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Malaria Matters: Issue 5, May 1999
Note from the technical editor
In order to promote the use of Insecticide Treated Nets (ITNs) there needs to be reasonably priced nets and insecticides available for people to purchase. This issue of Malaria Matters looks at different approaches to the provision and distribution of nets and insecticide. Approaches considered in this issue include:
Insecticide Treated Materials (ITMs) are an important component of the Ghana National
Malaria control Strategy. The Ministry of Health in Ghana (MOH), WHO and donor agencies
are keen to promote their use in sub-
The plan presented examples of ways in which the commercial sector has been engaged in partnerships in other areas, as well as the steps involved in developing and facilitating such relationships. Research carried out in November 1998 illustrated the abundant capacity and willingness of private and public partners in Ghana to consider such a plan.
There was much discussion by public and commercial sector representatives on topics including: the availability of products, nets and insecticide, promotional strategies, demand generation, distribution, equity, trade barriers, and the local capacity to undertake such a program. The outcome of these debates was a validation of the proposed plan, and a provisional budget of $1,200,000 for a two year program was presented. The establishment of a Task Force is the next priority, as this team will have responsibility to commission and approve a detailed action plan and budget. This body would include representatives from the MOH, the commercial partners, local NGOs, BASICS, PATH Canada and the Malaria Consortium. The Task Force would be responsible for fundraising and establishing a management structure for the program. There were strong expressions of interest by several donors to support such a program.
The meeting ended with agreement on the next steps for the process:
i) the invitation of prospective members by the MOH, to join the Task Force
ii) the scheduling of the first meeting of the Task Force in April 1999
iii) formulation of program goals and objectives, and
iv) the preparation and review of a detailed action plan and full budget to the Task Force. BASICS and PATH Canada will assist in the development of the detailed plan and budget.
For more information about developing partherships in Ghana, please contact:
Dr. David McGuire or Dr. Michael Macdonald
BASICS 1600 Wilson Blvd., Suite 300
Arlington, Virginia , USA 22209
The KINET Social Marketing Project
KINET is a large-
Formative and market research were conducted in order to understand community perceptions,
knowledge, attitudes and practice about the products that were to be marketed. "Zuia
Mbu" (Kiswahili for "prevent mosquitoes") was identified as a suitable brand name
for both treated nets and single-
A mix of both public and private sales outlets are used for distribution. In the first stage of a stepped introduction 31 net agents were appointed and trained in 18 villages.
Fifteeen were shop owners, fourteen were village leaders, one was a parish priest and one a health worker. Thirty seven young people were appointed in the same villages and trained as agents for net treatment. Also involved in distribution were other institutions such as hospitals, development projects and employers.
A total of 22,410 nets and 8,072 treatments were sold during the first year. Eighteen months after program launch, 46% (N=312) of families with children under 5 reported that their children were sleeping under treated nets.
A strong evaluation component including over 50,000 people allows assessment of the
KINET CONTACT INFORMATION
Ms. Joanna Schellenberg Ifakara Health Research & Development Centre P.O. Box 53, Ifakara, Tanzania
Promoting ITNs in Boarding Schools
By Ato Harry Brew, Osbourne Harold Brew, and Yaw Berko
Malaria is a leading cause of death and disability in Ghana. As part of the malaria control strategy, the Ghana National Malaria Control Program recommends that children attending boarding schools use treated nets. Though school age children are not most at risk of dying from malaria, they still suffer from debilitating attacks. They are also the future parents of young children who are at risk of dying.
One net importer, HUGE Limited of Accra and its associate Cefgrains Company Limited,
are spearheading the use of ITNs in boarding schools in Ghana. Starting in the Central
Region, over 1000 new bednets were sold and 2200 old and new nets were treated. HUGE
Limited has also supported the launching of a malaria awareness and control project
in the Volta Region, sponsored by the Lions Club of Accra. Nets were imported from
Kenya. Cyflutherin (both single dose and one-
The success of the project in the Central Region can be attributed to efforts made to sensitize the public. Malaria brochures were distributed beforehand to all the schools throughout the Central Regional Educational Directorate. In addition, there were numerous talks to Parent Teacher Association and students to promote ITNs. This outreach initiative is being expanded to more remote regions that have also been sensitized to the benefits of ITNs.
For more information, please contact:
E58 Avodire Street, Atomic Hills Estate
P.O. Box 674, Achimota, Ghana Tel. 028 21 3392
Over the past decade, the role of ITNs in preventing malaria has become well known
as a cost effective intervention, especially in sub-
Much of the challenge of introducing ITNs in SSA arises from the necessity of implementing equitable, lasting, and sustainable collaborative programs. Working independently, each group faces barriers that impede widespread ITN distribution. For example, governments cannot afford to supply ITNs for all people who are at risk; the public sector does not have the capacity to manufacture and sell goods; and the commercial sector is loathe to invest in the costly and risky work of creating a market. However, by pooling resources, expertise and creativity, the strengths of each partner can be maximized. Governments can affect policy, the commercial sector can ensure that the product is available to the public, and NGOs can play a large role in health promotion and demand generation.
The following chart provides a comparison of the qualities, strengths and limitations that each partner brings to the table. By creating a dialogue between the partners, and exploring these strengths and weaknesses, a plan can be developed to work together, and increase the use of ITNs by the most vulnerable population groups.
Developing Partnerships between public and commercial sectors in Ghana
What they have to offer
What are their limitations
Tools to promote ITNs
No experience in sales
Modest financial resources
Not finding appropriate partners
Credibility and influence with partners
Production and sales
Not often partners with government agencies
May not be willing to disclose innovative ideas
Bureaucratic practices imposed on the commercial sector
Moderate financial gain in the short term
Legislative and administrative support
Slowed down by bureaucratic process
Not as willing to take risks
Relinquish some responsibility and power
Adjust to different working methods
Summary of Insecticide Treated Bednets and Curtains for Malaria Control
By C. Lengeler,Cochrane Library Issue 1, 1999
The effectiveness of insecticide treated bednets or curtains in preventing illness and death in malarious areas was reviewed using the Cochrane Collaboration framework. All randomized controlled trials (published or unpublished) using either insecticide treated bednets or curtains with a sufficient dose of a suitable insecticide were reviewed. Trials using alternate allocation methods that appeared unbiased were also included.
A total of 18 trials met inclusion criteria. The overall reduction in mortality (i.e., the protective efficacy, PE) was 17% in comparison with control participants not using nets, and 23% in comparison with untreated nets. When impregnated nets were compared with untreated nets or no nets (pooling all trials), the overall estimate of PE was 18%.
A trend for the PE of ITNs to decrease with increasing transmission intensity was
detected (p<0.03). The summary risk difference (expressing how many lives can be
saved for every 1000 children protected) was 6 per 1000 children protected per year.
ITNs reduced substantially the incidence of mild malarial episodes. In areas of stable
malaria, PE was 48% when the control group did not have any nets and 39% when the
control group had untreated nets. A consistent impact was also found in areas of
low transmission against both P.falciparum and P.vivax. Impact on P.falciparum and
P.vivax prevalence was modest but significant for certain sub-
ITNs have been shown in trials to reduce overall mortality by about 20% in sub-
THE IMPLICATIONS FOR PRACTICE
Given that there is strong evidence that ITNs can reduce overall mortality by 20%,
and that the impact of the use of ITNs on clinical episodes of mild malaria is considerable,
there is a need to promote the large-
SOME RESEARCH AREAS THAT NEED FURTHER WORK
For more information, please contact:
Swiss Tropical Institute, Department of Public Health, and Epidemiology.
P.O Box (no #). 4002 Basel Switzerland.
Treating a net, as simple as 1, 2, 3!
This is a technique known as "bag dipping and treatment". This is remarkably fast
and avoids virtually all contact with insecticide, without wearing gloves. Most commercial
manufacturer´s nets are supplied in plastic bags, but A-
Step 1: Put a clean dry net into a carrier or other plastic bag (if the net is new, shake it out first).
Step 2: Make a solution of water and insecticide in a jug and mix well. The amount of water and insecticide depend upon the type of net and insecticide you are using. (This technique works best when just the right amount of water is used so that there is no mixture left at the bottom of the bag when all three steps are finished). Pour this mixture onto the net in the bag.
Step 3: Seal the bag and hold it firmly then knead the net and solution inside the bag.
Quick tip: If there is a small hole in the bag, tie a knot over it!
INSECTICIDE TREATED NET PROJECTS: A HANDBOOK FOR MANAGERS
By Desmond Chavasse, Catherine Reed & Kathy Attawell
Insecticide treated mosquito nets have been widely hailed as a simple and cost-
COST FOR ITN PROJECTS HANDBOOK
UK 7.00 inc. postage and packaging for those in industrialized countries
FREE for those who live in a developing country and who receive a local currency or the equivalent of a local salary.
* Prepublication advance purchase of 15 copies or more receive a 15% discount.
Please enclose a cheque / money order in a stamped envelope and mail to:
Malaria Consortium, ITN Projects: A Handbook for Managers
P.O. Box 121, London SE 20 8ZQ
For inquiries please contact:
Stephanie Thorpe, Malaria Consortium.
Tel: +44 (0) 171 927 2439
Fax: +44 (0) 171 580 9075