Source: Financial Times

Author: Sarah Murray

When it comes to tackling malaria, it is often the little things that can make a difference. One is getting the right terminology for the tools of the trade. "The tendency now is to move away from calling them 'bed nets' because in some communities, people say they don't sleep on beds," says Kwaku Yeboah, director of malaria prevention and mitigation at Family Health International, the global health non-profit organisation.

While insecticide-treated nets have led to dramatic advances in reducing the number of malaria infections, it is this kind of local cultural knowledge that Mr Yeboah believes is essential when it comes to accelerating the uptake of the nets.

Another is colour. In some cultures, for example, the colour white is associated with the delivery of a baby. "In programmes where [nets] are given to women to sleep under during pregnancy, some of them don't use them until they have delivered, because traditionally most women wear white clothes only during delivery," explains Mr Yeboah.

Despite such cultural barriers, however, the nets are proving one of the most powerful and cost-effective devices in the fight against malaria. And while use of netting to fend off mosquitoes has been around for many decades, in recent years technological developments have dramatically improved its effectiveness.

Early advances included the dipping of nets in insecticide. Today however, the nets being produced by companies such as Vestergaard Frandsen, Japan's Sumitomo Chemical and BASF, the German chemical company, come already impregnated with insecticides and in tough fabrics that can last for up to seven years.

"The long-lasting insecticide-treated net repels and kills mosquitoes, and other bugs too, and has almost immediate impact on the disease burden," says Susan Lassen of NetsforLife, a consortium of companies and non-profit organisations that accesses remote communities through a network of local churches, faith-based groups and non-governmental organisations.

"The emergence of this new technology has created an extremely effective tool ... killing the mosquitoes on contact but also providing a barrier against them," says Elizabeth McKee Gore, executive director of partnership alliances at the United Nation Foundation's Nothing But Nets campaign, which encourages members of the public to donate at least $10 to buy nets.

The impregnated nets have also greatly reduced the costs associated with other prevention methods such as spraying. "Compared with indoor residual spraying, nets have been found to be about four to five times more cost effective," says Mr Yeboah.

However, simply handing out nets is not the end of the process. Experts stress the need for communities to be helped to understand how the disease is transmitted, what the symptoms are, when to seek medical help and why nets are so effective in preventing infection.

When net distribution is tied in with other health initiatives, the nets can help fight against other diseases. In some programmes, for example, the promise of a mosquito net encourages mothers to have their children immunised.

"The net has become an incentive," explains Ms McKee Gore. "Some mothers are afraid to vaccinate their children, but they understand the nets."

Another important element of the distribution campaign is ensuring they are used properly. This means discouraging people from using them as fishing nets or cutting them into bath sponges, for example.

Distributing the nets without charge can exacerbate this problem. "In sub-Saharan Africa, there's a tendency to look at products that are provided free as being of little or no value," says Mr Yeboah. "And charging some money is also a mechanism to ensure that one can sustain the supplies - because the donors are not going to continue providing them forever."

However, many believe the need is still too great to limit the impact of the nets by charging for them. "The price point in this doesn't make them available to the masses," says Ms McKee Gore.

"And I've yet to be in a country where mothers are not waiting desperately for these nets - because they know they're going to save their children's lives."

According to Nairobi-based Tessa Knox, trial manager for Vestergaard Frandsen, a leading Danish producer of disease control textiles: "In some cases, mass distribution of free or subsidised nets makes the most sense. In other locations, market-based approaches and retail operations work very well. There is no silver-bullet approach that will work everywhere."

Mr Yeboah agrees. "The policy as to whether there will be a cost recovery or not is determined by countries looking at the ability of recipients to pay," he says. "There are different socio-economic groups and some can pay and others can't."

Originally published April 24, 2009