World Mosquito Day: Health professionals recommend use of nets, clean environment

As the World Mosquito Day is observed today, experts have reiterated the need for people to sleep under insecticide treated mosquito nets, which is one of the effective means of preventing malaria.
And though the advocacy for use of mosquito nets has been on for a while, many people are still finding it hard to embrace the idea, which is impeding the success that could have been otherwise recorded.


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But why are people not using the nets?
A resident of Isolo, Lagos, Mr. Bernard Mathew, said hot weather and lack of electricity are the major reasons people don’t use bed nets. “Electricity is not constant, and that is the simple reason I do not use bed nets. So, government should encourage people by providing electricity,” he said. “Again, some people believe mosquito net is an unnecessary burden. For instance, some people feel that after building a beautiful house, where there are nice bedrooms, hanging mosquito nets would detract from the beauty. There are also people that believe the chemical in the net would affect their health. But I believe with more awareness, people may change.”

Dr. Chukwuma Ogunbor, a Consultant Family Physician, stated that mosquito nets by themselves are not a perfect barrier; so, they are treated with insecticide to kill the mosquito before it has time to search for a way through the net.

He said: “Insecticide-treated nets (ITN) are estimated to be twice as effective as the untreated ones, and offer greater than 70 per cent protection, as against no net. Although ITN are proven to be very effective against malaria, majority of individuals in rural and urban areas of Sub-Saharan Africa are not protected by ITNs.
“Since mosquitoes feed at night, the preferred method is to hang a large bed net above the centre of a bed, such that it drapes down and covers the bed completely.
“The extensive distribution of mosquito nets impregnated with insecticide (often permethrin or deltamethrin) has shown to be an extremely effective method of malaria prevention, and also one of the most cost-effective methods of prevention.“New technologies have allowed production of long-lasting insecticidal mosquito nets (LLINs), which release insecticide for approximately five years.
ITNs have the advantage of protecting people sleeping under them, while simultaneously killing mosquitoes that contact the net. This has the effect of killing the most dangerous mosquitoes.Some protection is also provided to others, including people sleeping in the same room, though not under the net.
“And though these benefits have been outlined, majority of individuals still don’t sleep under ITNs, which have been attributed to lack of awareness of its benefits, and its availability. Other reasons are the cost of obtaining an ITN. Lack of power supply is also a major reason why people don’t use it, due to the hot weather.
“As a family physician, I usually advise my patients to avoid mosquito bites by clearing surrounding bushes, and by wearing long sleeve shirts and trousers in the evenings. They should also avoid collection of water in ponds; gutters and remove used cans around the house. We also give counsel on the use of long-lasting insecticide treated nets and doors/ window nets.
“My recommendation is that government or NGOs should provide ITNs free for all citizens, especially children and pregnant women.”Dr. Sam Awolola, Head, Malaria Research Programme Nigeria Institute of Medical Research (NIMR), Yaba, Lagos, said though the fight against malaria has been on for quite a while, it wasn’t until 2000, when the Abuja Declaration was established that the issue of malaria is being considered from economic angle, which has helped in reducing malarial infections in the country.

He stated that children under five years and pregnant women are vulnerable to malaria infections, so, they should sleep under long-lasting treated mosquito nets, as well as to always buy nets at primary healthcare and pharmacy to avoid adulterated ones.

He said over the years, malaria has been over diagnosed, because every case of fever was taken as malaria. But now, malaria researchers know better, that it is not all cases of fever that are malaria.
He said: “We have scaled up our interventions, which include distribution of treated mosquito nets, which has been very wonderful. Over 70 million treated mosquito nets have been distributed to Nigerians. But have these been used? Have they reduced the number of malaria cases in Nigeria? The answer is no, because people do not use nets. We have distributed many rapid diagnoses test kits for malaria to enable us respond to treatment quickly. But will that alone lead us to reduction in malaria? Again, the answer is no, because there are critical areas that need to be looked at holistically. So, government needs to encourage malaria researchers in term of funding.
“Many people think eliminating mosquitoes would lead to reduction of malaria cases, but that is a wrong approach, as we do not need to eliminate all mosquitoes in the country. In most countries, where malaria has been eradicated as public health disease, mosquitoes are not eliminated totally. They only reduce mosquitoes in these countries, which include Brazil, Europe, Italy and America, among others.
“Mosquitoes are most difficult to eliminate because they have been in existence even before human beings. So, we can only reduce them to the barest minimum.
“Government must encourage strategies together with milestone to measure success in the fight against malaria. For us to achieve success in this regard, there must be a robust plan, but the execution of such plan is very important. When you have a plan, together with a team that is determined to support it, there must be a financial support, including measures to determine if you have achieved the plan.
“Indoor insecticide spread is a key prevention method in the countries that have eradicated malaria. Why is our government not investing in indoor insecticide spread? Today, we have a lot of unemployed youths. Government can invest in the youths and employ them to take indoor spread exercise to all communities in the country on regular basis, maybe once in six months interval. This would go a long way in reducing malaria.”
Awolola explained that NIMR is the only malaria research institute in the country, and that their findings show that, if government wants to eradicate malaria, there must investment in infrastructure, facility and people that will execute the project with trainings, capacity building and provision of medical facilities.
“There are basic local things needed to be done, aside other preventive methods,” he explained. “Environmental sanitation is very important, because mosquitoes breed in dirty environments. Mosquito does not transmit only malaria infection, but there are also such other infections as Zika virus, Chikungunya virus, yellow fever and dengue fever among others. All these are mosquito-transmitted diseases and we can avoid them, if our environment is clean.

“There is no country that would survive without research to compare. With other African countries that put in more money into malaria research, such as South Africa, Gambia, Kenya, Uganda and Malawi, among others. So, if there is political will in Nigeria to fight malaria, by 2020, the country would be where it ought to be in terms of malaria elimination.

“Most treated mosquito nets do not just enter the market, as they must have been tested by World Health Organisation (WHO) before sending them into the market. So, the chemical has been tested for human use and it is very safe. This is not a guarantee there would be no fake mosquito nets in the market, because you see people selling nets on the street, the source of which we do not know.
“This is a major challenge for most researchers in malaria treatment. Most of the fake mosquito nets do not have labels to show the company that manufactured them. So, people should go to primary healthcare and pharmacy close to them whenever they want to buy genuinely mosquitoes nets. I can assure you that genuine treated mosquito net can kill mosquitoes cockroaches, scorpions, spiders and snakes, among others.”