It is one thing to distribute insecticide treated nets in communities, whether for free, at subsidized rates or even at cost, but quite another for people to actually use them regularly. It is only net use that will help achieve drops in disease incidence as seen recently in Zanzibar and Kenya. The question is how do we ensure use. Experiences from Sierra Leone and Ghana offer two suggestions.
The Canadian Red Cross reported that, “worked with over 4,000 Sierra Leone Red Cross volunteers who helped distribute more than 875,000 nets directly to families.” What is even more important is that one year later, “over 97 per cent of families in Sierra Leone still have their nets hung up and nearly 80 per cent of children aged five and younger from these families sleep under the nets. As well, net use increases by 23 per cent after a follow-up visit by a volunteer to teach families how to hang and properly use nets.” The Red Cross example shows the importance of follow-up reinforcement by community volunteers.
Experiences from Ghana also have a positive tone about net use, although actual coverage with ITNs is still below target. The Ghana Health Service‘s Roll Back Malaria offers another lesson. The program has been conducting annual surveys since 2005, and these, as seen to the left, offer important information that when households have nets, they are for the most part being used by the intended groups. As seen here, without regular monitoring data, we will not know if people are actually using the nets.
Hopefully these experiences will encourage all countries to plan and donors to support and encourage programs that not only educate the public to use their ITNs, but also establish a good monitoring and evaluation system that will track net use and provide timely feedback to improve program performance.