Insecticide treated mosquito nets for malaria control in India-experience from a tribal area on operational feasibility and uptake

• Published in: Memórias do Instituto Oswaldo Cruz Vol. 103; no. 2; pp. 165 - 171
• Main Authors: Jambulingam, P, Gunasekaran, K, Sahu, S.S, Vijayakumar, T
• Format: Journal Article
• Language: English
• Published: Brazil Fundação Oswaldo Cruz, Fiocruz 01-03-2008; Instituto Oswaldo Cruz, Ministério da Saúde; Fundação Oswaldo Cruz (FIOCRUZ)
• Subjects: acceptability; Animals; Anopheles; Attitude; Awareness; cost-recovery; Feasibility Studies; Female; Humans; India; Insecticides; Interviews as Topic; ITNs; ITNs - acceptability - usage - re-treatment - cost-recovery - Orissa - India; Malaria, Falciparum - transmission; Male; Mosquito Control - economics; Mosquito Control - instrumentation; Mosquito Control - methods; Orissa; PARASITOLOGY; re-treatment; Rural Population; Seasons; TROPICAL MEDICINE; India; ITNs; re-treatment; usage; Orissa; cost-recovery; acceptability; India
• ISSN: 1678-8060; 0074-0276; 1678-8060
• DOI: 10.1590/S0074-02762008005000009

The study assessed the operational feasibility and acceptability of
insecticide-treated mosquito nets (ITNs) in one Primary Health Centre
(PHC) in a falciparum malaria endemic district in the state of Orissa,
India, where 74% of the people are tribes and DDT indoor residual
spraying had been withdrawn and ITNs introduced by the National Vector
Borne Disease Control Programme. To a population of 63,920, 24,442 ITNs
were distributed free of charge through 101 treatment centers during
July-August 2002. Interview of 1,130, 1,012 and 126 respondents showed
that the net use rates were 80%, 74% and 55% in the cold, rainy and
summer seasons, respectively. Since using ITNs, 74.5-76.6% of the
respondents observed reduction of mosquito bites and 7.2-32.1%
reduction of malaria incidence; 37% expressed willingness to buy ITNs
if the cost was lower and they were affordable. Up to ten months
post-treatment, almost 100% mortality of vector mosquitoes was recorded
on unwashed and washed nets (once or twice). Health workers re-treated
the nets at the treatment centers eight months after distribution on a
cost-recovery basis. The coverage reported by the PHC was only 4.2%,
mainly because of unwillingness of the people to pay for re-treatment
and to go to the treatment centers from their villages. When the
re-treatment was continued at the villages involving personnel from
several departments, the coverage improved to about 90%.Interview of
126 respondents showed that among those who got their nets re-treated,
81.4% paid cash for the re-treatment and the remainder were reluctant
to pay. Majority of those who paid said that they did so due to the
fear that if they did not do so they would lose benefits from other
government welfare schemes. The 2nd re-treatment was therefore carried
out free of charge nine months after the 1st re-treatment and thus
achieved coverage of 70.4%. The study showed community acceptance to
use ITNs as they perceived the benefit. Distribution and re-treatment
of nets was thus possible through the PHC system, if done free of
charge and when personnel from different departments, especially those
at village level, were involved.