Malaria has been described as both a cause and consequence of poverty and there is little doubt that the consequences of the disease are likely to be worse for the poor and the marginalized than for the better off.  Insofar, ITNs are the only one of a few malaria control tools with proven effect on child survival, a research conducted recently by  Ifakara Health Institute, Tanzania in collaboration with London School of Hygiene and Tropical Medicine, London UK, Swiss Tropical Institute, Basel , Switzerland and Federal University of Pelotas, Brazil revealed.    

 

Furthermore, a recent programme evaluation in Tanzania shows a 27 per cent reduction in the risk of death in children aged one to 59 months among those using any net.   

 

Despite this evidence, implementation of treated nets use across Africa remains alarmingly slow making the coverage target of 60 per cent at the Abuja summit Roll Back Malaria in April 2000 unattainable.  

 

 They point out that one reason for the lack of action on ITN implementation is the problem of insecticide treatment and re-treatment. However, there is no doubt that treated nets save lives; the evidence on treated nets is somewhat less clear.  

 

Treating a net is simple, inexpensive and reduces nuisance insects as well as malaria. Despite major effort, uptake has remained poor and hence increasing inertia among the implementing group.

 

However, long lasting treatment is becoming a reality and increasing awareness that treated nets are also associated with the increase in child survival.   Another reason for the slow pace with nets is a perceived lack of evidence of how to distribute nets in poor rural areas of Africa.

 

Nets are generally thought to be too expensive for the majority, of the most at risk of malaria, to afford and hence Ministries of Health, local NGOs and international agencies continue to seek ways to reduce the prices through total or partial subsidy.   

 

Social marketing programmes offer a way to increase demand through promotion at the same time supplying the nets at subsidized prices. Yet subsidies are equated with the lack of sustainability, and social marketing may be relatively inefficient use of resources.  

 

Some have argued that nets should be seen as a ‘global public good’ and should be given out at no cost to young children and pregnant women who compose the group at most risk of life threatening malaria in most of SSA.  

 

According to a study carried out in  a rural population of about 60,000 in 12,000 household  in 25 villages of Kilombero and Ulanga districts in  Morogoro Region  whereby  the population is ethnically heterogeneous engaging in substance farming, fishing and small trading, social marketing of treated nets started in May 1997, following several months of sensitization meetings and formative  research on householders’ perceptions of causes of child death, mosquito nets, net treatment  and malaria.

 

Briefly, treated nets and insecticides were packaged and branded according to local preferences. Village based sales agents included health workers, shopkeepers, religious leaders and village government members, with at least one agent in each village. 

 

Successful agents were generally shopkeepers with few exceptional health personnel.   Furthermore a comprehensive information, education and communication campaign was developed and implemented.

 

 Retail prices were set at around $5.0 for a treated net and $0.42 for insect treated kits. The private sector sold ordinary mosquito nets throughout the period of the study.   

 

In Kilombero and Ulanga median monthly household expenditure in 1997 in a representative sample of local households varied from $77 to $96 depending on the season, of which approximately 75 per cent was expenditure on food.   

 

The study revealed that all households in the study area were included in a demographic surveillance system whereby every household was visited every 4 months. At these visits the household heads interviewed about births, deaths, in and out migrations and pregnancies arising in his/her household since the last visit.   

 

The visits shows both 1997 and 2000 information were conducted on whether the household owned a bicycle, a radio, any animals, ducks or chickens and a tin roof  also or  occupation  of the household head whether  involved in farming , fishing,  business, driving, masonry or other employment.

 

 However there are households in the study which could be classified as ‘rich’ and therefore researcher prefers the term poorer and the least poor as an opposition to poor and rich.   

 

The results of their study shows that  household net ownership rose  over the 3 years of the study  from 3820 out of  10291 households equivalent to 37 per cent with at least one net  in 1997, to 8745 of 11,970 households equivalent to 73 per cent in 2000.   

 

In 2000, 734 (53 percent) of the poorest households owned at least one net as did 1234 (93 percent) of the least poor households. The association of net ownership and wealth score remained statistically significant but the poorest to least poor ratio had improved from 0.4 to 0.6.   

 

Though the study focus on the  household ownership, the poor,  there are programmers which  attempted to target the poorest of the poor, individually  with limited success with some positive  experiences from  Asia and Latin America but very few from Africa.   

 

In Tanzania there is a dynamic market for mosquito nets which is progressively reaching the further into rural communities. A social marketing programme can build for large scale distribution. 

 

They suggest that demand is high in all social economic groups, but it is also clear that cost remains an obstacle.  A higher value voucher is being developed to address this issue. In other settings, untargeted nets distributed to all free of charge might need to be further explored. 

 

It is against this background that Tanzania, through the Malaria Haikibaliki programme,  has scored a first when the government embarked on a massive countrywide ITNs distribution programme that saw children under the age of five getting ITNs free of charge.

 

The national campaign is anchored at the community and household level by community mobilisation activities implemented by PSI-Tanzania and District Advocacy activities led by Voices 11.

 

Malaria is one of the main health problems in the world with 300-500 millions cases yearly and about one million deaths. It remains sad that despite having methods to control the disease, the malaria problem in Africa has increased over the years.