In areas hard-hit by malaria, one of the best defenses is an insecticide-treated net. But for years, malaria experts and health advocates have debated about the best way to get nets to the people who need them. New data from Kenya suggest that the answer is clear: Hand them out for free. The World Health Organization (WHO) underscored the point today by issuing new recommendations that urge countries and aid organizations to distribute nets free of charge or at very low prices to everyone in malaria-affected communities.
The solution might sound obvious, but for years some experts have recommended an approach called social marketing. Proponents argued that it was more sustainable in the long term, and that people would value nets more if they paid for them rather than received them as handouts.
But a 2-year study of net distribution programs in Kenya contradicts that position. In findings announced by the Kenyan Ministry of Health today and in a paper scheduled to be published next week in the Public Library of Science Medicine, researchers and officials report that a 2-week distribution of 3.4 million free insecticide-treated nets had a huge impact: Several months after the campaign, two-thirds of children under age 4--the most vulnerable group for developing serious malaria--were sleeping under treated nets.
The researchers, led by Abdisalan Noor and Robert Snow of the Kenya Medical Research Institute in Nairobi, found that the poorest people benefited the most from the mass giveaway. At the beginning of the study, when the primary source of nets was the retail sector, only 2.9% of the poorest children slept under nets, whereas 15.6% of the better-off children were covered. By the end, there was no difference between the two groups: 66% of both groups were covered. "Even when you charge small amounts [for nets], families have to make a choice: bed net or school books," Snow says.
Ricki Orford, a malaria technical adviser for a nonprofit group called PSI that focuses on social-marketing techniques to promote health programs in developing countries, says his group supports the new WHO recommendations. When funding is available, he says, mass distributions are a proven way to increase coverage quickly. "This is not the time to argue about which model works where," he says. "We should be focusing on models which we can scale up now."