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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

dscn0216a.JPGLikewise, 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.

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