The challenge of getting people to use mosquito nets

With the recent observance of World Malaria Day, a commentary today reminds us of one big challenge with mosquito nets.

The anti-malarial nets have been widely distributed in areas prone to the disease. Yet, the challenge is getting Africans to use the nets. Nearly half of all Africans do not use the nets or their intended purpose of sleeping.

From this commentary found in the Los Angeles Times, author Sonia Shah talks about the problem. Shaha is about to publish a book on malaria titled, "The Fever: How Malaria Has Ruled Humankind for 500,000 Years."

Why that is gets to the heart of the trouble with our efforts to dislodge the diseases of the very poor. When scientists first developed the treated nets in the late 1990s, they were hailed by international donors and aid agencies as a magic bullet for malaria. Unlike nearly everything else that combats the disease, including better housing and drainage, anti-malarial drugs and insecticidal spray campaigns, the insecticide-doused nets are cheap and easy to use. Equally important, they require little infrastructure on the ground. A single volunteer on a motorcycle can distribute hundreds of nets a day, in even the most remote locales. There is no need for cold storage to keep drugs and vaccines refrigerated, nor for expert clinicians to oversee proper dosage.

To date, millions of dollars from international agencies, NGOs and USAID have been spent to get treated nets into the hands of impoverished, sub-Saharan Africans. The inter-agency Roll Back Malaria Partnership is calling for 730 million more.

But, as even the staunchest advocate will admit, the treated nets were not designed with the cultural preferences of the rural African villager in mind. Among other design flaws, their tight mesh blocks ventilation, a serious problem in the hot, humid places where malaria roosts. Minor discomfort might be tolerable in rural African communities desperate for anti-malarial prevention. But, as medical anthropologists have consistently found, because malaria is so common in much of sub-Saharan Africa, and because the overwhelming majority of cases go away on their own, most rural Africans consider malaria a minor ailment, the way that Westerners might think of the cold or flu. Many rural people also believe that malaria is caused not just by mosquitoes but also by other factors such as mangoes, or hard work.

As a result, while we see the treated nets as a lifesaving gift, they see them as a discomfort that provides only partial protection against a trivial illness. Is it any wonder that many use their nets to catch fish or as wedding veils or room dividers — all documented uses of insecticide-treated bed nets? If that sounds ungrateful, think about what would happen if public health officials, concerned about the 41,000 lives that Americans lose every year due to flu, blanketed the United States with anti-viral face masks to be worn during the winter flu season. Donning masks would be a simple, safe and effective measure that could save thousands of lives. But would people wear them?