Discussion on Modes of Mosquito Net Distribution

| 25 Jul 2023
Africa Fighting Malaria Several articles were published this month on modes of distribution for long-lasting insecticidal nets (LLINs). Global Fund Malaria Coordinator Dr. Mark Grabowsky et al. provide evidence that combining mass distribution of nets (Catch Up) with ongoing antenatal clinic-based distribution (Keep Up) can provide and sustain high levels of population coverage for young children and pregnant women, the most vulnerable to malaria. According to the authors, "The campaign nets covered virtually all extant households while clinic-based distribution provided nets for the new sleeping spaces created post-campaign. Because nets can be shared, and most children are born into families that already have a net, the number of new nets needed to sustain high coverage is substantially lower than the number of newborn children."

Teklehaimanot et al. argue in the Lancet that mass distribution of LLINs to all members of a population at-risk of malaria is a more effective malaria prevention strategy. Even if young children and pregnant women are protected with LLINs, older children and adults, who may contract but not die from malaria due to naturally acquired immunity, still provide ample parasite reservoir for transmission cycles to continue. Thus young children and pregnant women will still be at risk if LLINs are used sporadically, improperly or fail. The authors write, "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."

Evidence from Uganda, however, shows that the private sector can be a viable source of nets. A survey conducted by NetMark, a US government funded public-private partnership for commercial net sector development, shows that 3 out of every 4 nets owned was obtained from a commercial source. The number of retail outlets selling nets has increased substantially along with household ownership while prices have dropped.

AFM advocates flexible strategies based on what works in different settings. Collecting and analayzing accurate data on net usage, malaria cases and related deaths will reveal the most effective distribution strategies for a given population. This should be a fundamental part of every donor-facilitated net distribution campaign.