Implementing a nationwide insecticide-impregnated bednet programme in The Gambia
Background and Objective: Earlier studies in The Gambia suggested that the use of impregnated bednets might prove to be a useful malaria control strategy. Based on the results of these studies, in 1992 the Government of The Gambia was encouraged to initiate a National Impregnated Bednet Programme (NIBP) as part of the National Malaria Control Programme Strategy. This paper describes the implementation process/procedure of the NIBP. Evaluation results showed that, overall, 83% of the bednets surveyed had been impregnated, and 77% of children under the age of five years and 78% of women of childbearing age were reported to be sleeping under impregnated bednets. On the basis of pilot studies indicating that bednets impregnated with the insecticide Permethrin are an effective, acceptable method of malaria control, the Gambian government introduced the National Impregnated Bednet Program (NIBP) in 1992.
Methods: Implementation activities included sensitization sessions with government officials, representatives of nongovernmental organizations, local health care workers, and village leaders; an IEC campaign involving posters, t-shirts, radio programming, and a videotape; staff training; and supply ordering and distribution. A compound-by-compound impregnation strategy was used, and women were instructed not to wash the nets until the end of the rainy season (5 months). At the end of 5 months, a cross-sectional survey involving 6 compounds in 221 villages was conducted.
Results: Overall bednet use was 73%, while that for bednet impregnation was 83%. 77% of children under 5 years old and 78% of women of childbearing age (those at greatest risk of malaria) were sleeping under impregnated nets in program villages. During the first year of the intervention, a 25% reduction was achieved in all-cause mortality in children 1-9 years old living in treated villages.
Conclusion:Although the insecticide was provided free of charge by the government, continued subsidy is not feasible and some form of cost recovery must be developed.