Study shows inconsistency in Africa’s use of treated bed nets, hindering fight against Malaria

AFRICA – East Africa has been reporting mixed results in its use of and access to insecticide-treated bed nets (ITNs), which have been crucial in the fight against malaria infections since the 1990s.

While Uganda and Kenya are mentioned positively in surveys on the use and distribution of ITNS, Tanzania and Burundi feature in lists of countries that are recording drops over the past 20 years.

The “Maps and metrics of insecticide-treated net access, use, and nets-per-capita in Africa from 2000-2020” survey released on June 11, shows that only 14 of these 40 African countries, among them Uganda, have ever achieved 80 percent access or use as per the World Health Organisation benchmark for universal coverage.

When planning mass campaigns, WHO recommends that countries procure one net per 1.8 people at risk to ensure universal access.

In 2020, Uganda, Benin, Mali, Niger and Togo, were the only countries estimated to achieve over 80 percent use. This was sustained by historically large campaigns completed in 2020 despite Covid-related disruptions.

Burundi, Gambia, and Ghana have seen particularly steep coverage declines in recent years, while Kenya, Sierra Leone, Burkina Faso, Malawi, and Mozambique, may distribute sufficient nets for universal coverage within the next one or two mass campaigns. Countries such as Tanzania, Cote d’Ivoire and Liberia, have lost ground or stalled progress.

“We found that ITN distributions increased enormously since 2000 and those who own nets tend to use them, but a combination of insufficient net volume, distribution inefficiency, and short retention times keep ITN access and use below the WHO targets of 80 percent coverage,” said the report authored by Peter W. Gething, the Kerry M. Stokes AC, chair of Child Health at Curtin University, Australia, and Samir Bhatt, a researcher at the Department of Public Health at University of Copenhagen.

According to the researchers’ estimates, long-lasting insecticide-treated nets (LLINs) — the primary net distributed in Africa for many years — have been having shorter lifespans than the three-year retention time assumed by WHO and other agencies. Of the 40 countries in this analysis, 35 show LLIN median retention times of under 3 years, with an overall median value of 1.64 years.

The primary motivation for discarding a net, the study found, was the perception that it was too torn.

According to WHO, the estimated number of malaria deaths stood at 409,000 in 2019, compared with 411,000 deaths in 2018.

WHO African Region continues to carry a disproportionately high share of the global malaria burden. In 2019, the region was home to 94% of all malaria cases and deaths.

The main method of preventing malaria in high risk areas with one or more malaria cases per 1000 inhabitants per year is the use of insecticide-treated bed nets and the spraying of insecticide on the inside walls of houses.

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