WHO Backs Free, Treated Mosquito Nets to Prevent Malaria

By Stephanie McCrummen
Washington Post Foreign Service
Friday, August 17, 2007

NAIROBI, Aug. 16 -- Long-lasting, insecticide-treated mosquito nets should be distributed free, rapidly and widely in malaria-endemic areas, World Health Organization officials said here Thursday, setting new guidelines for fighting the mosquito-borne disease around the globe.

For years, a policy debate has raged not so much over the effectiveness of mosquito nets in preventing the disease, but over how best to distribute them.

One camp, including organizations that produce and distribute nets with U.S. and other donor funds, has argued that the nets should be sold, albeit cheaply, because people who spend their own money on them are more likely to value them and use them properly.

Another camp has argued that poverty is so profound in some areas that even at a cost of $1 each, the nets are unaffordable to the people who need them most.

Thursday's announcement "ends the debate" over which method is best, said Arata Kochi, director of WHO's global malaria program. "No longer should the safety and well-being of your family be based upon whether you are rich or poor," Kochi said in a statement. "When insecticide treated mosquito nets are easily available for every person, young or old, malaria is reduced."

WHO has no power to order governments to adopt this approach. But health ministries that use funding from international donors often take cues from the U.N. agency's guidelines.

Malaria, which is caused by a parasite transmitted by infected mosquitoes, can kill if left untreated and is rampant in about 114 countries across Africa, Asia and Latin America. African children younger than 5 are disproportionately killed by the disease.

The WHO announcement was paired with what Kochi called "impressive" findings by Kenyan health authorities that widespread, free distribution of mosquito nets can effectively save children's lives.

After several years of using a combination of free distribution and sales, the Kenyan government last year conducted a massive, almost military-style campaign to distribute without charge 3.4 million insecticide-treated mosquito nets over three days in 46 malaria-endemic districts across the country.

Among a monitored group of 3,500 children in four of those districts, the number sleeping under the nets increased nearly tenfold from 2004 to 2006, WHO said, citing Kenyan government figures. The result was 44 percent fewer deaths than among children not sleeping under nets.

Insecticide-treated mosquito nets kill mosquitoes on contact. If enough nets are distributed and used, they can have a kind of collective impact of eradicating mosquitoes in a given area.

Critics have said that the approach of selling the nets is too slow and distribution too spotty to achieve such a result.

"The issue now is coverage," said Peter Olumese, a WHO medical officer who has advised the Kenyan government.

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