Baseline Malaria and Mosquito Net Survey

Introduction

Malaria is the most frequent cause of morbidity and mortality in children under 5 years of age in Malawi. Over 40% of deaths in children under 2 years of age are caused by Malaria. Malawi has the 8th highest childhood mortality rate (223/1000) in the world, many of these deaths are malaria related, and many could be prevented (Malawi National Plan of Action for malaria Control, 1995; Malawi KAP survey, 1996; Wirima, 1996 (Trop.Med. Parasit. 45. 52-53)) . Not only does malaria contribute to high mortality but it also contributes to high morbidity and over-burdening of health facilities. Children under 5 suffer on average 9.7 malaria episodes per year. Adults suffer on average 6.1 episodes of malaria per year (Malawi KAP survey, 1996; Wirima, 1996 (Trop.Med. Parasit. 45. 52-53)).

Malaria episodes contribute to a general decline in overall health status, making individuals more susceptible to other illnesses and diseases. In addition to the cost of consultation, treatment, hospitalisation and travel, the economic costs of malaria include low productivity and potential loss of income through days of work lost. It has been estimated that the total annual cost of malaria to the average Malawian household is US$35, this
amounts to 7.2% of average household income. For very low-income households (i.e <$167 per year, which accounts for 52% of households) the annual cost of malaria is $22 which is equivalent to a staggering 32% of annual household income for this group (Ettling et al., 1996 (Trop. Med. Parasit. 45 75-79)).

Insecticide treated nets (ITNs) have been proven to significantly reduce malaria related morbidity and mortality in multiple field trials in Africa. The next step is to promote the widescale use of ITNs through cost effective programmes. Few large-scale operational projects have been implemented and even fewer have been evaluated. The Blantyre Insecticide Treated Net (BITNET) project aims to reduce malaria disease and death in Blantyre district by maximising ownership and appropriate use of ITNs through creating demand and improving access to affordable ITNs. The wider objectives of BITNET are to:

• make affordable ITNs widely available
• focus on promotion of retreatment
• promote year round use of ITNs
• develop specific strategies to target the rural population
• develop specific strategies to target poorer sections of the community
• to promote preferential use of ITNs among young children and pregnant women.

In order to measure whether the objectives have been met, BITNET needs to utilise a number of different monitoring and evaluation methods. This household survey will be 6 the principal method for evaluating the extent to which the project objectives have been achieved. This baseline survey was carried out before the launch of Chitetezo Net (the brand of insecticide treated mosquito net) in October 1998, and a follow up survey will be carried out by October 2001. This baseline survey focused on four key areas (in addition to general household information) they are:

• malaria knowledge
• malaria practices
• mosquito knowledge and prevention practices
• mosquito net knowledge, attitudes and practice

In line with the wider objectives of the project analysis includes the effect of urban vs rural and socio-economic status of the households interviewed. In addition to providing baseline data on which the objectives and success of BITNET can be measured against this household survey will be used to guide the further development of the marketing strategy, and supplement other monitoring and evaluation activities.