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Insecticide-treated bednet use, anaemia, and malaria parasitaemia in Blantyre District, Malawi
Timothy H Holtz1, Lawrence H Marum, Christopher Mkandala
1Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. tkh3@cdc.gov
Insights
Insecticide-treated bednets (ITNs) distribution via social marketing showed health benefits for children in Malawi. However, low ownership, especially in rural areas, and cost barriers highlight challenges in achieving widespread malaria prevention.
Area of Science:
- Public Health
- Malaria Prevention
- Social Marketing
Background:
- Insecticide-treated bednets (ITNs) are crucial for malaria prevention.
- Assessing the effectiveness of social marketing for ITN distribution is vital for public health interventions.
- Malaria prevalence remains a significant concern, particularly for children under five.
Purpose of the Study:
- To evaluate the utilization of insecticide-treated bednets (ITNs).
- To assess the effectiveness of social marketing strategies in distributing ITNs.
- To determine the impact of ITN ownership on malaria parasitaemia in children under five.
Main Methods:
- A systematic cluster sample survey was conducted in 1080 households across 36 census enumeration areas in Blantyre district, Malawi.
- Data collection focused on bednet ownership, usage, and reasons for non-ownership, alongside malaria parasitaemia prevalence.
- Multivariate statistical models were employed to control for confounding factors such as location, household structure, and education.
Main Results:
- Overall bednet ownership was low (20.5%), significantly lower in rural (6.4%) versus urban (29.8%) areas.
- Children in households without bednets had a significantly higher prevalence of malaria parasitaemia (Rural RR 4.9; Urban RR 2.1).
- Lack of funds was the primary reason (94.9%) for not owning a bednet, indicating a significant cost barrier.
Conclusions:
- Social marketing of ITNs in Blantyre District may have yielded health benefits for participating households.
- Market-based approaches for ITN distribution may require extended periods to achieve high coverage.
- Existing distribution strategies may exacerbate health inequities between urban and rural populations.
Objective:
To evaluate the use of insecticide-treated bednets and the effectiveness of social marketing for their distribution.
Methods:
Systematic cluster sample survey of 1080 households in 36 census enumeration areas across Blantyre district, Malawi, in February 2000.
Results:
A total of 672 households had one or more children under 5. Bednet ownership was low (20.5% of households) overall, and significantly lower in rural areas than urban areas (6.4 vs. 29.8%, P=0.001). Only 3.3% of rural children under 5 had slept under a net the previous night, compared with 24.0% of urban children (P < 0.001). When asked why they did not own a net, nearly all (94.9%) caretakers in households without nets stated they had no money to buy them. In multivariate statistical models that controlled for the influence of house structure, urban vs. rural location, gender of the head of household, and the primary caretaker's education, rural children under 5 in households without nets experienced a statistically significant higher prevalence of malaria parasitaemia [RR (risk ratio) 4.9, 95% CI (confidence interval) 2.3-10.5] than children in households with at least one bednet. This was also true for urban children under 5 (RR 2.1, 95% CI 1.0-4.2, P=0.04).
Conclusion:
Social marketing approaches to promoting insecticide-treated nets in Blantyre District may have produced measurable health benefits for children in those households in which residents bought and used the products. Market-based approaches may take years to achieve high levels of coverage and may exaggerate inequities between urban and rural populations.
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