A small price to pay: preventing malaria in rural Afghanistan

After 23 years of conflict, malaria is common in many rural areas of Afghanistan. HealthNet International developed a programme of insecticide-treated bednet (ITN) sales and re-treatment in lowland areas. Can this approach effectively replace the pre-war strategy of house spraying with DDT?

Bednets were uncommon in Afghanistan until the last decade. HealthNet’s programme involved social marketing of ITNs through a network of district clinics run by international and local non-governmental organisations (NGOs) in the east of the country. This area became secure in the early 1990s, when the focus of the war shifted to central and northern regions. Most villages were partly destroyed during the conflict but by 1995, the first year of the study, many residents had returned from refugee camps in Pakistan. They rebuilt their homes, de-mined the area, repaired irrigation systems and began to farm again.

HealthNet International offered 14 538 people in 12 villages the chance to buy nets over two years. The price per net was 8 000 afghanis (US$ 2.9) in 1995, increasing to 35 000 afghanis (US$ 3.3) in 1996 due to inflation. This involved a 25 per cent subsidy on the manufacturer’s price. Treatment was free at the time of sales, but re-treatment was offered for US$ 0.05 in 1996 and 1997. Research showed that:

• 59 percent of families bought nets.
• Net use grew from 24 per cent in 1995 to 34 per cent in 1997.
• There was a 59 to 69 percent reduction in the risk of P. falciparum malaria infection among ITN users compared to non-users.
• The risk of symptomatic P. vivax malaria also dropped by one-quarter to one-half. The full effect was probably masked by relapses.
• Re-treatment rates in villages buying ITNs were 64 per cent in year two and 47 per cent in year three even though there was only a nominal charge.

The researchers conclude that ITNs are one of the few feasible options for protection against malaria in chronic emergencies. It is more practical to help people to protect themselves than to return to centralised programmes of DDT spraying that are easily disrupted by crisis. Achieving high coverage is related more to affordability than willingness to buy a net. The researchers recommend a dual marketing strategy involving:

• a first wave of sales in rural districts
• a second phase targeting highly-subsidised nets at the most endemic areas or malaria patients attending public clinics.

The rural population at risk is just a few million. With double nets costing about four dollars each (even less with cost-recovery), it should be relatively easy for donors who have promised aid for the rebuilding of Afghanistan to provide its inhabitants with the malaria protection they want.

 

Source(s):
‘Prevention of malaria in Afghanistan through social marketing of insecticide-treated nets: evaluation of coverage and effectiveness by cross-sectional surveys and passive surveillance’, Tropical Medicine and International Health 7 (10): 813-822, by M. Rowland, et al., 2002
HINARI subscribers can access the full-text article here. Full document.

Funded by: European Commission; United Nations High Commission for Refugees; WHO Special Programme for Research and Training in Tropical Diseases; UK Department for International Development; Gates Foundation

id21 Research Highlight: 10 April 2003

Further Information:
Mark Rowland
London School of Hygiene and Tropical Medicine
Keppel Street
London
WC1E 7HT
UK

Fax: +44 (0) 20 7299 4720
Contact the contributor: mark.rowland@lshtm.ac.uk

HealthNet International

London School of Hygiene and Tropical Medicine, UK

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'Net cost - affording bednets in rural highland Kenya'

'Casting the net – free bednets for pregnant Kenyan women'

'Unsafe haven? The risk of malaria in refugee camps'

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