Impregnated Mosquito Bed Netting in Preventing Malaria in Western Kenya

Malaria in areas such as Western Kenya has become am increasingly serious disease, which is responsible for more deaths than HIV / AIDS. The advent and introduction of impregnated mosquito bed netting in areas of Africa has raised hopes of a new method of combating malaria. Numerous studies attest to the fact that impregnated nets significantly reduce the transmission and infection of malaria in the region; especially among very young children.

However, account must also be taken of the various other concomitant factors that impact on the spread of malaria, including cultural and economic issues. Studies also caution against the expectation that impregnated bed nets are a final solution or panacea to malaria in Kenya. While impregnated bed nets have been shown to be extremely effective in reducing the incidence of malaria, yet the solution to the problem lies in an integrative view, which includes impregnated bed nets as well as a myriad of other related factors.

Introduction

While HIV / AIDS is commonly considered to the most devastating disease in Africa, numerous studies point out that the real killer is malaria. "...malaria is still the leading killer in Africa" (Patel, 1997)

This is particularly the case in Kenya. "In Kenya, malaria remains one of the biggest health problems and 75 per cent of the children born in the malaria-prone areas of the Rift Valley Province get infected with the disease. "(Patel, 1997)

Malaria in this region has both medical as well as social ramifications. This is related to poor urban conditions and to the movement of the population from the rural to the urban areas. "As the urban population continues to swell, poor sanitation, poor sewage facilities and stagnant water are encouraging mosquito breeding." (Patel, 1997)

Another factor that is important in understanding the implications of the impact of malaria on Kenyan society is finance and economics. This relates to the issue of affordable personal protection against malaria and the economic ability to combat and eradicate the causes of malaria.

The introduction of impregnated mosquito bed netting in preventing malaria in Western Kenya has therefore become an important aspect of fighting malaria in this region. In the first instance it has been found to be a more affordable as well as a significant way of dealing with a disease that has devastated this part of Africa. This paper will provide an overview of the various factors related to the fight against malaria in the region and will attempt, through the current literature, to ascertain the effectiveness of impregnated mosquito bed netting in the fight against malaria in the area.

Brief overview

Malaria is a highly infectious disease that is transmitted by mosquitoes. It is estimated that worldwide, about 300 million to 500 million people get malaria each year. (Garner, 2000, p. 54) Of the malaria transmitting mosquitoes the Plasmodium falciparum strain is the cause of most fatalities. (Garner, 2000, p. 54) One of the central reasons why malaria kills so many African children is "...because they lack immunity." (Garner, 2000, p. 54)

Ironically, malaria was almost completely eradicated in the developed world more than half a century ago. (Shell, 1997) While the spread of this disease was suppressed in the less developed regions of the world in the 50's and 60's, it has "...returned in full force to North Africa, India, Southeast Asia, China, South America, and the Caribbean." (Shell, 1997)

The literature estimates that the "...Worldwide incidence of the disease has quadrupled in the past five years, and resistance to available drugs for prevention and treatment is growing rapidly." (Shell, 1997) It is a startling fact that more than 40% of the world's population lives in areas where the disease is endemic.

In terms of the present study it is a significant and alarming fact that in Kenya, physicians report that it is estimated that one in twenty children are extremely anemic. This is a result of the malaria parasites in the blood. (Shell, 1997)

It is also important to consider the overall social and healthcare situation of the people in this region, as this obviously impacts on the issue of the fight against malaria.

In terms of the political and social history of this region, the post - colonial era has seen a backlog in healthcare developments. This is emphasized by studies which indicate that the advent of HIV / AIDS and other disease like malaria have had a profound and detrimental effect on the situation in Kenya and surrounding countries.

As Kenya... struggles with "structural adjustment," dictated by the world's financial and loan markets, the International Monetary Fund and the World Bank, and with consequent reductions in contributions from the public sector for health care, medicine as a profession is reeling from a challenge of a different magnitude." (Good, Mwaikambo, Amayo & Machoki, 1999, p. 167)

This refers to the rapid increase in HIV / AIDS cases in this region. The facts with regard to this disease are significant and must be taken into account within regard to the overall healthcare situation and the way that it impacts on the fight against malaria. "In 1998, the World Health Organization/Joint United Nations Programme on HIV / AIDS (WHO/UNAIDS) estimated that the overall HIV adult prevalence rate in Kenya was 11.6%; 1.6 million people were estimated to be infected with HIV Type I, our of a total population of approximately 30 million." (Good, Mwaikambo, Amayo & Machoki, 1999, p. 167) This factor has obviously exacerbated the situation with regard to malaria and has siphoned off medical and healthcare resources that could have been used in the fight again this disease.

Another aspect that has been mentioned and which is strongly related to an understanding go the overall picture is the lack of finances.

This is an issue that will be dealt with in greater detail with regard to the economic feasibly of impregnated bed netting.

In essence, due to a lack of money, the authorities have been prevented from providing better healthcare services. This in turn has led to "...poor environmental conditions leading to mosquito breeding. In the absence of a vaccine and affordable personal protection devices that lead to total eradication, it is important to stress the need for prevention and control." (Patel, 1997)

All of the above aspects suggest the importance and the significance of insecticide treated or impregnated bed nets. Insecticide treated or impregnated nets, known as ITNs, were developed as a new technology to combat malaria in the 1980's. It is important to realize that before this time nets were already being used by the Kenyan people to protect themselves against the mosquitoes. However, the treated or impregnated nets have only recently been found to be effective. "It was only recently appreciated that a net treated with insecticide offers much greater protection against malaria: not only does the net act as a barrier to prevent mosquitoes biting, but also the insecticide repels, inhibits, or kills any mosquitoes attracted to feed." (The Africa Malaria Report - 2003)

Therefore, the importance of impregnated nets extends beyond only the immediate protection of the individual under the net. It also repels the mosquitoes in the area and therefore provides indirect protection for others in the community.

A number of studies estimate that the importance of these impregnated nets is extremely significant in the fight against Malaria in this region. "The effect is so significant that use of ITNs is considered to be one of the most effective prevention measures for malaria." (The Africa Malaria Report - 2003)

Literature review.

There is a fairly wide range of data and studies on the aspect of impregnated mosquito bed netting in the African and Kenyan context. A concise history of the preventative measures in Kenya and in other related regions is outlined in the short but informative article by Banfield (1998) entitled, Malaria: Africa's Public Enemy No. 1.

Importantly, Banfield notes that, "The challenge of preventing or effectively treating malaria is not new. In the mid-1950s, concerted efforts were made to eradicate the disease through the use of the insecticide DDT. "(Banfield, 1998. p. 35)

However, the use of DDT was found to be dangerous and a long-term health hazard. It was "...found to enter the food chain with detrimental effects extending even to mothers' milk." (Banfield, 1998. p.35) This program came to an official end in 1969.

This informative article also outlines some of the more contemporary measures that have been introduced to combater and prevent malaria; for example, the spraying with pyrethroids which has less harmful results. (Banfield, 1998, p. 35)

However, as Banfield and many other studies point out, these measures are far from an adequate solution to the problem.

Another significant aspect that must be taken into account is the fact that there has been increasing reports in recent years of the evolution of the malaria parasite, which has become more and more resistant to the various agents and drugs previously found to be effective.…