Bed net’s role in East Africa’s anti-malaria war

Mr Peter Amanyire, the officer-in-charge of Kasenda Health Centre III, responds to a resident, who wanted to know how to use mosquito insecticide-treated nets, recently at Rwakenzi Village, Kabarole District-Uganda. (Photo by Courtney of Daily Monitor)


ON the beaches of Zanzibar, where the waters of the Indian Ocean kiss sandy landings all day and night, malaria is on the way out, almost eliminated through years of research, sensitisation, and vector control via, primarily, the bed net.

On the shores of Lake Kyoga in Uganda, where waters of the Victoria Nile reach for the shallow depths on their way from Lake Victoria to Lake Albert, the mosquito is at its best ferocity, sinking its labrum into one’s body as many as 1,500 times a year...

if one does not have a bed net. And in the highlands of Kenya, where dewy tea plantations stretch under the watchful majesty of Mt Kenya, the mosquito is slowly carving a habitat, aided by climate change, its own ability to adapt, and, you guessed it right, low use of bed nets.

These are the contrasting experiences of East Africa’s war on malaria, a disease long regarded as one of the region’s most dangerous. While recent studies indicate prevalence is on the decline, the deaths associated with it are not abating.

Globally, there were 212 million new cases of malaria in 2015, and the African region accounted for about 90 per cent of these cases, followed by south-east Asia at seven per cent and the eastern Mediterranean region, at two per cent.

For East Africa, as the opening paragraphs above indicate, the war against the disease has yielded a bag of mixed fortunes. Where it has succeeded, the bed net has always been the uncelebrated hero.

In Kenya, where prevalence is at around eight per cent, and where the disease killed at least 16,000 people last year, the journey towards manageable levels of infection is fraught with challenges despite considerable resource allocation in terms of finance, medicine, and personnel.

The National Malaria Strategy of 2001/10 puts emphasis on scaling up distribution of insecticide-treated nets, improving access to effective medicines for treatment, and epidemic preparedness.

A large-scale bed net trial at Kilifi in the coast, covering 53,000 people, marked the beginning of the country’s efforts to provide treated bed nets to its people, with a subsequent Unicef campaign targeting 700,000 others in 35 districts in 2001, a further five million nets being distributed through ante-natal clinic in 2006, and 3.4 million nets being given out in 2006.

Across the border in Tanzania, 10 to 12 million people contract the disease every year, according to the National Malaria Control Programme. About 80,000 of these never survive, many of them being children under the age of five and pregnant women.

The net, again, is at the centre of the battle. And in Uganda, despite the national prevalence declining from 42 per cent in 2009 to 19 per cent in 2015, the disease remains the number one cause of illness and death.

Because the mosquito seems to be clawing back — latest data from the country’s annual health sector performance report indicates that the number of malaria cases per 1,000 persons increased to 433 in the Financial Year 2016/17, from 408 in 2015/16, way above the Health Sector Development Plan target of 329 per 1,000 — the government is, you guessed it right, again, ramping up the supply of treated bed nets.

While a recent research by Kemri-Wellcome Trust found that sub-Saharan Africa has experienced a decline in the prevalence of the P. falciparum malaria parasite — from 40 per cent prevalence in children aged two to 10 years between 1900 and 1929, to 24 per cent in the same age group between 2010 and 2015 — scientists and medical experts are worried by the possibility of resurgence in the wake of growing resistance to medication, as well as climate changeinduced outbreaks.

More than 50 people died in Kenya early October of the disease, which infected 2,000 others. Authorities blamed the outbreak on rain, saying it had created fertile breeding grounds for vector mosquitoes.

In Tanzania, the threat remains huge as more than 93 per cent of the population lives in malaria-endemic zones. Prevalence has risen from nine per cent in 2011/12 to 14 per cent in 2015/16, according to the Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS) for the period 2015/2016.

Infection is highest in children from Geita, Kigoma and Kagera regions, and almost zero in Arusha, Njombe, Iringa, Dodoma, Kilimanjaro, and the Manyara regions of the mainland, and in all the regions of Zanzibar.

The battle is relying heavily on insecticide-treated nets, whose use among children under the age of five has increased substantially in recent years, from only 16 per cent in 2004/05 to a high of 72 per cent in 2011/12, before declining to 54 per cent in 2015/16.

Dr Amos Kahwa of the National Institute for Medical Research says that bed net coverage in Tanzania is still facing challenges, hence “more research is still needed, especially on how to better increase the coverage without relying on free distribution.”

There are people, says Dr Kahwa, who use the free nets for fishing, even though the minister for Health, Community Development, Gender, Elderly and Children, Ms Ummy Mwalimu, believes the government has to keep budgeting for the service.

The national action plan for control of malaria on mainland Tanzania focuses on sustaining the gains made so far in controlling the disease, and also exploring the possibilities of moving towards the malaria preelimination phase by 2020 and the World Health Organisation’s target of eliminating the disease by 2030.

Dr Frederick Haraka, a clinical epidemiologist and a research scientist from the Ifakara Health Institute, says Tanzania’s goal to eliminate malaria will also depend on how much investment the country will put in vaccine development.

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