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Mass use of insecticide-treated bednets in malaria endemic poor countries: public health concerns and remedies.
Journal of Public Health Policy. 2004; 25(1):9-22.Over the last two decades, morbidity and mortality from malaria have increased in sub-Saharan Africa due to civil unrest, resistance to available drugs, human migration, population displacements, deteriorating health systems, and the HIV/AIDS epidemic which consumes much of the resources for disease prevention. In response to this growing challenge, international development agencies, spearheaded by the World Health Organization (WHO), founded the Roll Back Malaria (RBM) initiative, a global partnership for prevention and control of malaria. The primary goal of RBM is to achieve a 50% reduction in the global malaria burden by 2010, and the period 2001-2010 has been tagged the "United Nations Decade to Roll Back Malaria". RBM has adopted use of insecticide-treated mosquito nets as a major tool for the achievement of its malaria control objectives. Treatment of mosquito nets with insecticide was probably introduced for the first time during World War II, when nearly half a million American servicemen were stricken with malaria. Wider use of insecticide treated nets began in the 1980s following the development in the early 1970s of photostable synthetic pyrethroids which are fast-acting, effective in small quantities, relatively stable, adhere to fabric, and relatively safe to humans. Based on a series of field studies of the effect of insecticide-treated nets (ITNs) on malaria morbidity and mortality in sub-Saharan Africa, promotion of use of ITNs has emerged as a key intervention for malaria control. RBM's target is to have 60% of the world's population at risk of malaria sleeping under ITNs by 2005 (I). Realization of this goal could see tens of millions of doses of pesticides for net impregnation entering thousands of homes in malaria endemic poor countries annually. Thus, strategies to ensure a fuller understanding of their health risk and to minimize actual and potential adverse effects on human health are urgently needed. (excerpt)