I have heard many reasons why people will not use treated mosquito nets for protection against malaria attacks. But equating use of nets to lying in a coffin was mind boggling.

“The women in my area do not want to use bed-nets to protect themselves from mosquito. They picture themselves as ghosts when they sleep under the net,” the sub chief of the Awutu Traditional Area of the Central Region of Ghana, Nae Kwao Kurabi Clottey III tells me.

The Chief, who doubles as a medical practitioner at the Humble Home Clinic at his palace at Awutu Bereku says malaria is a major problem as he attends to about 10 cases of malaria every day at his clinic.

“The belief that they picture themselves as ghosts when they sleep under the bed net, is embedded in the  subconscious of the people and we need to do more civic  education,’’ Nae Clottey says.

The refusal to use the insecticide treated net (ITNs) is a major challenge to the health authorities. The recent demographic surveillance report indicates that only 17 per cent of Ghanaians use ITNs.

Ms. Patricia Antwi, the Awutu-Senya District Director of Health Service says the district recorded 35,000 cases of malaria in 2008, representing 35 per cent of Out Patient Department attendance at the public health institution in the area.

Ms Antwi notes that malaria prevention and control efforts in the area were being hampered by the attitudes of the people towards the use of bed nets and other preventive measures.

“It appears the people are not using the preventive measures well,”she says.

“They have the ITNs, but they are not using them. Some claim it is uncomfortable because of the heat, we have an attitude problem at hand,” says Ms Antwi.

According to the District Director of Health Service, a lot of ITNs have been made available in all the 208 communities in the district with the support from UNICEF, PLAN International as well as the health directorate, but the problem of non-use still remains.

Results of studies carried out in some parts have shown that the use of ITNs holds the key to solving the problem of malaria in Africa. A bed net trial conducted in the Kassena Nankana District of the Upper East Region of Ghana bed nets from 1993-94  showed a 17 percent reduction in deaths among children under five.

Unfortunately socio-cultural beliefs and practices as well as poverty, continue to prevent people from using the nets.

In Kenya, there were reports that some beneficiaries of the net found the nets useful as fishing gear rather than as a malaria prevention method. There is the story of a beneficiary of the net who said she had stopped using the net because there were no more mosquitoes. After she felt sick she decided to sleep under the net to see whether she would be cured of the ailment. Still in the Ghana study, a man chose to use the pre-emptive approach cutting the net into pieces and using them as window and door curtains to ward off the mosquitoes before they could have access to his room to do any damage.

From a traditional approach, Nae Clottey III suggests health experts should consult the gods to exorcise the ghosts from the nets. Ms. Patricia Antwi, the Awutu-Senya District Director also has an equally interesting suggestion. She wants the research community to come out with an ‘air-conditioned” bed net to make it cooler for the people to use.

Clearly there is an urgent need for health authorities to undertake vigorous public education campaign to encourage the use of bed nets, particularly in rural communities. Equally important, is the need for the training of trainers of health workers to enhance their capacities to deliver primary health care service to reduce the incidence of malaria in the area. Such an intervention would ensure the mirth and humour generated by insecticide treated nets (ITNs) do not become a comic strip.