A Stitch in Time May Save Lives: Turning Poor Bednets Into Good Ones

Sleeping under an insecticide-treated net protects the sleeper from mosquito bites and is highly effective means of reducing the risk of malaria. Recent studies in The Gambia and Kenya have shown that untreated bednets in good condition can also protect against malaria (51% protection against parasitaemia, 95% CIs 34-64%). However, most children in rural Gambia sleep under untreated nets in poor condition, often with a few holes, and do not close their nets properly at night. These children remain exposed to mosquito bites and the risk of malaria.

This pilot study examines whether subsistence farmers in rural Africa can be encouraged to repair their mosquito nets and use their bednets appropriately. Attitudes and practises on sewing and net use were examined in rural Gambia and an intervention developed to promote net repair. Songs and posters were used to emphasise the importance of repairing nets and their correct use, and served as aural and visual reminders to repair nets now rather than postpone this household chore. The intervention was aimed at effectively and cheaply turning a poor net into a good one.

The intervention was developed and implemented in two neighbouring villages in The Gambia, with each village composing their own songs. There was no formal control village. An internal comparison group was used in which the nets of responders and non-responders living within the same village were compared.The success of the intervention was assessed by: recording the number of nets repaired and used correctly for malarial prevention before and after the intervention; by counts of mosquitoes entering the nets classified according to number of holes and degree of repair; as well as by canvassing participants' opinions.