Bed net usage increases, but 90 million African children still exposed to malaria
19 November 2008
Malaria kills nearly a million people in Africa every year. For over 15 years it has been known that sleeping under a net treated with an insecticide can substantially reduce the chances of a young African child dying. When African heads of state met in 2000, the Abuja Declaration stated that they would work towards protecting 60 per cent of their vulnerable populations with insecticide-treated nets. A study published online by the ‘Lancet’ highlights what has been achieved since this historic declaration.
Kenyan and British scientists have published data from 40 African countries that shows that at the time of the Abuja meeting in 2000 just over 3 per cent of Africa's young children were protected by a treated mosquito net. Seven years later this has increased to only 18.5 per cent. In 2007, 90 million children have not yet received this simple protective tool. Most of these children live within seven African countries; one country in particular stands out - a quarter of all African children living without nets are Nigerian.
The authors report that the use of bed nets increases faster in countries that distribute them free of charge compared to countries that make people pay for them. Usage rises to an average of 25 per cent when they are given free, but is much lower at 4 per cent when people have to pay for them.
The research was conducted by Dr Abdisalan Noor, from the Kenyan Medical Research Institute in Nairobi, who says: "Our analysis clearly shows that countries that provide insecticide-treated mosquito nets free to their rural populations have achieved the highest levels of coverage in Africa in 2007. Making poor people pay the full costs of life-saving interventions like treated nets doesn't increase coverage."
The success of ITN coverage in a few countries, including Kenya, shows what can be achieved in a few years with adequate funding, political backing and a good distribution network. The researchers believe this success can be replicated in other places, and the research shows that attention increasingly needs to turn to areas where progress has been minimal.
Professor Bob Snow from the University of Oxford, who heads the group in Kenya, is working with colleagues to develop the Malaria Atlas Project (MAP), which aims to identify areas where malaria risk is greatest.
"Maps of where people live in relation to risk and current coverage of interventions are powerful tools to guide future public health investment," says Professor Snow. "What is clear is that despite 20 years of scientific evidence the challenge for donors and governments to protect children with a bed net is a battle only just beginning. New donor money must be targeted to areas where needs are greatest."
One of the UN's Millennium Development Goals aims to ensure that at least 80 per cent of vulnerable children sleep under ITNs within six years. Recently, however, even more ambitious malaria targets were announced. Last month the UN agencies pledged to renew commitments to malaria eradication worldwide. Given that progress on extending net coverage so far has been modest, meeting this target appears unimaginable for much of Africa.
However, Dr Melanie Renshaw, of UNICEF's health section malaria department in New York, says: "We now have a stronger commitment backed by more funding to universally protect Africa's children with treated nets and hopefully the map of net coverage in Africa will look very different by 2015."
Image: Anopheles gambiae mosquito sucking blood from human skin; Audio Visual, LSHTM, Wellcome Images
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Notes for editors
1. Noor AM et al. Insecticide treated net coverage in Africa: mapping progress in 2000-2007. Lancet 2008, 372. doi:10.1016/S0140-6736(08)61345-8
2. The Wellcome Trust is the largest charity in the UK. It funds innovative biomedical research, in the UK and internationally, spending over £600 million each year to support the brightest scientists with the best ideas. The Wellcome Trust supports public debate about biomedical research and its impact on health and wellbeing.
3. The Kenya Medical Research Institute (KEMRI) is a Kenya government parastatal with responsibility for health research to improve the health of Kenyans. It is one of the most well-developed national research institutes in Africa, with a network of centres across Kenya.
4. Oxford University’s Medical Sciences Division is one of the largest biomedical research centres in Europe. It represents almost one-third of Oxford University's income and expenditure, and two-thirds of its external research income. Oxford's world-renowned global health programme is a leader in the fight against infectious diseases (such as malaria, HIV/AIDS, tuberculosis and avian flu). Key to its success is a long-standing network of dedicated Wellcome Trust-funded research units Kenya, The Gambia, Thailand, Laos and Vietnam. Long-term studies of patients around the world are supported by basic science at Oxford and have led to many exciting developments, including potential vaccines for TB, malaria and HIV, which are in clinical trials.
5. The Malaria Atlas Project (MAP) is funded by The Wellcome Trust (UK) to assemble medical intelligence and survey data to provide informed statistical maps on the distribution of malaria risk, human population, disease burdens, mosquito vectors, financing and control worldwide. Evidence-based malaria risk maps generated by MAP are the first of their kind since 1968 and the results of a collaboration between malaria scientists in Kenya, UK, Vietnam, Indonesia and Ecuador.