Drive to produce more long-lasting insecticidal mosquito nets for malaria.

Abstract

International efforts are under way to step up production of new long-lasting insecticidal mosquito nets which falls far short of the massive demand, experts say. The new nets, which were first developed in the 1990s but have only recently become more readily available, provide fresh hope for preventing malaria, the number one killer of children aged under-five in Africa. Production has increased and more money is there to buy them, but experts say major obstacles to delivering treatment are supply, distribution and red tape. In an unprecedented meeting last month, humanitarian and health agencies working in malaria control linked up with the private sector to discuss ways of speeding up production and distribution of these improved insecticidal mosquito nets. Members of the Roll Back Malaria Partnership including WHO and the United Nations Children's Fund (UNICEF) organized the two-day event in Johannesburg, South Africa with the Rockefeller Foundation and USAID NetMark Plus, a US government initiative to fight malaria in Africa. The new net retains insecticide for the life of the net, which can be four years or more. This is a major improvement on existing insecticidal mosquito nets, which needed to be re-treated every 6-12 months. High levels of re-treatment, however, have proved very difficult to achieve in Africa, partly due to the cost of insecticide but also because of a lack of proper organization. According to WHO less than 20% of nets there are re-treated. "Those who expected people in poor rural areas to take the initiative to re-treat their mosquito nets have been proven wrong", said Dr Allan Schapira, coordinator of the strategy and policy team in WHO's Roll Back Malaria Department. "In East Asia this is organized by the public health services but in most areas in Africa re-treatment has been left to individuals," Schapira said. Of the one million deaths annually from malaria, 90% are in Africa and are mostly among young children and pregnant women. A systematic review found that using insecticidal nets is a highly effective way to reduce childhood mortality and morbidity from malaria (Cochrane Database Syst Rev 2004; (2): CD000363). One of the targets set at the Abuja Summit in April 2000, a key meeting of the Roll Back Malaria Partnership of humanitarian agencies and governments, was to have 60% of populations at risk sleeping under insecticidal nets by 2005. However, the Africa Malaria Report produced by the Roll Back Malaria Partnership in 2003 found that although 15% of children under five years old were sleeping under a net, only 2% were sleeping under an insecticical mosquito net (www.rollbackmalaria.org). UNICEF estimates that 30-40 million long-lasting insecticidal nets are required annually for the next five years to meet demand. At the moment only 13 million are being produced each year. UNICEF's Regional Director for Eastern and Southern Africa, Per Engebak said: "Our goal is to save lives. Every 30 seconds, a child dies of malaria, a life that could be saved with an insecticidal net. A quantum leap in production will help us save millions and also enable the private sector to do good business." Several long-lasting nets are currently under development and two products were approved by WHO last year. Long lasting insecticidal nets are subject to assessment by the WHO Pesticide Evaluation Scheme as part of the WHO recommendation process. This is a rigid scientific review of their efficacy, effectiveness and safety based on a series of laboratory, experimental hut and field studies (www. …