18 Nov 08

Dr Abdisalan Noor, a young Kenyan scientist with an honorary appointment at the University of Oxford, has shown how much still needs to be done to provide children with bed nets and protect them from malaria.

The use of insecticide-treated bed nets (ITNs) to protect children from malaria has risen six-fold in the past seven years, according to research carried out by the Kenya Unit of the Centre for Tropical Medicine, University of Oxford. Despite this success, however, 90 million children still do not have access to this simple protective tool and remain at risk from the life-threatening disease.

Malaria kills nearly a million people in Africa every year. For over 15 years it has been known that sleeping under a net treated with an insecticide can substantially reduce the chances of a young African child dying.

When African heads of state met in 2000, the Abuja Declaration stated that they would work towards protecting 60 per cent of their vulnerable populations with insecticide-treated nets. Now, a study funded by the Wellcome Trust and published in the Lancet highlights what has been achieved since this historic declaration.

Kenyan and UK scientists at the KEMRI-Wellcome Trust Research Programme in Nairobi, Kenya, have published data from 40 African countries which shows that at the time of the Abuja meeting in 2000 just over 3 per cent of Africa’s young children were protected by a treated mosquito net. Seven years later this increased to only 18.5 per cent.

In 2007 90 million children had not yet received this simple protective tool, and remain at risk from life-threatening malaria. Most of these children live in only seven African countries. One country in particular stands out – a quarter of all African children living without nets are Nigerian.

The authors report that bed net use increases faster in countries that distribute them free of charge compared with countries that make people pay for them. Usage rises to an average of 25 per cent when they are given free but is much lower, at 4 per cent, when people have to pay for them.

The research was led by Dr Abdisalan Noor from the Kenyan Medical Research Institute (KEMRI) in Nairobi. ‘Our analysis clearly shows that countries that provide insecticide-treated mosquito nets free to their rural populations have achieved the highest levels of coverage in Africa in 2007,’ he says. ‘Making poor people pay the full costs of life-saving interventions like treated nets doesn’t increase coverage.’

The success of ITN coverage in a few countries, including Kenya, shows what can be achieved in a few short years with adequate funding, political will, and a good distribution network. The researchers believe this success can be replicated in other places, and the research shows that attention increasingly needs to turn to areas where progress has been minimal.

Professor Bob Snow, of the Centre for Tropical Medicine, University of Oxford, and head of the group in Kenya, is working with colleagues to develop the Malaria Atlas Project, which aims to identify areas where malaria risk is greatest.

‘Maps of where people live in relation to risk and current coverage of interventions are powerful tools to guide future public health investment.’ Professor Snow says it is clear that ‘despite 20 years of scientific evidence the challenge for donors and governments to protect children with a bed net is a battle only just beginning. New donor money must be targeted to areas where needs are greatest.’

One of the UN’s Millennium Development Goals aims to ensure that at least 80 per cent of vulnerable children sleep under ITNs within 6 years. Recently, however, even more ambitious malaria targets have been announced. Last month the UN agencies pledged to renew commitments to malaria eradication worldwide. Given that progress on extending net coverage so far has been modest, this target appears unimaginable for much of Africa.

However, Dr Melanie Renshaw, of UNICEF’s health section malaria department in New York, says: ‘We now have a stronger commitment backed by more funding to universally protect Africa’s children with treated nets and hopefully the map of net coverage in Africa will look very different by 2015.’