CHALLENGES TO THE USE OF LONG LASTING INSECTICIDE TREATED NETS IN MALARIA CONTROL
Malaria is a life-threatening disease caused by Plasmodium parasites. The parasites are spread to people through the bites of infected female Anopheles mosquitoes, called "malaria vectors". Several interventions are widely used for malaria control and prevention, and one of the most cost-effective and widely available methods is long-lasting insecticide-treated nets (LLINs). Long lasting insecticidal nets (LLINs) are being promoted by WHO and Roll Back Malaria partners as a cost effective and sustainable method for protection against malaria. Substantial increases in funding for malaria control and the procurement and distribution of LLINs have been associated with declines in malaria burden. LLINs were associated with decreases in malaria incidence, mortality, and associated morbidity such as anemia in various settings. Several challenges have been identified to influence LLIN utilization. These include demographic factors such as family size, marital status and occupation. Some reasons given for not using LLINs include discomfort, heat or inconvenience, limited perceived benefit or the preference to use other malaria preventive methods. Evidence from some studies found that the reason for the poor LLIN utilization is attributable to difficulty or lack of access to LLIN.. Some of the misconceptions that have been identified to reduce the ownership and utilization of LLIN include; perceiving malaria as ordinary fever caused by over-work, sunlight, excessive sex, noise, witchcraft, not resting/or sleeping enough, drinking too much alcohol/beer, eating too much/groundnut oil, physical contact with a malaria patient, exposure to cold air or drinking contaminated water
TABLE OF CONTENTS
Title page i
Approval Page ii
CHAPTER ONE: Introduction 1
CHAPTER TWO: Malaria and Malaria Control using Long Lasting
Insecticidal Nets 4
2.1 The Disease Malaria 5
2.1.1 Transmission 6
2.1.2 Symptoms 6
2.3 Malaria Control Using Long Lasting Insecticidal Treated Net 8
CHAPTER THREE: Challenges Associated With The Use Of Long Lasting
Insecticide Treated Nets
3.1 Knowledge of the health condition 10
3.2 Socio-demographic Factors 11
3.3 Economic Factors 12
3.4 Education 13
3.5 Misconceptions 14
3.6 Access/Availability 15
3.7 Discomfort 16
Malaria is a disease caused by infection with single-celled parasite of the genus Plasmodium Anopheles mosquitoes transmit this parasites from one person to another through their bites. Malaria is characterized by periodic bouts of severe chills and high fever (WHO, 2010). It is number one public health issue in Nigeria, accounting for 25% of under-5 mortality, 30% of total childhood mortality and 11% maternal mortality. In 2017, there were an estimated 219 million cases of malaria in 87 countries (WHO, 2019). Nigeria accounted for up to 25 percent of the global cases and deaths. Malaria is preventable and curable, and increased efforts are dramatically reducing the malaria burden in many places Globally, between 2000 and 2015, malaria incidence (the rate of new cases) among populations at risk fell by 37% while malaria death rate fell by 60% among all age groups, and by 65% among children less than 5years (CDC, 2017). Malaria remains a public health problem, causing significant maternal and child morbidity and mortality annually in sub-Saharan Africa. WHO (2000) has recommended the use of ITNs as a vital tool in combating malaria but the public awareness of this approach vary from place to place (Widmar et al., 2009). International efforts to combat malaria have led to a scaling-up of the key existing malaria control measures in recent years. Mosquito nets have been in use since very early times to protect people against blood sucking insects at night; they also help to protect against other creatures, such as spiders, cockroaches, beetles, lizards, snakes and rats. When made of thicker opaque sheeting they also protect against cold and dust and provide privacy (Ali et al., 2004).
An ITNs is a mosquito net that repels, disables and/or kills mosquitoes coming into contact with insecticide on the netting material. There are two categories of ITNs which are conventionally treated nets and long-lasting insecticidal nets (LLINs). A conventionally treated net is a mosquito net that has been treated by dipping in a WHO-recommended insecticide. To ensure its continued insecticidal effect, the net should be re-treated after three washes, or at least once a year (WHO, 2000). A LLINs is a factory-treated mosquito net made with netting material that has insecticide incorporated within or bound around the fibers. The net must retain its effective biological activity without re-treatment for at least 20 washes under laboratory conditions and three years of recommended use under field conditions. The above-mentioned problems of standard mosquito nets can be solved by impregnating them with a quick-acting pyrethroid insecticide which irritates or kills mosquitoes on contact, preventing them from finding openings (RBM, 2002). An impregnated net with holes that are not too large is as effective as an undamaged net. Insecticide treatment thus extends the useful life of a net. Mosquitoes that land on an impregnated net and attempt to feed through it on part of the body in contact with the net are likely to be killed. The behavior of a mosquito that survives contact with the insecticide is so disturbed that it is unlikely to attack again. People without a net and sleeping near someone with a treated net may receive some protection from bites. A person leaving such a net during the night or in the morning runs a reduced risk of being bitten. (RBM, 2002).
The World Health Organization recommends that LLINs be distributed for free to achieve universal coverage (one LLIN for every 1.8 people in the target population) of those at risk for malaria (WHO, 2015). An LLIN distribution involves surveying people to determine the need for LLINs; delivering LLINs; and promoting the use of LLINs. The WHO distributed bed nets to families with children under age 5 in several African countries and found that the death rate from malaria dropped by 50 to 60 percent among children in these countries (WHO, 2000). ITNs have raised a renewed interest to serve as tools for malaria control in Africa. The use of this control method has been proved to be a cost-effective means for the control of malaria (Hanson and Jones, 2000)
LLINs are very effective as they are estimated to be twice as effective as untreated nets and offer greater than 70% protection compared with no net. These nets are dip treated using a synthetic pyrethroid insecticide such as deltamethrin or permethrin which double the protection over a non-treated net by killing and repelling mosquitoes (RBM, 2002). The distribution of mosquito nets impregnated with insecticides such as permethrin or deltamethrin has been shown to be an extremely effective method of malaria prevention, and it is also one of the most cost-effective methods of prevention. A current challenge that is facing many sub-Saharan African countries like Nigeria is how to achieve widespread distribution and use of LLINs for the control of malaria.
Community perceptions relating to causation, transmission, prevention and treatment are the main socio-cultural factors that can influence malaria control Roll Back Malaria (RBM), (2002). The success of malaria control programs at present relies on community perceptions of the disease; incorrect beliefs or inappropriate behavior that can interfere with the effectiveness of a control measure such as vector control or chemotherapy (Legesse and Deressa, 2009). These issues are particularly important in tropical areas where malaria control options are limited because of the parasite and vector resistance to anti-malarial drugs and insecticides respectively. For the participation of the community to be meaningful, the views of the community should be sought and incorporated into any control program.
Some reasons given for not using LLINs include discomfort, heat or inconvenience, limited perceived benefit or the preference to use other malaria preventive methods. Evidence from some studies found that the reason for the poor LLIN utilization is attributable to difficulty or lack of access to LLIN.. Some of the misconceptions that have been identified to reduce the ownership and utilization of LLIN include; perceiving malaria as ordinary fever caused by over-work, sunlight, excessive sex, noise, witchcraft, not resting/or sleeping enough, drinking too much alcohol/beer, eating too much/groundnut oil, physical contact with a malaria patient, exposure to cold air or drinking contaminated water. Hence this seminar seeks to conduct a study on the challenges militating against the use of long lasting insecticide treated nets.