New studies conducted by the World Health Organization confirm that mosquito nets treated with insecticide can reduce childhood mortality by as much as one-third in malaria-ridden parts of Africa. The results of two large bednet trials in Kenya and Ghana, showed that mortality among children ages one month to six years fell by 30% in Kenya and 17% in Ghana.

In April 1995, PSI started the first social marketing impregnated mosquito net (IMN) project for malaria prevention with the branded bednet, FA NGOUNGOU, (Kill the Mosquitos!). This innovative private sector program—implemented by PSI in collaboration with the Central African Republic's Ministry of Health and Population, and funded by USAID and the World Health Organization—will reduce malaria-related death and disease, particularly among children. The project has been successful in assuring that those in danger of malaria are getting the nets and in establishing an accessible retreatment service. The nets are sold at low prices so that they are affordable to lower-income people.

Malaria is one of the leading causes of death to children in most African countries. Millions of adults also become chronically debilitated by this deadly disease. In Africa alone, there are approximately 300 to 500 million malaria episodes per year resulting in 1.5 to 2.5 million deaths. In addition to the high cost of human life, the economic costs of malaria are staggering. The loss of productivity due to illness, excessive household expenditures on preventative and curative treatments, and the monopolization of public health resources combine to make malaria a major constraint to social and economic development. It was estimated that in 1995, 20% of household incomes and 40% of health facility expenditures in Africa were devoted to the treatment of malaria.

The promising results of clinical efficacy trials such as those in Kenya and Ghana, call for an intervention to make insecticide-treated nets widely available to the general public. What has been missing is an effective delivery system. This has led PSI to apply a social marketing approach to malaria prevention by developing a pilot IMN delivery and retreatment program in Bossembele in the Central African Republic.

The project offers three components as part of its intervention. The first is a polyester mosquito net which has been pre-treated with permethrin, a WHO-approved and safe insecticide that kills and repels mosquitoes and other biting insects. With standard mosquito nets, malaria-carrying mosquitoes often find their way into the net or bite through the net. However, the insecticide on an impregnated net creates a repellent effect and therefore protects those sleeping under, as well as outside, the net. To retain their insecticidal properties, the nets must be retreated with permethrin every six months.

In order to ensure net retreatment, PSI provides a second product in the Central African Republic-a retreatment service called "Zingo Moustiquaire," meaning "Come Alive, Mosquito Net" in the local Sango language. Trained retreatment agents man Zingo kiosks which have been erected in areas of high consumer activity. Additional agents perform roving door-to-door retreatment services on bicycles equipped with bucket, insecticide and measuring cups.

The third component is an intensive information, education and communication campaign conducted by PSI to sensitize the local population to the causes of malaria, to motivate use of preventive measures and to encourage immediate and effective treatment of the disease. Prominent local figures whose views are respected, such as the mayor and the school principal, assist in the education efforts.

PSI and the Ministries of Health and Social Affairs initially conducted baseline formative research on the attitudes of Bossembele residents toward nuisance bites, mosquitoes and malaria. Brand images and concepts were also tested. Results demonstrated that participants were concerned primarily about their inability to sleep well at night due to nuisance bites and secondly, their fear of disease. Participants cited burning spiral coils and leaves as the most common method of preventing insect bites, but expressed dissatisfaction with these methods. Previous use of mosquito nets in the target area was minimal due to sparse availability, inadequate promotion, and the high cost of the product.

The research conducted by PSI resulted in the marketing of a green, polyester net with the brand name, FA NGOUNGOU, which retails at a price of 1,500 FCFA (the equivalent of $3.00), an amount lower-income families can afford. The nets are sold to consumers by local merchants and village committees. As evidence of FA NGOUNGOU's popularity, all 12,000 nets have been sold out among the 4,000 households in Bossembele. While the retreatment phase of the project is in its infancy, to date 14% of the target population has retreated their net. Consumers are bringing their own nets to be re-dipped which is evidence that the message is reaching its audience.

Insecticide-treated nets offer a promising breakthrough in the fight against malaria. The C.A.R. program will be evaluated this year and, if successful, will be replicated in other countries. PSI remains committed to malaria prevention and to providing lower income people in the developing world the opportunity to avoid death and debilitation from this deadly disease.

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