The Untapped Potential of Bed Nets

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Abstract
After reading the News Focus story “Battling over bed nets” by L. Roberts (26 October 2007, p. [556][1]), we wish to emphasize that the higher the percentage of coverage of a population with insecticide-treated nets, the more mosquitoes will be killed and the greater the reduction in the infective mosquito population ([1][2]). Coverage targeted only at children and pregnant women achieves good, but not perfect, personal protection for those categories ([2][3]), but it has little impact on the vector population. This was the main basis of the plea by Jeffrey Sachs and collaborators ([3][4]) for community- wide, not just targeted, distribution. As Dr. Lengeler admits in the story, one can legitimately criticize the Tanzanian social marketing and vouchers scheme for only achieving 35% coverage of all Tanzanian children. In fact, coverage was considerably worse in rural areas, where the main burden of malaria exists ([4][5]). In the past, when funding for malaria control was very limited, it was reasonable to accept the need for partial cost-recovery of the price of nets, even from very poor rural people. Fortunately, this is no longer the case; the cost of a sustained program of long-lasting insecticidal net (LLIN) distribution, including replacement for worn-out nets, throughout lowland rural tropical Africa would be easily affordable by rich countries for far less than their citizens spend on cat flea control ([5][6])! Regarding concerns about sustainability, distribution of LLINs is comparable to vaccination programs, and these are sustained remarkably well in Tanzania and many other African countries. Roberts describes Jeffrey Sachs as an impatient man, and he is right to be impatient with a system that leaves thousands of children to die when the world has the technology and resources to massively reduce this toll. 1. 1.[↵][7]1. S. M. Magesa 2. et al. , Acta Trop. 49, 97 (1991). [OpenUrl][8][CrossRef][9][PubMed][10][Web of Science][11] 2. 2.[↵][12]1. S. Soremekun 2. et al. , Trop. Med. Int. Health 9, 664 (2004). [OpenUrl][13][CrossRef][14][PubMed][15][Web of Science][16] 3. 3.[↵][17]1. A. Teklahaimanot, 2. J. D. Sachs, 3. C. F. Curtis , Lancet 369, 2143 (2007). [OpenUrl][18][CrossRef][19][PubMed][20][Web of Science][21] 4. 4.[↵][22]1. S. Hay, 2. C. A. Guerra, 3. A. J. Tatem, 4. P. M. Atkinson, 5. R. W. Snow , Nat. Rev. Microbiol. 3, 81 (2003). [OpenUrl][23][CrossRef][24] 5. 5.[↵][25]1. M. K. Rust , Trends Parasit. 21, 232 (2005). 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