to have, to hang and to use – is that enough?

Use of long lasting insecticide-treated nets has an impact on malaria transmission, but the key to achieving an effect is ensuring that people both own and use the net.  A study from southern Benin has taken this process to the next level. Georgia Damien and colleagues found that, “only correct use of LLINs conferred 26% individual protection against only infection.”

The authors distinguished the use of LLINs – whether children were sleeping under it during the control – from the correct use – whether the LLINs were correctly hung and tucked and were not torn.
challenge-of-diminishing-net-returns.jpgAs reported by other sources, possession of a LLIN, in this case over 90% of households in a southern Benin community, did not guarantee use, which varied on average from 73% in the rainy to 67% in the dry seasons.  Correct use likewise varied from 68% to 42% by season.

Although the Benin study implies that the protective effect of nets may result only from ‘correct use’, earlier work in Ghana showed that some protection was possible even if a household did not have LLINs.

Binka and co-researchers reported that, “The death rate among unprotected individuals increased with distance from the nearest compounds with bed nets. This suggests that (insecticide-treated nets) are protecting other individuals without bed nets who sleep close to protected compounds.”

correct-net-use-in-eye-of-beholder.jpgMuch of our hope for achieving morbidity and mortality goals rests on what could be called this community protective effect of nets, since it is difficult, considering the nature of human behavior, to expect everyone to use a net, let alone use it correctly.

We now know our goal for universal net coverage will not be met until well into 2011. The challenge as can be seen in the photos is not just distribution, but effective community health education to ensure that nets are valued and used correctly.

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