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From The Boston Globe


Bed Nets Promoted to Reduce Malaria

BYLINE: By Karen Hsu, Globe Correspondent

DATELINE: October 13, 1999, Wednesday, City Edition


The World Health Organization today plans to announce an ambitious new program to fight malaria among children in Third World countries by distributing special mosquito-net bedding dipped in insecticide.

WHO wants to help provide 60 million African families with these insecticide-treated mosquito nets over the next five years as part of a WHO initiative called Roll Back Malaria that started last year, said the project manager, Dr. David Nabarro.

Fewer than 2 million African households are estimated to have bednets, and the number of households actually using them properly is much lower, Nabarro said.

Malaria, spread through mosquito bites between dusk and dawn, kills 1.1 million people worldwide each year, and about 1 million of them are in Africa. One of every four childhood deaths in Africa is from malaria, resulting in 700,000 children in Africa, most of them under 5 years old.

Two years ago, studies showed that insecticide-treated nets could reduce malaria deaths by 25 percent. The nets were dipped in synthetic pyrethroids, a substance derived from a plant common in East Africa that has a long safety history and is environmentally friendly. The insecticide creates an invisible chemical wall that keeps the bugs away.

Although not the only solution, treated nets are a cheap and immediate solution to combatting the increase of malaria, said Dr. Dyann Wirth, director of the Harvard Malaria Initiative.

Nils Daulaire, president and chief executive of Global Health Council, a membership alliance of improving health worldwide, said: "It is clear that we have the technology, and it can have a huge effect now on child deaths with malaria. Nobody leaves from the hospital anymore without a child car seat in the US, but that doesn't make more than a 5 percent difference in our child death rate. With malaria, no mother in Africa should leave the hospital without a bednet."

Between 1991 and 1996, Vietnam launched use of a new antimalaria drug and distributed insecticide-treated bednets on a massive scale and was able to reduce the malaria incidence by more than 95 percent, said Dr. Kamini Mendis, a WHO malaria specialist in Geneva. Mendis said that a trial of treated bednets in the southern part of Sri Lanka reduced the number of malaria infections by 80 percent over 18 months.

Malaria control experts meeting this week at a conference in Dar es Salaam, Tanzania, are discussing strategies to increase the availability of bednets, working with manufacturers to bring down the cost, and promoting the need to retreat the bednets every six months with the insecticide. "It will reduce the reliance on DDT," said Nabarro.

The World Bank, one of the partners in the Roll Back Malaria initiative, is supporting a loan program allowing countries to begin to provide bednets and trying to reduce the tax and tariffs on bednets.

In some countries, bednets are still categorized as a luxury or higher-tariff good, not a public-health good like pharmaceuticals, said Julie McLaughlin, health specialist for the World Bank. In some places, a net could cost $20, although Nabarro said he hopes that they can eventually get the cost down to $3.50.

Britain's Department for International Development, the British equivalent of the US Agency for International Development, has already pledged 70 million US dollars for the bednet project.

But one problem will be distribution, said Dr. Peter Winch, a specialist at the Johns Hopkins School of Hygiene and Public Health. "The time people need nets and antimalaria drug treatments the most is in the rainy season, but that is also when people don't have the money, because the harvests haven't come in yet and roads are impassable because of the rain."

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