By Jaclyn Schiff
While Americans view bed nets, used to stop the spread of malaria, "as a lifesaving gift," rural Africans often consider them an inconvenience, investigative journalist Sonia Shah, writes in the Los Angeles Times.
Shah, the author of a forthcoming book examining the history of malaria, argues that the nets are tangled in their own trap. "Is it any wonder that many use their nets to catch fish or as wedding veils or room dividers," she asks. Additional cultural misunderstandings arise because most rural Africans think of malaria the way Westerners think of the flu or a cold, Shah says, while many others attribute it to mangoes, which ripen during the rainy season when malaria transmission peaks.
Several public health experts caution that a focus on bed nets oversimplifies malaria prevention. Like Shah, they don't deny the strong evidence that bed nets reduce malaria transmission, but they question the sustainability of an approach that requires replacing the nets about every five years.
Sure, Bill Breiger, a professor at the Johns Hopkins Bloomberg School of Public Health's department of international health, says he's heard lots of stories about the misuse of bed nets.
"This is a normal thing," he says. "When you have an innovation, you give it to people, they interpret it differently in their culture and they don't always use it the way you intend."
Breiger points out that this is a larger problem with health programs, which often lack the "social science component." The follow up with nets -- teaching people how to use, maintain and store them -- has been "one of the weaker links in the overall program."
Some groups, such as Malaria No More, have programs focused on using local personalities to help with bed net education.
The public health community -- concerned about almost 1 million deaths annually -- certainly isn't moving away from bed nets.
The U.S. global malaria program, which rolled out a six-year strategy in April, includes bed nets in its prevention methods. The World Bank also announced a commitment of $200 million for the purchase of 25 million nets in response to an appeal from the U.N. special envoy for malaria. A recent report from U.N. agencies found that 150 million additional nets are needed to achieve the U.N. Secretary-General's goal of universal coverage this year.
But the "key thing," according to Breiger is to use nets in conjunction with other tools, such as insecticide spraying and appropriate medicines. Malaria is a "tricky disease," he says. "You need to look at the mosquitoes, look at the parasites and look at the human behavior." He blogs about the latest questions about aid and the use of nets here.
Correction: The initial version of this post said 350 additional nets are needed to achieve the U.N. Secretary-General's goal of universal coverage this year. The actual number of nets needed is 150 million, 200 million have already been distributed.
Schiff is a reporter for Kaiser Health News, a nonprofit news service.
categories: Public Health