WASHINGTON, D.C. -- Â鶹´«Ã½AV Polls conducted in 23 sub-Saharan African countries reveal that, in most of these countries, more people reported having mosquito nets in their homes in 2008 than they did in 2006. The largest increase was in Benin, where the reported presence of mosquito nets increased from 44% to 79%. Chad was a close second, where rates jumped from 45% to 75%.
Across all 23 countries, the median change was an increase of 12 percentage points. Further, 18 out of 23 countries showed an increase of at least five points. Because using a mosquito net while sleeping can be a highly effective form of malaria prevention, these figures should be welcome news to those fighting the battle against malaria.
Perhaps the most noteworthy increase in the reported availability of mosquito nets occurred in Nigeria. Although Nigeria showed only a modest increase (14% to 21%), the World Health Organization estimates that in 2006 Nigeria alone accounted for almost a quarter of the estimated 247 million malaria cases worldwide.
Despite these positive trends, there was one country, Burkina Faso, where the reported availability of mosquito nets dropped significantly between 2006 and 2008. This is troubling because in 2006, WHO ranked Burkina Faso 10th in the number of malaria cases in Africa.
Use of Antimalarial Drugs
Another weapon in the battle against malaria is the use of antimalarial drugs, especially the recently developed artemisinin-based combination therapies. Beginning in 2007, and again in 2008, Â鶹´«Ã½AV asked Africans who said they had ever been diagnosed with malaria whether they had used any antimalarial drugs in the past 12 months. Across 17 countries for which data were available, the median change in self-reported use of antimalarial drugs during this one-year window was an increase of six points.
Although the average increase was small, there was a great deal of variation across countries. In Burkina Faso, the self-reported use of antimalarials increased dramatically from 46% to 87%. Zimbabwe, Senegal, and Zambia also showed increases in excess of 10 points. In contrast, in Liberia and Kenya, reported use of antimalarials dropped by nine points between 2007 and 2008.
Perceptions of the Prevalence of Malaria
One might suspect that these positive, albeit modest, signs regarding the prevention and treatment of malaria might be accompanied by some degree of public awareness that malaria is becoming less prevalent. This was not the case. In the 22 countries for which data were available, the median change in the perceptions of the prevalence of malaria was an increase of one point, which is well within the margin of error for this survey.
Again, there is a lot of variation in trends among countries. In Ethiopia and Mauritania, there were substantial drops in perceptions that malaria is the most common illness. In contrast, in countries such as Togo, Cameroon, Sierra Leone, and Chad, there were even more substantial increases in perceived prevalence.
This mixed bag of decreases and increases is not necessarily surprising. A likely consequence of some public education and intervention programs is to make the public more aware of the seriousness of a problem. It is possible that in so doing, governments and non-governmental organizations (NGOs) temporarily increase public perceptions of the prevalence of an illness. Alternately, it is also possible that the current efforts to eradicate malaria are having very limited success thus far.
Bottom Line
In the past five years, two dramatic technological achievements have emerged that each hold great promise in the battle against malaria. The first is the development of new generation, pesticide-embedded mosquito nets that repel mosquitoes much longer than nets used in the past. The second is the development of artemisinin-based combination drug therapies that are more potent than previous drug treatments. These two developments are not the only weapons in the battle against malaria, but both have recently been gaining attention and funding inside and outside Africa. However, cost remains a significant barrier, especially in the case of artemisinin-based drugs. Whether tools such as these make it possible to reach the United Nation's Millennium Development Goal of halting and beginning to reverse the spread of malaria by 2015 may depend in great part on whether affected countries and NGOs can procure funding to maintain and expand these new interventions.
Survey Methods
Results for access to mosquito nets and for perceptions of the prevalence of malaria are based on face-to-face interviews conducted between 2006 and 2008 with about 1,000 adults in most countries. Margins of error (based on 95% confidence intervals) for all countries were less than ±6 percentage points. Margins of error for reported use of antimalarials drugs are typically wider because they are based only on the subset of respondents who reported having been diagnosed with malaria at some point in their lives. Sample sizes for this question ranged from a low of 377 in Ethiopia in 2008 to a high of 2,046 in Kenya in 2008. In Angola, Chad, and Niger, some inaccessible or dangerous areas were excluded from coverage (but about equally so during the time periods compared). In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.
