BACKGROUND
The lack of suitable options for prevention is a major constraint facing national and international programs to reduce the burden of malaria, especially among children and pregnant women. Trials of insecticide-treated mosquito nets conducted recently in East and West Africa have demonstrated that this simple technology can reduce deaths among young children, not just from malaria, but from all causes. These were mainly controlled trials in which mosquito nets and insecticide were distributed for free. How effective bednets and other insecticide-treated materials, such as curtains, would be under conditions of voluntary acquisition and use is less clear.
To examine this and other questions related to insecticide-treated materials (ITMs), USAID hosted an international conference bringing together:
Malaria control program managers and other public health practitioners
from Africa, Asia, Europe, and the United States
Private-sector manufacturers of netting materials and insecticides
Representatives from nongovernmental organizations (NGOs) and international donors.
Conference Goals
The purpose of the conference was to create a stage where a diverse group of public health practitioners, private sector representatives and international donors could share the lessons learned to date in addressing these challenges and to explore how these lessons could be applied operationally.
Three outcomes were anticipated:
Input for a handbook to be used by programmers and planners
from the public sector, NGOs, etc. on the when, where, and how
of implementing an ITM program. It will summarize what is known
(experience and lessons learned), what is not known (questions
that need to be answered in the next few years), and what options
for action exist (the guide will not be prescriptive; there is
not just one right way to plan and carry out an ITM program).
An initial framework for ITM planners to use for monitoring
the progress of their programs
Development of a new partnership between the private and public
sectors in the planning and implementation of ITM programs.
Other goals articulated by conference participants included:
A mechanism for information sharing and coordination of ITM
activities among the conference participantsCeven after the end
of the conference
A clear statement of next steps to be acted on following the
closure of the conference.
Conference Design
The conference combined plenary and small group sessions. Participants were asked to work in groups to examine ITM programs from two completely different perspectives: first from the perspective of four key themes (demand, access, affordability, and appropriate use) (see Box 1-1), and then from a programming perspective. They discussed how the four themes applied to each step in the programming processCassessment, planning, implementation, and monitoring and evaluation. All small group sessions were facilitated and each group had a technical moderator and rapporteur.|
° Public Demand. At present, demand for insecticides, bednets,
and other insecticide-treated materials is marginal in the region.
What little demand exists is for mosquito netting. There is no
history of personal use of insecticides for treatment of bednets. ° Access. Bednets are generally available only in urban areas-if at all-and no organized public or private systems exist for delivery of insecticide services for treatment of nets. ° Affordability. In many places, bednets currently cost $10 to $25, and insecticide treatments $1 to $2 per year. The typical household is likely to need three or four bednets. This means that the use of insecticide-treated bednets could be unaffordable for most households. ° Appropriate Use. A number of ingrained behavioral and social patterns strongly influence appropriate use of bednets. Ensuring that the right populations use the nets (children under the age of five years and pregnant women) and use them correctly requires promotional efforts that adequately take into account local factors. |
Two events brought participants together outside the conference halls. The first was a poster session on the evening of the first day. Eighteen posters were presented. Poster session abstracts may be found in Annex 4. The second event was a reception on Capitol Hill hosted by Senator Patrick J. Leahy of Vermont and funded by Bayer AG.
Context
USAID promotion of bednets and other insecticide-treated materials is in the context of the agency's overall malaria control strategy for Africa. As articulated in the agency's Integrated Malaria Control Strategy, the goal of USAID malaria programs is to mitigate the impact of malaria on sustainable development through strengthening the capacity of developing African countries to reduce mortality and severe morbidity among high-risk groups, particularly infants, children under five years of age, pregnant women, and migrants and other displaced populations.
To meet the challenge of malaria in Sub-Saharan Africa, the strategy
promotes three areas critical to reducing the malaria burden:
Preventing infection and managing malaria-related illness
Building sustainable malaria control programs
Developing new technologies and approaches for malaria control.
At the core of the strategy=s approach is a package of proven
maternal and child health interventions for malaria prevention
and control, with particular emphasis on strengthening:
The diagnosis and treatment of malaria at the health facility
Early recognition in the home of malaria illness and appropriate
health-seeking behavior by the caretaker
Chemoprophylaxis for pregnant women
Increased access to and appropriate use of insecticide-impregnated
mosquito nets.
The conference may also be viewed in the context of the infectious
diseases strategy being developed by USAID in response to a Congressional
mandate. Congress has allocated additional funds to USAID to address
the infectious diseases problem; Senator Leahy was instrumental
in raising the problem in Congress. (Remarks made by Senator Leahy's
aide, Tim Reiser, at the opening of the conference are to be found
in Annex 5.) The new strategy will focus on malaria, tuberculosis,
anti-microbial resistance, and surveillance.
How This Report Is Organized
Following a preface and this introduction, which provide background on the conference and its goals and organization, are three additional chapters, a bibliography, and a number of annexes.
Summary of the opening plenary presentations
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