Malaria control needs mass distribution of insecticidal bednets

Teklehaimanot et al. | 30 Jun 2007
The Lancet

Long-lasting insecticidal bednets (LLINs) are one of the major ways to control malaria, and they are widely accepted worldwide by communities in areas affected by malaria. One LLIN costs about US$5 to manufacture and is effective for about 5 years. They have two kinds of protective effects—one for the people directly under the nets, and one for the community at large. The second effect is important, but often ignored. By achieving high community coverage to ensure a substantial community protection, malaria-control efforts can be more powerful than when only individual protection is attempted.

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Mass coverage by LLINs reduces the number of mosquitoes in the community...shortens the lifespan of the mosquitoes, thus reducing the possibility for maturation of Plasmodium sporozoites and hence decreasing the proportion of mosquitoes that become infective. Therefore the possibility of transmitting the illness to others is greatly reduced.

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Tragically, funds mobilised for malaria prevention and control are not used for saving lives, but are instead diverted to try to create new markets for bednets that do not exist. This approach has compromised the effectiveness of malaria control efforts. We strongly suggest that malaria-endemic countries and donor agencies should abandon the idea of social marketing, especially in rural areas greatly affected by malaria, and also in urban areas with malaria transmission. They should also commit to a policy that regards antimalarial commodities—such as drugs, diagnostic methods, and insecticides—as public goods to be available free of charge for mass distribution to affected communities. Comprehensive malaria control in Africa is achievable by 2010, at the minimal cost of $3 billion per year if sound principles of public health and economics are observed.5,18,23 Millions of lives can be saved, and Africa will be given vital help in escaping from the vicious circle of poverty and disease that continues to grip the continent.

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