It’s not an easy ride for governments and malaria stakeholders as they strive to meet the World Health Organization (WHO)’s recommendation of ensuring every two household members use Long Lasting Insecticides treated Net (LLIN), especially in malaria-endemic areas.
On Monday, as researchers convened in Dar es Salaam to evaluate the gains made in distributing the LLINs in Tanzania, the big question on top of their mind was: “Are we reaching the goals?”
The researchers from the Ifakara Health Institute (IHI) and Tulane University, in collaboration with the National Malaria Control Program (NMCP) were keen on explaining what must be done to ensure universal coverage of the LLINs.
Over 90 per cent of the population in the country still lives in areas with a high risk of malaria transmission, data from the NMCP show.
According to various studies, the distribution of treated bed net has consistently proven to be an efficacious and cost effective strategy for malaria control in Africa.
The widespread ownership and use of the nets is necessary to reach the desired malaria control targets and improvements in other health and nutrition indicators, the researchers say.
For the NMCP’s Deputy Programme Manager, Dr Renatia Mandike, pertinent questions must be answered if the long-held targets of attaining a malaria-free country are to be reached.
“There are areas in Tanzania where bed-nets have been distributed but cases of malaria are getting high. Why is malaria not decreasing in those areas? This is where we need to intervene now,’’ Dr Mandike queried as she addressed researchers.
One of the specific areas that the researchers have been working on is the distribution of the LLINs in schools, under the School Nets distribution Program (SNP).
“When it comes to distributing bed nets in schools, there is need to start looking at how private schools are involved in this. Quite often, programs have been targeting public schools alone,’’ suggested Ms Madina Kemilembe, the Coordinator of advisory services on crosscutting issues in Schools.
According to Ms Kemilembe, private school children might be left out in the programs and this could point to reasons why malaria cases don’t go down in areas where bed nets are distributed.
“Malaria has a huge impact on the education development of the children. They miss school due to illness. It’s high time we started researching further on how to increase bed nets coverage. This will complement the current government’s efforts to reduce malaria transmission,’’ she said as researchers presented findings in Dar es Salaam.
The NMCP has been implementing the School Nets program in Lindi, Mtwara, and Ruvuma regions as a keep-up strategy to maintain universal coverage of the LLINs.
This push mechanism aims to maintain LLIN coverage through annual distribution of bed nets to school children in specified classes, the researchers said.
During their study evaluation in Nachingwea, Mtwara Urban, Sengerema and Chato districts, the researchers found that the four districts which benefitted from previous bed net distribution were almost attaining universal coverage. This was done between April-May this year.
The researchers’ initial evaluations indicated that the bed-nets coverage in the southern zone of Tanzania has remained overall high and largely stable.
However, a third-round of survey indicated there may have seen a slow decline in coverage over time in southern Tanzania where the distribution was also done. Yet, results from the fourth round show an increased coverage in nets ownership within the southern zone.
According to the report presented on Monday, the large increase in LLIN coverage in the southern regions is likely attributed to the increase in a number of nets distributed, increase in target population particularly in Mtwara and the existence of parallel intervention targeting pregnant women and infants.
The researchers emphasized that it was high time efforts to increase bed net coverage leveraged on the school net distribution programs.
“Without SNP, ownership of LLIN per two people in the household is low in Nachingwea (21. percent) and Mtwara urban (25.3 per cent,’’ said Dr Ester Elisaria, a senior Research Scientist of the Ifakara Health Institute (IHI).
“Ownership of any net was nearly universal and that of at least one LLIN [long lasting insecticidal nets] was high ranging from 83.3 per cent in Nachingwea to 96.6 percent in Sengerema,’’ she said during the presentation.
Why people don’t use the bed nets
For areas where people were not using bed nets, the most frequently stated reasons for not using net were “the nets contain bed bugs” or “no mosquitoes”.
After successful implementation of the school net program, the scientists now want to investigate the association between the distributed treated mosquito bed nets with increased household bed bugs particularly in the lake zone.
Research is needed to explore and evaluate innovative strategies for increasing and sustaining coverage and use of the nets, particularly those which can supplement mass distribution campaigns.
When the researchers carried out their evaluation, the central goal of the fourth-round evaluation of SNP was to answer the question: “Do the nets issued to school children reach the majority of households and contribute to maintaining the coverage achieved through the earlier mass distribution?”
The field work for the evaluation covered a period of sixteen weeks starting April-May 2017 which is approximately nine months since school bed nets were distributed.
The evaluation targeted four districts of Tanzania namely Mtwara Urban and Nachingwea in Southern Zone (intervention area); and Sengerema and Chato in Lake Zone (comparison area.