UN agency issues new guidance for insecticide-treated mosquito nets to fight malaria
Until now, UN World Health Organization (WHO) guidelines focused primarily on providing nets for children under five and pregnant women, but recent studies from Kenya show that expanding use of the nets to all people in targeted areas increases coverage and enhances protection of vulnerable groups while protecting all community members.
“WHO's new evidence-based guidance provides a road map for ensuring that life-saving, long-lasting insecticidal nets are more widely available and used by communities, and are more effective in protecting poor women and children,” WHO Director-General Margaret Chan said. “The collaboration between the Government of Kenya, WHO, and donors serves as a model that should be replicated throughout malarious countries in Africa.”
The nets are treated with insecticides that repel, disable or kill the vector mosquitoes which transmit malaria. Conventional insecticide-treated mosquito nets need to be re-treated regularly, while long-lasting insecticidal nets, costing about $5 each, are designed to be effective without re-treatment for the life of the net – up to five years.
In areas of high transmission where young children and pregnant women are the most vulnerable, WHO now recommends making their protection the immediate priority while progressively achieving full coverage. Malaria kills a child every 30 seconds somewhere in the world, mostly in Africa.
In Kenya, from 2004 to 2006, a near ten-fold increase in the number of young children sleeping under insecticide-treated nets was observed in targeted districts, resulting in 44 per cent fewer deaths than among children not protected, according to preliminary data from the Government.
These achievements can be attributed to three principal ingredients, which all need to be present for malaria control efforts to succeed - high political commitment from the government, strong technical assistance from WHO, and adequate funding from bilateral and multilateral donors.
Between 2002 and 2006, with a £6 million grant from the United Kingdom Department for International Development, WHO supported the Kenyan Government's free mass distribution of nets and provided technical support and a full-time logistician to support planning and implementation.
The new WHO guidance recommends that campaign-like mass distribution strategies be complemented by delivery through routine health services to achieve and maintain high levels of coverage.
Until recently, progress in scaling up use of the nets has been slow in many countries, due in part to the inability of the international community to reach a consensus on how to deliver them. Approaches have included commercial channels, social marketing, and free or subsidized distribution through routine public health services or campaigns.
The new WHO guidance stresses that cost should not be a barrier to access. Thus far, only free distribution has enabled rapid achievement of high population coverage and elimination of inequities in net use, as has been demonstrated in Kenya.
“This data from Kenya ends the debate about how to deliver long-lasting insecticidal (or just mosquito nets) nets,” Arata Kochi, head of WHO's Global Malaria Programme, said. “No longer should the safety and well-being of your family be based upon whether you are rich or poor. When insecticide-treated mosquito nets are easily available for every person, young or old, malaria is reduced.”