History of the Use of Insecticide Treated Nets (ITNs) As a Malaria Prevention Strategy - Essay Sample

Introduction

Mosquito nets that have been treated with insecticide that are popularly known as insecticide-treated nets (ITNs) were developed in the 1980s as one of the key malaria prevention strategies. Ntonifor and Veyufambom (2016) have stated that ITNs are twice as effective as untreated mosquito nets in the prevention of malaria especially among the most vulnerable populations (children under the age of 5 years, pregnant women, and the elderly) (Ntonifor and Veyufambom, 2016). On 25th April 2000, The African Summit on Roll Back Malaria was held in Abuja, Nigeria. In this summit, there was a commitment to intensify the effort in the reduction of malaria mortality by ensuring that at least 60% of those suffering from malaria not only have access to, but also can correctly use, afford, and access appropriate treatment within 24 hours after the onset of malaria symptoms (Ntonifor and Veyufambom, 2016). It is also important to point out that in the Summit, it was declared that the most vulnerable populations should benefit from a combination of both personal, and community protective measures against malaria, and this includes using insecticide-treated mosquito nets, and other malaria prevention measures. According to WHO (2002), it proposed, other than the use of ITNs, pregnant women, especially the ones in their first pregnancies, who are at high risk of being diagnosed with malaria should have adequate access to presumptive intermittent treatment to reduce the mortality rate of pregnant women from malaria disease (WHO, 2002).

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Government Programs on Provision of ITNs for Vulnerable Groups

One of the targets that were set in the Abuja summit in 2000 was to increase the proportion of the vulnerable population in Nigeria who were under ITNs to 60% by the year 2005. It was determined as an effective measure in terms of reducing new infections and mortality rates as a result of malaria (Ibrahim, 2014). In 2005, the Malaria Control Programme in Nigeria conducted a national household survey to determine the number of households that owned ITNs, and its use among households that had pregnant women and children who were less than five years (OE, 2012). This was a follow-up program to determine the progress of the set target in 2000. It is important to note that this was the first national survey that was assessing the progress of the use of ITNs after the Abuja target was made. During the five-year period, the government had managed only to provide 2.8% of the 60% of households with the ITNs.

Although it was way below the set target, it cannot be considered to be a non-negligible achievement given its impact in terms of reducing new infections, and mortality rates in the most vulnerable populations. For instance, according to Oresanya et al. (2008), the use of ITNs in areas of high malaria infection reduced by 50%, in comparison to areas where nets were not used, and 39% in comparison to areas where the nets that were in use were untreated. The use of ITNs also led to the reduction of severe malaria incidences, parasite prevalence, splenomegaly and improvement in hemoglobin levels of children (Oresanya et al. 2008). Oresanya et al. (2008) pointed out that there was a 27% reduction in child mortality rate after an ITN social marketing program was implemented in Tanzania. Also, according to WHO (2007), the use of ITNs in Kenya after the free mass distribution was seen to be a quick method of increasing the coverage of people who use this mosquito prevention strategy, especially among the poorest populations. These two studies have provided overwhelming evidence on the efficacy of the utilization of ITNs as a malaria control strategy.

WHO (2002) noted that previously, efforts against malaria prevention and spread focused on distributing mosquito nets for use to households that had pregnant women, or children under the age of five years. However, recent studies ( Ezeama et al. 2014; Atenchong and Ozims, 2016; Ntonifor and Veyufambom (2016) have pointed out that through the expansion of the use of the nets to all people in the high-risk areas, enhances the protection of the vulnerable groups. The reason for this is that protecting all community members in the areas of high transmission of malaria ensures that full coverage is achieved, and reduced new infections and mortalities as a result of this disease (Ezeama et al., 2014).

Ogbeide et al. (2014) pointed out that that the increasing prevalence of malaria, led Nigeria to adopt WHO's recommendation of providing ITNs free of charge at different points of distribution to people who are at high risk of contracting the disease (Ogbeide et al. 2014). However, Adaramala and Babalola (2015) argued that there are people or households that owned nets but do not use them, pointing out that the level of awareness of the impact of ITNs on the reduction of malaria infections, can have a positive impact on helping people use these devices appropriately (Adaramala and Babalola, 2015).

The Relevance of Knowledge in the Usage of ITNs Among Pregnant Mothers

According to a study by Ankomah et al. (2014), pregnant mothers who regularly listened to mass media campaigns on the use of ITNs as a malaria prevention strategy were highly likely to adopt the strategies that will help protect themselves against the disease. The research established that behavior change communication messages that aim at promoting the use of different malaria treatment methods are an important strategy in terms of combating malaria (Ankomah et al., 2014). For instance, one of the strategies that have been adopted by the Nigerian National strategic plan for malaria is to create awareness of the mass media on the prevention of malaria during pregnancy using ITNs, and other malaria prevention strategies.

A study by Atenchong and Ozims (2016) established that the knowledge of the use of ITNs as a preventive measure against malaria did not have a significant impact on the actual use of the net by its study participants. The study recommended that the Nigerian government should increase its efforts in terms of educating the people, especially the rural populations on the benefits of using ITNs (Atenchong and Ozims, 2016). In addition to that, they should ensure that there is free distribution in the high transmission zones that are accompanied by a participatory approach. This means that the targeted groups should be educated on how these nets are fitted in the beds, and how they can be cleaned. Ezeigbo et al. (2014) research findings indicated that the perceived malaria risk and adequate knowledge of malaria are crucial determinants in terms of the ownership and regular usage of these nets (Ezeigbo et al., 2014).

Okonta (2012) conducted a study in the Delta State, showed a correlation of high transmission rates in pregnant women who did not use ITNs to prevent mosquito bites when they were sleeping at night. The study identified that some of the major obstacles that prevented vulnerable populations in this region from using ITNs as a malaria prevention strategy were accessibility and affordability of the ITNs by pregnant women (Okonta, 2012). The researcher recommended that effective strategies should be put in place to reduce the gap between the acquisition of ITNs, and their consistent utilization.

The Role of Attitude and Practice in Relation to the Effective Use of ITNs in the Prevention of Malaria

For msquito nets to be effective, they have to be placed in a tent-like manner covering the bed. The nets should not have holes or gaps that are large enough to allow the insects to enter. It is also important for the users to 'seal' the net- ensure that they tuck it in under the mattress along the edges to ensure that mosquitoes cannot gain access to the occupants that are inside the net (Yassin et al., 2011). In addition to that, an individual should not rest directly on the net because the insect can bite through the nets. Ezeigbo et al. (2014) highlighted that the use of ITNs reduces the human-vector contact by ensuring that people who sleep under the nets do not have physical contact with the malaria-transmitting mosquitoes during the night when they are asleep. They also kill the mosquitoes when they land on the net or repel them when they come close to the mosquito net, which is an indicator that they reduce the number of mosquitoes that are within the vicinity of individuals who are sleeping (Ezeigbo et al., 2014).

Ezeama et al. (2014) noted that although there was an increase in terms of awareness of the benefits of using ITNs, the usage of this malaria prevention strategy, especially in areas of high transmission was significantly low. Ezeama et al. (2014) noted that a majority of people failed to sleep under the nets because of excessive heat and fear of the chemical that is used during the treatment of the nets. The researchers noted that there was the need for intensive public education to dispel the misconception in regards to the fear of the chemical used during the treatment of the mosquito nets, excessive heat, and increased availability of ITNs to encourage increased usage of this prevention strategy (Ezeama et al., 2014).

Musa et al. (2009) noted that if ITNs are properly used, especially in areas of high transmission, then they can reduce new infection rates by approximately 60%, and child deaths by 20% (Musa et al., 2009). Augustininc et al. (2015) pointed out that the increased usage and knowledge of benefits can be enhanced if the relevant stakeholders (national government and WHO) use strategies that lead to an increase in terms of ownership of ITNs, and ensuring that the people know how to hang them properly (Augustininc et al., 2015).

Conclusion

Proper usage of the ITNs can significantly reduce the infection and mortality rates of the populations that have for years been affected by malaria. However, existing evidence, which was highlighted in this literature review pointed out that there are relatively few people, especially in the high-risk regions that have access, and regularly use them. In addition to that, the some of the studies that were mentioned in this literature review noted that the low usage of ITNs can be attributed to mosquito net not being hanged properly, excessive heat, and fear of the chemicals that are used during the treatment of the nets. The government and other organizations that are concerned with the implementation of malaria prevention strategies should increase their efforts in terms of making ITNs accessible, improving the knowledge on how to use them, and the expected benefits. This is highly likely to change the behaviors and perceptions of people who are at high risk of malaria infection but do not use ITNs because of the mentioned reasons.

References

Adaramola, E. F., & Babalola, B. I. (2015). Factors influencing the utilization of insecticide treated nets among children under the age of five in Nigeria. Federal University Oye-Ekiti, Ekiti State Nigeria.

Ankomah, A., Adebayo, S. B., Arogundade, E. D., Anyati, J., Nwokolo, E., & Inyang, U. (2014). The effect of mass media campaign on the use of insecticidetreated bed nets among pregnant women in Nigeria. Malaria Res Treat.

Atenchong, N., & Ozims, J. (2016). Attitudes toward utilization of insecticide-treated bed nets among pregnant women and care-takers of under-five. Infection Control tips.

Augustincic, P. L., Petkovic, J., Welch, V., Ueffing, E., Tanjong, G. E., & Pardo, J. (2015). Strategies to Increase the Ownership and Use of Insecticide-Treated Bednets to Prevent. Cochrane Database Syst Rev. (3).

Ezeama, M., Ezeamah, F., & Akor, O. G. (2014). Factors militating against the use of insecticide treated nets...