Malaria Prevalence, Mosquito net Preventive Therapy and Future Impl...

This is my first write-up after my introduction post. Having talked about my niche and and the first set of topics I will be sharing, I deem it fit to start this way. Few months ago, a Non-Governmental Organization launched a program to distribute mosquito nets to all residents of my state (Ogun state, Nigeria) in order to reduce the prevalence of malaria outbreak in the state under the program called "Roll Back Malaria". Since I was part of the health officers that mobilized and supervised the net distribution, I can categorically report that the program was a success. But what emerged after just 4 months after the distribution marveled me. I have made this post to report this case and at the same time writes on the controversies within the distribution, abuses that have transpired and the future implications on the eradication of malaria parasites.

A look at the Prevalence of Malaria and the Mosquito net Preventive therapy

In order to do justice to some of the concerns raised, I will like to expatiate on the subject matter 'Malaria'. It is a world renowned human (sometimes animal) diseases known to be caused by a parasitic protozoan referred to as Plasmodium (majorly Plasmodium falciparum). This organism is transmitted by an insect vector called Female Anopheles mosquito. Though very rampant in developing countries, with a high mortality rate in sub-saharan african, it is still a worldwide known diseases.

_{Female Anopheles Mosquito [License: Public Domain]: Pixabay}

The countries that records high incidence have been known to have a larger population of the victims living in an unclean environment, living below the standard of living, could not have access to basic medical needs and have a higher number of people who are easily prone to the disease (such as the sickle cell anemia patients, pregnant women and children under 5 years of age). The initiation of the diseases starts from when a low immune person is bitten by the female anopheles mosquito, the mosquito injects the blood into the victim's blood and passes to the liver where it multiplies thereby infecting the red blood cells (erythrocytes).

The red blood cell has the most abundant blood cells in the body and is responsible for the transportation of oxygen in the body cells. Therefore, an infected person will certainly undergo symptoms to show the presence of the parasite in the victim’s body. When the symptoms is not complicated, headache, cold, fever, pain, vomiting etc might occur but when left untreated, complications can lead to oedema, convulsion, severe body pain, difficulty in breathing and may result to death.

According to the World Health Organization data reports, about half of the world population are prone to malaria. However, about 90% cases of malaria were reported to have occurred from sub-saharan african countries with an alarming 92% deaths caused by malaria.

_{Treated mosquito net BY Tjeerd Wiersma: FROMWikipedia commons:CC BY SA 3.0}

With this report, the Government of African countries are really affiliating with local and international non-governmental organizations (especially the World Health Organizations and the United Nations Children's Fund) to solicit for support in reducing the cases and rate of malaria mortality in their respective countries.

However, everyone is aware that prevention is the best form of therapy for the eradication of any diseases; which is why the Catholic Relief service (CRS) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) in conjunction with the Ogun state government organized the distribution of a special mosquito nets called Long Lasting Insecticidal Net (LLIN).

Aside from the use of treated mosquito nets for the prevention of malaria, there are other forms of prevention which had been severally used by an average african person which include the use of mosquito coil, mosquito insecticides/chemicals, use of repellants, use of preventive drugs, wearing of clothes that covered the body, dislodging every form of stagnant water body, cutting of surrounding bushes etc. However, if prevention are not adequately put in place especially in malaria prone areas such as the sub-saharan african countries, then transmission is possible.

In Ogun state, Nigeria, reports of malaria cases from different health clinics were higher than the required threshold; therefore all public health centres were supplied with the malaria diagnosis kit referred to as the Rapid Diagnosis Test (RDT) kits (which fast-track the detection of malaria parasite in the blood of an infected person); and the ACTs drug (Artemisinin-based combination therapy) which eliminates the parasite in the blood stream of the victim. However, all these relief materials did not receive much accolade as much as the distribution of the Long Lasting Insecticide Mosquito Net due to the fact that the nets were distributed directly to the beneficiaries as against the RDT and the ACT medicines in which only suspected and/or diagnosed victims were beneficiaries via the health facilities.

How the Treated Mosquito Nets were distributed

Between May 1 to 5, more than 3 million mosquito nets were supplied by the Catholic Relief service (CRS) to Ogun state residents which have about 20 Local Governments and 37 Local Council Development with a population of over 4 million residents.

_{Collection of Treated Mosquito nets: Picture taken by myself using Samsung Galaxy Tab E camera}

According to the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) who provided the funds for the program, the mosquito nets which worth more than 3 billion naira was directed to only the region to tackle the prevalence of malaria in the state. From the proportion of the mosquito nets supplied to the population of the residents, the proposed plan for the usage is that 2 people would sleep in 1 mosquito net.

This, plus other vital information was disseminated during the training especially on the reasons for the distribution and the procedures before and during usage. However, of the other malaria eradication programs that i have participated in, the program was the most organized and efficient due to the use of electronic gadgets in the distribution of the nets.

Aftermath of the Mosquito net distribution

It's been 4 months after the distribution of the mosquito nets. Normally, evaluations are done to find out if the aim of the program was achieved. To my surprise, the outcome is too critical to mention. It was surprising to see the mosquito nets not being used for its sole aim. After going round some communities in which larger turnouts of mosquito net collections were recorded, it was surprising and alarming to see that these mosquito nets were used for other purposes other than to sleep underneath. The following were observed:

1. Use of mosquito nets for Agricultural purposes

This was the most alarming way in which the newly distributed mosquito nets were abused. In places visited, especially in 5 Local Government areas, residents boldly make use of these nets as if that was what it was really meant for. Such agricultural sites on which these nets were seen are on farm lands (majorly to make a barrier to what was planted), Poultry (surprisingly, other form of mosquito preventive products such as mosquito coils and insecticides were used to repel insects), Fish ponds (newly distributed mosquito nets were seen tied round the ponds as barrier, some reports even submit the use of mosquito nets for hauling fish), local agricultural processing plants (old mosquito nets were seen to be used as covering for cassava and tools on the processing sites) etc

_{Use of Treated Mosquito nets for Agricultural Purposes: Picture taken by myself using Samsung Galaxy Tab E camera}

2. Use of mosquito nets for household usage:

From evaluations, the newly distributed mosquito nets were seen in some households displayed as window shield and curtains, door curtains or used as room demarcations.

3. Other abuses

Some other abuse reports which is worthy of note are; use of mosquito nets as inner lay for bags; as sponges for bathing, as wedding veil etc

Implications of mosquito net abuse on the eradication of malaria

With the emerging abuses of mosquitoes nets outlined above, the major implication for these abuses is that the mosquitoes responsible for the transmission of malaria is likely to develop resistance to treated nets. This means that the eradication of malaria through mosquito nets or any other mosquito repellants is under threat and the global aim to reduce the mortality rate due to malaria might be hitting the rock.

My view on the cause of this abuse is based on the numbers of mosquito nets distributed. Every four years, Nigerian government in affiliation with a specific NGO do ensure that treated mosquito nets are freely distributed to its citizens. Over-saturation of these nets is one of the major reasons why these nets have been abused. Another reason for the abuse is wrong/misinformation on the usage. Lastly, many people that wrongly used these mosquito nets are discovered not to have ever slept under the net before. This means that the intention to use these nets for other purposes have been decided before collection.

600px-Mosquito,net,inside,TamilNadu404-1.jpg

_{Mosquito showing resistance to Treated mosquito net BY LOGANATHAN . R.: FROMWikipedia commons:CC BY SA 3.0}

Conclusion

I will conclude by suggesting few likely measures to prevent abuses on subsequent Mosquito net distributions. Firstly, i will advise that henceforth, collection of mosquito nets should be done by demand through the nearest health facilities. Adequate measures should be put in place to ensure effective usage of collected mosquito nets and strict laws should be passed to punish those found to wrongly use the nets. Likewise, priority should be given to pregnant women and nursing mothers who are in dire need of the nets. Other preventive therapy such as the use of genetically modified mosquitoes should be considered.

Thank you for listening

|REFERENCES|

Malaria: Symptoms, treatment, and prevention

Malaria: Wikipedia

Key points on world malaria report 2017: World Health Organisation

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Malaria Prevalence, Mosquito net Preventive Therapy and Future Implications: A case study of Ogun state, Nigeria