I work at the Malaria Program of the Earth Institute’s Center for Global Health and Economic Development. The bulk of our work takes place at the Center for National Health Development in Ethiopia, which supports national malaria control programs in ten African countries and contributes to the achievement of the Millennium Development Goals in Ethiopia. In addition to this, we are responsible for malaria prevention efforts in all 13 Millennium Villages across Africa. The project began five years ago in Koraro, Ethiopia and Sauri, Kenya and has since expanded to the other villages. In each site Long Lasting Insecticidal Nets (LLINs) were distributed in every household to cover all of the population at risk.
Each village cluster organized their own distribution of the nets. Koraro and Sauri conducted a mass distribution of bednets in 2005. In all other clusters, the nets were distributed in 2007. Our LLINs are manufactured by the Japanese company Sumitomo. The insecticide embedded in their fibers lasts for five years of normal use, including regular washing.
This year, Sauri and Koraro’s LLINs will complete five years of utilization, while most others will turn four years old. As time has passed, some nets remain in good condition, others have wear and tear holes that may have or not have been repaired, while others are badly damaged. Recently, we did a survey in all villages to find out the proportion of nets that remain in good condition three years after distribution, and the results are highly variable, ranging from 15% to 85% of nets in bad condition.
We know how many total nets were distributed in each village, but only in a few cases can we track how many LLINs a given household received, and when. Now that we are preparing to replace old nets with new ones, generously donated to the project by Sumitomo, we are working on a system to register newly distributed nets in each household, and to track their condition over time with the Child Count + system, via cell phones. Once we have a “census” of the people in each household and the number of LLINs they have, community health workers can use their cell phones to track people who do not have nets and to detect any net that needs to be replaced due to poor physical condition.
While people may have received the LLINs, the issue of utilization is different altogether. Over time, the nets lose their novelty, and perhaps because during the dry season nets are believed unnecessary, or because it is too hot, not all nets are used. Part of a community health worker’s job is to continuously educate the community on the importance of sleeping under a bednet, and on properly hanging the nets and maintaining them, for instance, by sewing small holes before they turn into large tears. Through the Child Count + system, the community health workers can also do periodic surveys of utilization.
LLINs have played a central role in decreasing malaria in all the villages, which is why we want to make sure they are properly used. Through our work over the last five years we are refining the way we distribute bednets and educate communities so that malaria can be effectively prevented.
Paola Mejia is the Malaria and NTD Coordinator at the Center for Global Health and Economic Development.
The Center for Global Health and Economic Development (CGHED) mobilizes health research and programs that enable low-resource countries to develop quality health systems for the poor, promote sustainable economic development and achieve the Millennium Development Goals (MDGs) – global targets for reducing extreme poverty and hunger and improving education, health, gender equality and environmental sustainability. For more information about CGHED’s work, please visit our website.