Information gap challenges Zanzibar's antimalaria campaign

Although Zanzibar's Kataa Malaria initiative has reduced the malaria caseload on the island, misinformation about the safety of insecticide-treated bed nets - a cornerstone of the programme - has left many people exposed to the disease, which kills one million people around the world each year. In December 2005, Tanzania became one of 15 beneficiaries of a US $1.2-billion initiative to fight malaria in sub-Sahara Africa, where 90 percent of all global malaria deaths occur. United States President George W Bush's Malaria Initiative (PMI) is funded through the US Agency for International Development (USAID). As a beneficiary, Zanzibar received 240,000 long-lasting, insecticide-treated bed nets for local distribution to pregnant women and children up to age five years, the groups most vulnerable to the disease. At least 200,000 nets have been distributed free of charge in Unguja and Pemba, the main islands of Zanzibar. Unfortunately, many of these nets have been used incorrectly or remain in their packaging - the potentially deadly result of ignorance about their proper use and fear over health concerns. Zanzibar resident Bimkubwa Hassan, 33, is a pregnant mother of eight children. She received three free insecticide-treated mosquito nets under the Kataa Malaria (Kiswahili for "Reject Malaria") project to protect herself and two of her children, who are under five years, from malaria-transmitting mosquitoes. However, when she returned home with the nets, she stored one under the bed and split the other two to be used as curtains. "We have been told by the antimalaria campaigners to use the nets against mosquitoes," she said. "This is the best way, because the mosquitoes pass through the window. Now we have blocked the insects' path." A number of people Hassan knows had decided not to use the bed nets at all, because they believed the chemical used to treat them was poisonous to humans. When hung over the bed, Hassan said the nets "can cause death to children and also cause infertility in women". Thus, her solution of using the treated nets as curtains. Mosquitoes are plentiful in Zanzibar, which has an annual average temperature of 30 degrees Celsius and high humidity. The climate, together with below-par sanitation, conspires to make the island a prime breeding ground for the anopheles mosquitoes, which carry the deadly Plasmodium falciparum and plasmodium vivax parasite that cause malaria. Malaria, transmitted to humans via mosquito bites, is the leading cause of morbidity and mortality in all health facilities in Zanzibar: 50 percent of all outpatient attendance is due to malaria. Prevention With proper preventive measures and treatment, however, malaria in Zanzibar could be controlled. Kataa Malaria, a joint effort between USAID, the government and local nongovernmental organisations, is engaged in activities to create public awareness about the disease; to advocate behaviour change and a clean environment; to promote the use of insecticide-treated bed nets and the spraying of homes and compounds with pesticides; to encourage effective case management of malaria; and to support intermittent preventative treatment during pregnancy. A survey of bed-net use in Zanzibar conducted in April, four months after the launch of the Kataa Malaria programme, found that many beneficiaries still did not understand that using insecticide-treated bed nets could save their lives. These results were discussed as part of a two-day ‘Malaria Community Mobilisation Stakeholders Evaluation’ in the Zanzibari capital of Stone Town on 6-7 May. Attendees of the workshop included civic leaders, representatives of community-based health organisations and religious leaders, all of whom play a role in following up on the implementation of government policies and directives. "Although the campaign to eradicate malaria has been fruitful in most parts of Zanzibar, we have noticed that we still encounter the challenge of lack of proper awareness on how to use the nets," said Deogratus Peter, the health programmes manager for Africare, an antimalaria NGO. "The problems in some areas include lack of proper knowledge to put up the mosquito nets, unfamiliarity with the nets, and the notion that the nets cause heat and have been treated with chemicals dangerous to children's health," another participant said. The attendees agreed that efforts to educate the public must be improved. Peter said: "I think the first awareness campaigns carried out before the distribution of the mosquito nets were inadequate. We have to carry out more advocacy for proper use of the nets to get people to accept them as health-friendly." The next step in the Kataa Malaria project would also include spraying pyrethroid pesticides - the chemical dichloro-diphenyl-trichloroethane (DDT) is prohibited but under review in Tanzania - to control mosquito breeding, "possibly starting from July or August this year," Peter said. The public would also be educated about the safety of the spraying so the project does not run into the same problems as with the insecticide-treated nets. At the commemoration of African Malaria Day on 25 April, Zanzibar's director for disease prevention in the Ministry of Health and Social Welfare, Salhiya Ali Muhsin, praised the community’s determination in their battle against malaria. "The campaign on proper use of insecticide-treated nets in most areas, keeping the environment clean and the growing awareness on malaria - including patients getting proper treatment - have been key factors in controlling malaria," Muhsin said. Despite progress in the Unguja South region, which had greatly reduced its malaria prevalence, the number of malaria cases in some areas was still high, especially in Micheweni village in Pemba, she said. Muhsin appealed to Zanzibaris to join hands in combating malaria on the island. "When time comes for the spraying exercise in our homes, let us collaborate with the sprayers by not closing our doors and hiding," she said. [TANZANIA: Gov't to lift DDT ban to fight malaria]