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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 Universal Prevention

The universal distribution and hang-up of treated bed nets for malaria prevention is a great idea and the best thing that ever happened to malaria control in this part of the world. But it seems to fall short of the expectation of those who have come to accept the commodity as a preserver of life.

One such typical example can be found in certain quarters of the Brong-Ahafo region in Ghana, where some community members have shown dissatisfaction with the universal coverage distribution formula which means two people in any registered household nation-wide would own a common net.

And so depending on the sleeping rooms and regardless of the sleeping arrangements and habits of people, some may have to sacrifice and allow others in the household to own a net.
According to a team of volunteers who visited homes to hang the nets, some complaints had to be addressed to make the project achieve its aim.   

A resident of New Krobo community in the Techiman Municipality was not happy about the two-to-one approach.  Akwasi Addai Bosompem who was on a bike on his way out of his compound did not miss the opportunity to pour his anger on volunteers who had come to hang his net.

He was furious and emphatic that it is not prevention because not everyone in his family of four was going to benefit from the exercise.  

With the two nets he received, he and his wife would understandably share one of the nets but he was in a dilemma about how his two children, a boy and girl, aged 12 and 18, could share the other bed net as they do not sleep together.

“Which one of us should die?  If the plan is two is to one, I’m repeating that it is not prevention. I have not asked anyone to give me any net. You can’t prevent one person from getting malaria and leave the others to die,” an angry Bosompem shouted at a team headed by Alhassan Ahmed, from the Disease Control Unit in the Techiman Municipality who had gone to check on the complaints raised by Mr Bosompem.

Fortunately, Mr Ahmed quickly got in touch with the Field Supervisor in charge of the area to sort the confusion and ensure the volunteers got back to correct the situation by explaining matters to them.

According to Mr Ahmed, a lot of education had gone through the local FM stations but issues of misunderstanding have become a problem.

Prince Charles Osei, one of the volunteers, said he had been told when he got to Mr Bosompem’s house  that he will not be allowed access to the veranda much less the bed room to hang the net.

Some inmates of the compound house, which had 24 families had received the nets but had insisted they will hang it themselves. Upon entering the house, one could see the nets on the drying line and the volunteers had left without ensuring that it was all going to be hanged.

 “We told them we’re from the Ghana Health Service and an NGO. We are not here for politics.” Osei explained.

Others like Emmanuel Gyarko, a student who had little taste for politics, understood everything but according to him, he did not allow the team to hang the net for him because he preferred doing it himself, after airing the net for some time.

There were other minor complaints, which had to do with the nets. Simon Appiah, a volunteer at Nsawkaw in the Tain district said he had experienced some itches as he went about hanging, which he attributed to the chemicals in the net.

“We need things to protect ourselves such as gloves,” he made the appeal and called for more education because the principle of two people sharing one net had generated some heat as everybody wanted one for him or herself.

The good news
But the story was not always so problematic. A beneficiary in the New Krobo community, Mary Takyiwaa, was more than happy with the exercise.

Mary had a mat neatly spread out in the corner of her room in the uncompleted building for her bed, when the volunteers came in to hang the net.
“I was buying spray and mosquito coil every now and then… I thank all who gave us the net. Everybody should use it,” she said.  

Health officials in the Brong-Ahafo region also gave the needed leadership to ensure the success of the hang up programme.
Dr Timothy Letsa, Regional Director of Health Services, said leadership and community support have been given to the exercise at every stage and even the Ghana Private Road Transport Union (GPRTU) has been involved by helping to cart the nets to the Pre Positioning Sites, (PPS), which serves as the collection point where the nets are stored for collection and onward distributions to the districts and communities, while the volunteers have helped to return the empty packaging to account for work done.
Dr Jacob Abebrese heads one of the cleanest and newest health facilities in the country, the Brong-Ahafo Regional hospital. He believes that the national strategy of hanging nets in the bed rooms is such a wonderful idea.
He said if clinicians are able to go into people’s bedrooms, it shows that “people trust a lot in what you are doing. If we have access to bedrooms, we must make the needed impact.”

He also sounds a note of caution that the hang-up campaign is to complement other preventive and control measures.

“People must not abandon other protective measures such as using insect repellants when sitting outdoors late at night before retiring in doors.”

 It is in a bid to arrest the rising malaria statistics that a mix of tools – treated bed nets, ACTs and rapid diagnostic test kits, among others, are interventions to contain malaria.

This latest approach in the use of bed nets is a shift from just distributing free treated bed nets to actually hanging it correctly and effectively to break transmission in the spread of the disease.

In the past people took delivery of free bed nets and misappropriated them. Health officials say although distribution of bed nets has been around for a long time people were not utilising them partly because they did not know how to hang them.
The push is now to encourage people to sleep under bed nets and allow volunteers into their homes to hang the nets and educate them on usage.

Fortunately it is a private-public partnership ensuring that a large army of volunteers, health officials, chiefs, media and donors are all on the war path.
And it is gratifying that chiefs like the Nkosuohene (Chief) of Yawhimah, in the Brong-Ahafo region, Nana Kwaku Agyir, have embraced this new strategy.
Nana Agyir told his people to make good use of the nets and deplored instances where bed nets have been used as wardrobes, cover cloth or partition for rooms.

“Malaria is a killer and expensive. We are farmers and we work hard. Without strength, we cannot work”, he told his people. We have spoken to everyone to accept the volunteers when they come in to hang the nets and we have used the FM stations to educate them and will continue with the education.”
Time will tell whether the hang-up exercise will achieve the needed impact and join the other offensive tools to bring malaria statistics down. Much depends on people’s attitude to accept the correct use of the nets.

Generally the exercise in the areas visited in the Brong-Ahafo region, appeared to have gone on well as time was spent on orientation and education of the field workers, health officials and other stakeholders.
At the start of the programme in the region, caution was sounded to the workers involved in the hang-up by an official of the National Malaria Control Programme (NMCP).

“Do not just hand the nets to recipients because it is a hang-up exercise. It is against the principle of the hang up.  If beneficiaries will not let you enter their rooms, volunteers are expected to give the tools to the person to hang the net and the volunteer will then peep into the room to see if the nets have been properly hanged. Then the recipient will thumb-print in the registration book.”

Mr Prince Owusu, Technical Officer (LLIN & Supply Chain) PROMPT Ghana Project, said they were  involved and supporting the NMCP in training of field workers and in monitoring to check on quality of work done.

He said the PROMPT is also involved in data validation and logistics to ensure that the right quantity of nets get to the communities and also that the quality of work is up to standard.

“By quality, I mean the nets should be hanged in such a way as to ensure that it can be tucked under the bed or mat,” he explained.

Others like Mr Gabriel Assaw, a Supervisor at Nsawkaw, who is supervising 19 communities such as Njau, Fulla and Yabraso, were also around to ensure quality of work.

He explained that as a supervisor he gets the material from the sub district to give to the volunteers. “I also see if they’ve worked and inspect their work and data collected and help them in their work.”

By Eunice Menka

Special Edition