Arresting Malaria with Insecticide Treated Nets

Keneya Ciwara recently distributed over 200,000 insecticide treated bednets to qualified women through scores of community health centers. Pregnant women and mothers with children under five years old could receive these subsidized nets by enrolling in prenatal care or by keeping their children’s vaccinations up to date. In making insecticide treated nets (ITN) and re-treatment kits widely available to vulnerable mothers and children, Keneya Ciwara intends to reduce malarial mortality in a country where such deaths are among the highest in the world.

In 2004, Keneya Ciwara and PSI joined forces to strengthen the Malian Government’s National Malarial Control Program. Just two years into the program, participating clinics in the program’s six districts have already experienced a tenfold increase in demand for prenatal care and child immunizations.

“I have never seen such an influx of clients in the clinic! Since the launch of the Famille Protégé bednet promotion, clinic visits by women, men and youth have shot up.” reported Ibrahima Dicko, a Keneya Ciwara Project Coordinator.

Malaria is the single biggest killer of African children under five, and a serious threat to pregnant women and newborns. The simple act of sleeping under an ITN can cut the number of children who die of malaria in half. They decrease malaria deaths among pregnant women and reduce premature births by nearly half. ITNs are beyond the reach of most who experience the greatest malaria burden: pregnant women and children under age five. According to the World Health Organization, less than 3% of African children are protected by highly-effective ITNs. By 2006, however, Keneya Ciwara had boosted the proportion of Malian children sleeping under ITNs to 23.5%

Subsidized and free distribution of ITNs has proven to be a successful approach for preventing infection among very vulnerable groups. Keneya Ciwara adopted this approach and engaged Community Health Centers as distribution sites. Pregnant women enrolling in comprehensive antenatal care received an ITN for use through pregnancy and breastfeeding, the most vulnerable periods for mothers and infants. By combining provision of ITNs with Intermittent Preventive Treatment (IPT), the program further strengthened antenatal care and improved birth outcomes.

The program also contributed to maternal and child health by linking ITN distribution (and re-treatment kits) with routine immunization. WHO emphasizes universal ITN coverage for infants and children. Keneya Ciwara extended protection to young children by providing mothers with an ITN when her child’s immunizations were up to date.

Local campaigns promoting ITNs generated a great deal of interest and demand for the nets. Those not in the habit of using ITNs often need to be convinced of their usefulness and persuaded to re-treat them regularly. Working closely with local leaders and radio stations, the program organized attention-getting regional events. Radio played a prominent role in every locale. Community stations created and broadcast ITN motivational spots over 800 times in multiple languages.

Entertainment-education is firmly rooted in Malian culture through nsiirin, traditional folktales with a moral message. The program developed several nsiirin extolling the virtues of ITNs widely aired by radio. Many political and administrative leaders took part in Run for a Malaria Free Future marathons. Press briefings at Community Health Centers featured re-treatment demonstrations. Drama troupes performed malaria prevention sketches developed especially for the campaign.

Community Health Centers reached an estimated 20,000 people through talks and re-treatment demonstrations. Clients received re-treatment brochures and kits. Counseling cards in French and Bambara helped clinic workers better educate clients. Visual aids addressed ITNs and pregnant women, nursing mothers, and young children; as well as correct use of SP therapy.

Program outcomes to date are impressive. In 2006 alone, the program distributed 199,889 ITNs, almost twice the 100,000 target. Clinics furnished clients with 59,763 re-treatment kits. The proportion of pregnant women who received two doses of SP jumped from less than 1% in 2004, to 8.7% in 2006. As a result of ITN promotion, demand for pre-natal care and immunizations increased tenfold in this two-year period.

Recent increases in the proportion of women and children sleeping under ITNs further attest to the program’s effectiveness. In 2006, 20.4% of pregnant women reported sleeping under an ITN, compared to just 6.8% in 2004. The proportion of children protected by ITNs jumped nearly 14% in a single year, from 9.7% in 2005, to 23.5% in 2006. ITN distribution through social networks and Community Health Centers is clearly a winning strategy.