Malaria : the impact of treated bed nets on childhood mortality in the Gambia

The effectiveness of insecticide-treated materials had been unclear, as earlier studies had based their results on the effects on vectors rather than on human morbidity and mortality rates from malaria. In 1988 the UK Medical Research Council began a systematic trial of a combined intervention for controlling malaria around the small town of Farafenni, in central Gambia. Two interventions, bed-nets treated with Permethrin and chemoprophylaxis with Maloprim, were conducted in primary health care (PHC) villages, with non-PHC villages serving as controls. The study showed that general and malaria specific mortality in young children was sharply reduced by introducing Permethrin-treated bed-nets. The treated bed-net intervention had the additional effect of reducing other causes of death. This frailty protection effect was substantial but is largely unexplained and requires more basic research. Also, not all children have to be sleeping in bed-nets for the benefit of the treatment to be felt. Small rates of noncompliance need not invalidate the effectiveness of the intervention. The nets were dipped by village women, supervised by the village health worker and the traditional birth attendant, with the support of the women's association. It appears that the washing and dipping process can be successfully undertaken by local people with a minimum of supervision, at a cost for the solution of a few US cents per net dipped.