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    Mosquitoes around the home can be reduced significantly by minimizing the amount of standing water available for mosquito breeding. Residents are urged to reduce standing water around the home in a variety of ways.


    The best way is to avoid being bitten by mosquitoes.This can be accomplished using personal protecting  while outdoors when mosquitoes are present. Treated bed nets should be used sleeping. Mosquito repellent should be used when outdoor.


    Nearly half of the world’s population is at risk of getting malaria. Pregnant women are particularly at risk of malaria. Children under 5 years are at high risk of malaria.


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A Cover for Life

The quest to control malaria does not seem impossible anymore with the call by the Roll Back Malaria (RBM) partnership to scale up effective malaria control tools and the response by endemic countries to do free mass distribution of bed nets, which rapidly led to major successes.

The use of long-lasting insecticide-treated nets (LLINs) is a highly effective and critical component of malaria prevention and control.

Net use has been shown to reduce mortality in children under five by about 20 per cent and malarial illnesses among children under five and pregnant women by up to 50 per cent.  

Experts say LLINs not only protect individuals sleeping under them from being bitten, but also kill mosquitoes that land on nets, reducing overall malaria transmission in the community.

Between 2008 and 2011, more than 25 African countries have implemented universal coverage strategies, delivering approximately 200 million LLINs to populations in endemic areas and saving hundreds of thousands of lives

Ghana is making strides in ensuring that all Ghanaians sleep under the net.  It is unimaginable that just over a decade ago National Malaria Control Programmes (NMCPs) did not have treated nets. And the treatment process for bed nets was complicated and seemed like rocket science.

Now the NMCP of Ghana, with support from stakeholders and partners, is providing the most popular malaria prevention tool, treated mosquito nets, in a simple exercise that takes only 5-minutes in the “sleeping places” of beneficiaries.

In Ghana, the Universal Access means that for every 2 people in a household a bed net is issued.

What is crucial to the exercise is that the beneficiaries know the registration assistants and volunteers so they can be trusted to enter peoples’ homes to hang mosquito nets within minutes, using basic tools.

It may be easy to hang insecticide treated nets ((ITNs). However, it is no easy task gaining access to the sleeping quarters or bedchambers of households. Even the description of a sleeping place was a sensitive issue, not to mention the uncomfortable experience of beneficiaries about the invasion of their privacy.

What has kept the exercise going is the determination of stakeholders to free community members from the irritating buzz and bites of mosquitoes.

Building on the past    
A journey back into time revealed that beneficiaries of bed nets were not sleeping in them because they did not know how to hang them in the first place.

This current campaign is therefore to address the shortcomings of the bed net distribution exercise carried out in1998 by NMCP and its partners.

The distribution of ITNs began on a small scale and targeted pregnant women and children under-5 in 1998 because they were the most vulnerable. After a decade of implementation, it was realized that people were not using the nets properly.

A survey by NetMark, a USAID agency, in 2008 showed that net usage rate was very low and a Demographic Health Survey (DHS) report also indicated that among pregnant women usage was around 20 per cent and 28 percent among under-5 children.

The survey led to the realization that bed net use among the vulnerable groups was not commensurate with nets distributed to them. The NetMark survey of 2008, also noted that the people were not using the bed net because they did not know how to hang it.

Meanwhile, the Global Malaria Action Plan of the Roll Back Malaria partnership in 2007-2008, proposed a universal access to malaria interventions including bed nets.

According to Mrs Aba Baffoe-Wilmot, a representative of the NMCP, in 2009, during the Child Health Promotion planning meeting, the NMCP, GHS and partners decided to take the nets to the door step of community members because  coverage was low and people could not hang the nets properly.

DHS figures indicated that the Northern region of the country had the lowest rates of bed net distribution and usage.

A decision was reached in 2009 but there were not enough nets to distribute, so it was not possible to achieve universal coverage through door-to-door distribution and hang up at the time.

Mrs Baffoe-Wilmot said there was the need to begin, therefore, with pregnant women and under-five children in the Northern region, taking into consideration that they represented the most vulnerable with the lowest rate of bed net coverage.
A registration was carried out to record persons in every household and in May 2010, with the few bed nets available to the NMCP, the door-to-door distribution and hang up to pregnant women and under-5 began in the Northern Region.

Scaling up
From the Northern Region, NMCP moved to the Eastern Region targeting 10 out of the 21 districts there, looking at the typographical and geographical conditions to test the Universal Access coverage under a pilot programme.

The NMCP did the net distribution on the ratio of 2 people to 1 in the Eastern region in December 2010 and gave out 450,000 pieces of nets to cover every household.

In April 2011, NMCP and partners including the United States Agency for International Development (USAID) and its agency- President’s Malaria Initiative (PMI), Department for International Development, Global Fund, United Nations International Children’s Fund (UNICEF) and the World Health Organization (WHO) covered the other 11 districts in the Eastern Region to complete the universal coverage there.

From Eastern region, attention was turned to the Volta region, which had bed net use culture because of the many water bodies and the communities needed the nets for protection against mosquito bites. The distribution and hanging of 1,045,443 bed nets in the Volta region ended in July 2011. Here also the NMCP attained Universal coverage.

The exercise then moved to the Western and Central Regions, where UNICEF and DFID provided 2,350,000 bed nets.

November 2011, saw the completion of the hang up in the Western Region while the exercise in the Central Region ended in December 2011.

The Global Fund topped up with 46,000 pieces of nets for the Central region.  The hang up campaign in the Ashanti Region began in February 2012 with nets provided by Global Fund and the USAID through the PMI.

The distribution of 2.5 million nets in the Ashanti Region’s 27 districts started in the 26 peripheral districts leaving the Kumasi Metro area itself to be catered for shortly afterwards.  
Mrs Baffoe-Wilmot said Kumasi being a metropolis required a special arrangement for the homeless especially the porters (Kaya) who sleep in groups.

“Here, the NMCP identifies a group leader who is given the bed nets and trained on how to hang them for the benefit of members. The porters’ groups were handled by Peace Corps volunteers who reached out to some twenty thousand members.”

The Kumasi Metropolis experience will inform how the porters in Ghana’s teeming capital of Accra are handled as far as bed net distribution is concerned, she explained.

Meanwhile, the Upper East and Upper West regions have also received their portion of the Universal Coverage, which ended in April, this year and the DFID and UNICEF provided the nets for the 2 Upper regions.

The NMCP and partners are expected to do a mop up in the Northern Region which did not enjoy the Universal Coverage because only pregnant women and children under- 5 were covered.
The Hang-Up exercise has not been without difficulties. Registration and social mobilization are very critical and the NMCP and partners had to emphasize the extreme importance of sleeping under the nets.

The media, gong-gong and mobile vans were used to mobilize the community. The NMCP trained and deployed community registration assistants selected by the community.

On partnership, Mrs Baffoe-Wilmot said, “Our partners were involved with supplies of the nets and with operational cost and distribution. Usually 80 per cent of nets are moved into the communities during the registration and after validation the top-up of 20 per cent are sent to the distribution area.”

Other critical stakeholders needed to make the entire programme successful are usually the district assemblies, traditional rulers, the Regional Coordinating Councils and community members themselves as they are involved in the exercise.

For instance, the communities have to select trusted volunteers who do the hang up and they also have to motivate them as some of these volunteers have to leave their farms or jobs to do the work.

There have been problems of deviant volunteers extorting monies before hanging the nets even though the nets are free.

Community education is also needed during the exercise, as for instance, it is important that communities observe the instruction that for the first 24 hours after the nets are hanged people should not sleep in them due to the concentration of chemicals in the materials.

By Eunice Menka


Special Edition