Wednesday, 14 March 2012

MALARIA: Misuse mosqito nets - Or are they?

PLANS by the government to fight malaria through the use of mosquito treated nets seem to be failing after it emerged that nearly 50 per cent of those who acquired the nets use them for different purposes.

A study by Population Service International revealed that 51 per cent of those having nets use them to protect their gardens and keep rodents from their kitchens.
Speaking during a tour of parts of Nyanza province to assess the feasibility of use of nets, in a programme dubbed hang up campaign, director maternal and child health division Antony Gitau said despite the fact that most of the homes have mosquito nets, they hardly use them to protect themselves against mosquitoes. According to the study, most of the people who have the nets do not use them either out of ignorance or taboo. Gitau said more than 200,000 people from 36 districts who had objected the use of mosquito nets are currently embracing them and through the campaign use of mosquito nets has seen a 10 per cent increase.
The campaign is funded by the United Kingdom to the tune of Sh9 million. Public health officials have in the past decried the misuse of mosquito nets in Nyanza with most of the people using them to cover gardens, green houses for mangoes and fishing activities. Nyanza provincial director of public health and sanitation Jackson Kioko said the misuse of mosquito nets is rampant in the province with others using them to make wedding dress.
Last year in an effort to curb the misuse of nets, the Ministry of Public Health and Sanitation teamed up with members of the provincial administration to apprehend and prosecute those who misuse nets. However, the campaign did not bear much fruit and the ministry together with PSI has launched a campaign spearheaded by scouts to tame misuse of insecticide treated nets through enlightening the community on their use.

I work in Nyanza but most of the nets I see used this way (gardens, chicken, fishing etc) are old nets which the residents are no longer using. Remember nets are not issued out together with a disposal mechanism and I think we cannot begrudge the residents their innovation to apply old ones for other uses. However, it would be a public health nightmare if well conducted compliance studies would show that residents actually prefer to use their nets elsewhere other than when sleeping.. I doubt it if there is any taboo anymore in Nyanza regarding the use of nets for sleeping. Statements like ‘hardly use’ remain speculative in the absence of programmatic evidence.

Peter Otieno: KEMRI_Nyanza province: Kenya

Incredible stories about net mis-use in African countries continue to come up. In Nigeria, field evidence also show net mis-use. This is mostly among farming communities where there similarly used for protection of gardens, animals such as goats as well as for finishing.

Mass nets campaign has actually increased nets availability in households but may not have influenced use accordingly. This might be due to the quality of health education on net use provided during the exercise. Available evidence like the one(10%) coming from the Kenya campaign and elsewhere has shown that with proper and appropriate information on net, use can be improved. Hope the Kenyan campaign is not a one time event. Also using Community directed intervention (CDI)approach to distribute and promote use has also improved net ownership and use. The approach involved communities selection of volunteers that are trained by the health service. These volunteers are responsible for net distribution in their respective communities as well as helping communities to hang and use their nets. The volunteers also visit homes of those that received nets from them using the community register developed for the purpose. Through this approach, communities are empowered to take their health in their own hands. This might not be for only the nets but other components of malaria prevention and control such as IPTp, and RDTs as a component of home management of malaria. Usually the community volunteers work under the guidance of the health service in clinic-community continuum of care. The CDI concept is an approach made popular by African Program for Onchocerciasis Control (APOC) that for several years reached hundreds of villages across Africa.
Community participation remains the vital missing link in our primary health care system. There is need to strengthen community health system that would improve the activities of primary health care. If we have done things one way and get poor results, there is need to try innovative and evidence-based method that would help improve our results. Well if we continue to insist on the traditional approach, perhaps the MDGs will only be but a mirage!

Sent from my BlackBerry® smartphone from MTN Ghana

Thank you for your very sensible response. The newspapers often make huge statements which are very misleading and can be quite destructive in terms of donor sentiment.
I would be VERY surprised if the nets being used for other purposes were brand-new or still viable for use over a sleeping space. Once a net has too many holes etc to use to protect a sleeper, it is not “mis-use” to use them for other purposes.
Matt Lynch
There will always be issues around the use of nets. What is important is to keep our feet on the pedal to get people sensitized to increase usage. In a state in Nigeria, certain colour of the nets were not used because by their culture they are used to cover corpses. With net campaign strategy, this is fast becoming a thing of the past.

My worry is the distribution strategy which is the same for every state and community instead of customizing to meet the processes of the people. We need more effective approach to distribution with the engagement of community stakeholders.
By the way, where did we miss it? Net were part of the compulsory items you have to take to the college at resumption. It is no longer so. What happened? Can we reach and surpass that again? Why has net suddenly become a new thing?
Dr. Fatai Wole Bello, ES CCM Nigeria

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