Are bednets the answer?

An article on IRIN NEWS, CAMEROON: SMS, singers and nets against malaria, tells of a bednet campaign in Cameroon. As part of the campaign there will be a media blitz reminding people about sleeping under a mosquito net. Alongside the media campaign will be a mass distribution of long-lasting insecticide treated bednets. There’s been quite a lot in the press recently about mosquito nets and malaria resistance. The IRIN article adds links to a study from Senegal published in the Lancet recently which showed resistant changes in caught mosquitoes after a long term campaign. An initial decrease in malaria cases was followed by a rise in cases after a couple of years in children older than 10 and adults. One theory behind this is that the level of immunity against malaria in older children and adults had decreased in the couple of years that effective bednets were used, but as the mosquitoes (Anopheles gambiae) mutated the insecticide was no longer effective and they therefore caught malaria again.

All this goes to show that the mantra ‘bednets against malaria’ is rather simplistic. An intact bednet, properly tucked in will prevent malaria-carrying mosquitoes biting during sleep. Insecticide-impregnated nets do kill mosquitoes which land on them. However, both drug resistant malaria and insecticide resistant mosquitoes are both well known. Many Africans who travel outside of malaria zones for more than a year or so know that it is common to contract malaria quite quickly on return to the malaria zone. A built up partial immunity is lost relatively quickly. What I did not see in the write-up of the Senegalese study was whether spraying of  mosquito breeding sites and clearance of potential sites (areas where water could collect) happened alongside the impregnated bednets and artesunate plus amodiaquine combination treatment of cases.

Here is the IRIN NEWS article:

DAKAR, 19 August (IRIN) – “It’s 9pm. Are you and your family sleeping under a mosquito net?”

That message – delivered by government officials, artists and other personalities in Cameroon – will run on private and state-run media each evening from 20 August as part of a nationwide media blitz accompanying the distribution of long-lasting insecticide-treated bed nets.

It will be welcome news to many Cameroonians who say they have seen the benefit of nets in preventing malaria but cannot afford them. It will be welcome news to many Cameroonians who say they have seen the benefits of nets in preventing malaria but cannot afford them. In private pharmacies nets cost between 7,000 and 10,000 CFA francs (US$15-$20), depending on the size. [ ]

“Three years ago I received a net for my household,” mother of two Djomo Marceline told IRIN in Yaoundé. “But it’s old and we can no longer use it. I need one for my children but can’t afford it.”

Financed by The Global Fund to Fight AIDS, Tuberculosis and Malaria – with additional support by the UN Foundation – the programme is to supply one net per two people throughout Cameroon (population 19.4 million).

According to UN Children’s Fund (UNICEF), 14-16 percent of children who die each year in Cameroon die from malaria. Most of the one million people who die annually of the disease worldwide are African children, according to World Health Organization (WHO).

Since late July mobile phone company MTN has been sending malaria education text messages to subscribers as part of the media drive developed by the Health Ministry, UNICEF, Malaria No More and other partners. The campaign includes a song, “KO Palu” (knock out malaria), performed by several local artists.

The song, performed in English, French and Douala, says in part: “Pregnant woman, pregnant woman, if only your unborn child could talk, he could tell you, `Mama, go see the doctor, Mama, go for your health consultation’.” Pregnant women are particularly vulnerable to malaria as pregnancy reduces a woman’s immunity to malaria, which can cause miscarriage and low birth weight, according WHO. The agency recommends that malaria prevention be part of basic antenatal care. [ ]

In preparation for the nationwide distribution, Cameroon’s Health Ministry and partner organizations did a pilot delivery in three northern districts in 2010.

The pilot shed light on potential constraints, cultural matters and other factors that will help enormously in the countrywide distribution, said Ora Musu Clemens Hope, UNICEF representative in Cameroon.

“For example during the pilot we found that in some areas it is more likely a family will send a child to pick up the net rather than the woman of the household – all that must be taken into account and addressed to ensure that all families receive the proper number of nets,” she said.

Nets feed resistance?

Treated mosquito nets are a pillar of anti-malaria efforts throughout sub-Saharan Africa, which sees most of the world’s one million annual deaths from the disease, but a study published on 18 August in the UK medical journal The Lancet – based on 2007-2010 research in a Senegalese village – showed that the use of treated bednets could lead to insecticide resistance in malaria-carrying mosquitoes. [ ]

Scientists commenting on the study commended the research but said the results cannot be generalized across other regions of Africa and that the findings should be the basis for further research. [ ]

This report on line:

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