The impact of charging for insecticide on the Gambian national impregnated bednetprogramme

Abstract

During the second year of the Gambian National Impregnated Bednet Programme (NIBP) charges for insecticide ($0.50 per net) were introduced into the half of the primary health care villages in the country where insecticide have been provided free of charge the previous year. Free insecticide was provided in the remaining villages that had acted as controls during the previous year. In villages where insecticide was provided free, 77% of nets were treated with insecticide. In contrast, in villages where charges were made coverage was only 14%. During the first year of the NIBP, mortality in children was significantly lower in villages where insecticide was provided free than in the control villages. Introduction of a charge for insecticide into the first group of villages and the provision of free insecticide in the latter abolished this difference. The cash income of rural Gambians is very limited and payment of even $2-3 for insecticide treatment for all the bednets in a household represents a substantial outlay. Further education on the benefits of treatment of nets and/or the provision of cheaper insecticide will be required before the full benefits of this powerful new malaria control measure can be fully realised in the Gambia. PIP:

Insecticide for the treatment of bednets was provided free of charge to half of Gambia's primary health care (PHC) villages during the first year of the Gambian National Impregnated Bednet Program (NIBP). A high level of coverage was obtained and overall mortality among children aged 1-9 years was reduced 25% in villages where insecticide was provided. During the second year of the program, charges for insecticide of $0.50 per net were introduced to the 221 PHC villages which had previously received free insecticide, while the remaining PHC villages received free insecticide. In villages where insecticide was provided free during year 2, 77% of nets were treated with insecticide, far higher than the 14% coverage achieved in villages where fees were charged. During the first year of the NIBP, mortality in children was significantly lower in villages where insecticide was provided free compared to that in the control villages. Introducing a charge for insecticide in the first group of villages and providing free insecticide in the latter abolished that difference. Additional education on the benefits of net treatment and/or the provision of cheaper insecticide will be needed before the full benefits of net treatment can be fully realized in the Gambia.