Expanding the Anti-Malaria Safety Net

In Africa, where nearly 3,000 children per day die of malaria, “safety net” is not a metaphor. A new anti-malaria program adminstered by Matthew Lynch, PhD, project director of the Global Program on Malaria at the Center for Communication Programs (CCP), aims to slash that startling mortality rate by making sure that every vulnerable child sleeps under a long-lasting insecticidal bed net (LLIN) every night. “Our goal is universal coverage,” says Lynch. “A net over every sleeping space in the home.” 

Data show that use of insecticide-treated nets reduces the incidence of malaria by 50 percent, and saves about 5.5 lives per 1,000 children protected with treated nets. Though mosquito nets are not a new technology, they are a readily available and relatively easily distributed tool to prevent malaria, Lynch says, noting, “We don’t need to wait to start saving lives. We have tools that will stop the carnage now.” 

Funded by a five-year cooperative agreement for up to $100 million from USAID, CCP’s NetWorks project has two main goals—increasing access to LLINs by distributing heavily subsidized nets, and ensuring that families use the high-quality nets consistently. “We have a couple of audiences for our message,” Lynch says. “It is likely to be the male head-of-household who makes the decision to buy the net, but the mother who is responsible for making sure that kids are under a net every night.”

In Senegal, the first country to sign on to the initiative, “preliminary reports show that approximately 80 percent of households own an insecticide-treated net”—a very high coverage rate, says Lynch. But only about 60 percent had nets hung up in their houses when the survey was done in the dry season.

Those nets cost approximately $8 to $16 in the markets. That’s “a significant chunk of dollars for most families,” Lynch points out, “when cheap untreated nylon nets can be had for $3 or $4.” 

The NetWorks program in Senegal will support the Ministry of Health to offer LLINs for little more than $1 per net through health facilities and antenatal and immunization centers, where large numbers of mothers and children are treated. Slightly less subsidized nets (approximately $2 per net) will be available through pharmacies and community-based organizations. “Pregnant women and young children are at the highest risk of death from malaria,” Lynch says, “and therefore are the target population for the higher subsidy rate in Senegal.”

But getting a net or nets into homes is only half the battle. “We’re trying to learn the barriers for using the nets every night—what the constraints are,” Lynch says.

In many homes, parents and infants sleep in one spot and younger children sleep together in another. Because sleeping rooms are often used for other purposes during the day, nets must be re-hung each night. People sometimes complain about the nets being too hot or confining, Lynch says.

In Senegal, the biggest challenge is to promote consistent use of the nets, particularly at the start of the dry season when the mosquitoes are less evident but still a threat.