ITNs & Universal Coverage Bill Brieger | 16 Mar 2010 10:43 pm
Universal Coverage 2010 - but how long will it last
The push is in high gear to ensure Universal Coverage of malaria interventions, especially long lasting insecticide-treated nets, by the end of 2010. Nigeria may have the biggest task - aiming to distribute over 60 million LLINs, but all endemic countries are facing the challenge.
The RBM partnership assisted countries conduct a gap analysis last year - known as the road map - in order to identify any funding and/or supply shortfalls. Through this we can see that concerted effort by partners is needed so that universal coverage can become a reality. Examples of the gaps facing universal coverage follow:
- Mozambique - 4.5 million nets
- Botswana - 0.35 million nets
- Angola - 3.4 million nets
- Kenya - 12 million nets
- Burkina Faso - 1 million nets
Let us assume that partners will pull together and nets will be found. Will the aim of universal coverage thereby be achieved by 2015? One issue that may have been neglected is how long lasting are ling lasting nets?
In Ghana a study collected 255 LLINs 38 months after distribution. Some key findings were
- An average of 40 holes of varying sizes per net
- Half had seam failure
- Only 15% retained full insecticide strength
Likewise, LLIN maintenance behavior was observed in Laos after 2–3 years of use, and “About 40% of the observed nets had holes/were torn.” Two years after LLINs were distributed as part of an immunization campaign in Togo, 200 nets were analyzed. Apparently 9% were not being used and one-third had unacceptable concentration levels of deltamethrin.
Finally in Uganda washing of LLINs did not appear excessive as in some reports, and so loss of insecticide was possibly attributed to “time which has to be seen as a proxy variable for regular use or handling of the net or exposure to environmental factors.”
The implication is that even if we fill the gaps and achieve universal coverage by December 31, 2010, will we be able to achieve the aims of reduced morbidity and mortality by 2015? The challenge is more than catch up and keep up. We may in fact need millions and millions of replacement LLINs by 2013.
on 18 Mar 2010 at 4:57 am 1.Rita Chico said …
The problem is not only finding enought financing for all the LLITN that are needed or how long lasting they are…the problem is to convince local population to use them for the right purpose and not to sell them away or go fishing wiht it..
Rita Chico- working on a malaria control project in Mozambique, where we did a pilot universal coverage last year (with EU funding)
on 20 Mar 2010 at 11:40 am 2.April said …
As you have commented yourself Bill, and as Rita notes, the problems of getting everyone sleeping under ITNs in endemic areas continue to be quite serious. Free net distribution is far from a panacea, and, through crowding out commercial sources, and reducing available net diversity is making some aspects (e.g. keep up AND sustainability when funds decline as they already are) of the problems worse.
For a sobering read, check out Jane Chuma’s and co-authors recent paper on the topic in BMC Public Health
http://www.biomedcentral.com/content/pdf/1471-2458-10-137.pdf