluctant to use the nets in the right quantities and ways. The key to achieving ITN coverage of at least 80 percent, and then maintaining that coverage, was a community health community mobilization strategy, with community health workers responsible for ensuring that residents understood what ITNs were and why they should use theirs.
The Broader Impact of ITNs
The example of success coming from these malaria-endemic regions illustrates the more general salience of ITNs to control malaria. It is therefore useful to highlight the key points:
1. Reduction in Malaria Mortality
Perhaps the most important thing that ITNs do is prevent death. Infants and young children are the most vulnerable to severe malaria and its complications. ITNs can reduce mortality in under-fives by up to 20 percent.
2. Improved Quality of Life
Because ITNs prevent malaria, their use saves lives and improves the quality of life for those living in infected areas – less malaria means less time spent in clinics and hospitals; there are fewer sick people, fewer disruptions to everyday life, and better health in the end.
3. Economic Benefits
There is also a substantial economic benefit to ITNs. Malaria can be a considerable expense to the household and community. Medical care comes at a cost, and a significant amount of that comes from productivity lost because you’re not well. So if you can prevent malaria, then you still have these people available, working, and the economic situation of the family is much better, along with the communities.
4. Community Empowerment
The success of ITN programs often stems from both community engagement and community-based empowerment. The distribution of ITNs and dissemination of information about effective use relies on local health workers as well as community members. Communities feel a level of ownership and responsibility for the sustainability of their malaria-prevention efforts.
Challenges and Future Directions
While these are encouraging findings, hurdles remain. One of the biggest is insecticide resistance, as mosquitoes might eventually become resistant to the insecticides on ITNs. ITNs and other interventions will also need to be sustained over the long term: for good reasons, some interpret the bugs’ survival in experimental cages and biting net holes as an outcome favoring mosquitoes, and a major challenge to control measures. Nonetheless, mosquitoes also face adversity, with their characteristic rasping sounds bespoke to a world rapidly routing them out.
Furthermore, there needs to continue to be heavy investment in providing educational programs to ensure that people are using ITNs consistently and correctly. The reason that we’ve seen these boosts in use is because of well-funded education/behavior change programs – and those should be scaled up and kept running to maintain the hard-won advantages.
When insecticide-treated nets are used widely in malaria-endemic areas, their impact is dramatic. Advances in ITN coverage in malaria-burdened countries – such as Nigeria, Tanzania, Ethiopia, and Kenya – demonstrate the potential that basic and affordable tools can have in transforming epidemiological outcomes. The encouraging results
