Community cooperatives and insecticide-treated materials for malaria control: a new experience in Latin America.

BACKGROUND AND OBJECTIVES: Insecticide-treated materials (ITMs) are effective in substantially reducing the burden of malaria and other vector-borne diseases; but how can high coverage rates of ITMs be achieved and maintained? In south Mexico and on the Pacific and Atlantic coasts of Colombia 14 community-based cooperatives offering three different kinds of ITM services (sale of impregnation services; sale of impregnated nets; production of nets and sale of impregnated nets) were formed and supervised by a national health service (IMSS-SOLIDARIDAD, Mexico) and by an academic institution (the Colombian Institute of Tropical Medicine) along with local district health services. The objectives of this research were to analyse the processes and results of this approach and to identify the favourable and limiting factors. METHODS: The methods used for data collection and analysis were group discussions, individual and semi-structured interviews with users and non-users of ITMs, individual in-depth interviews with cooperative members and supervisors, checks of sales book and observation of impregnation services. RESULTS: Coverage with unimpregnated nets was above 50% in all study areas. The fastest increase of ITM coverage was achieved through the exclusive sale of impregnation services. Low-cost social marketing techniques were used to increase demand. The large-scale production of nets in two cooperatives was only possible with the aid of an international NGO which ordered impregnated bednets for their target group. A number of favourable and limiting factors relating to the success of ITM cooperatives were identified. Of particular importance for the more successful Mexican cooperatives were: a) support by health services, b) smaller size, c) lesser desire for quick returns and d) lower ITM unit costs. CONCLUSIONS: ITM community cooperatives supported and supervised by the health services have good potential in the Latin American context for achieving and maintaining high impregnation rates.

Operational aspects of bednet impregnation for community-based malaria control in Nicaragua, Ecuador, Peru and Colombia.

Community intervention projects with pyrethroid (permethrin and lambdacyhalothrin) impregnated bednets and an accompanying community education programme were carried out in 6 malaria endemic areas on the Pacific coast of Nicaragua, Ecuador, Peru and Colombia as well as in the Peruvian Amazon basin. In this paper the operational aspects are analysed: bednet coverage, results of promotional activities for increased bednet use, the sale of low-cost bednets, techniques and difficulties with impregnation, acceptance of the programme (including washing of impregnated nets), side-effects, residual concentrations of the chemical in the nets, costs of the impregnation programme and insecticide resistance of the malaria vectors. We found that the local manufacture of bednets and their sale through village health workers, even in communities with low cash income, is a viable way of increasing bednet coverage; the impregnation of bednets is well accepted if villagers perceive a direct benefit; pretesting of the soaking capacity of different net materials should be done at central level; the instructions for the impregnation procedures of different net materials (cotton and synthetic) should be simple and unambiguous; very cheap thin net materials should be avoided, particularly in the case of lambdacyhalothrin impregnation; educational methods and/or promotion of dark-colour nets should be further tested in order to decrease the washing frequency of bednets at household level; in areas with early-biting mosquitoes further studies on the protective efficacy of bednets are necessary; careful monitoring of side-effects, particularly those of last-generation pyrethroids, is necessary; and the community-based impregnation programme is a powerful tool for strengthening community involvement in health actions.