Insecticide treated nets for malaria control: a review of lessons learnt, challenges and recommendations

Abstract

Introduction: Malaria, one of the world’s public health problems, can be controlled by Insecticide Treated Nets (ITNs) among many tools available. ITNs have been in part, responsible for the decline of malaria cases in many parts of the world. Encouraged by the reductions in malaria infections, the international community is now targeting malaria elimination/eradication. The use of one of the important arsenals in war against the disease, ITNs, is however threatened by pyrethroid resistance by the Anopheles vectors and the fact that in their reduction of human-vector contact, population immunity is decreased. There is also uncertainty about the long-term protective efficacy of ITNs in endemic areas. Furthermore, though there has been heavy investment in provision of the bednets by international, governmental and nongovernmental agencies in the recent years, the funding is far below that expected to translate into targeted outcomes. Tantalizing issues of bednet chemical and physical integrity encompassing survivorship, fabric integrity and bioefficacy portends loss/stagnation of their potential to prevent malaria if further improvements are not in the offing. Coverage, ownership and utilization rates are other factors that require attention because of their ability negate the efforts put in provision of ITNs. Methods: In bid to address these concerns and other surrounding ITNs, a review of available literature was carried out to provide a forum for interrogating known facts, challenges posed and recommendations from previous research thereby providing direction for future research. Results and Conclusions: Important among the findings is that ITNs are still important tools for malaria control although concerted efforts by all stake holders will be required to enable adequate funding for their availability and improvements.