High Morbidity and Mortality of Malaria


Why do insecticide-treated nets become the policy agenda?
The use of insecticide-treated nets (ITNs) become the policy agenda because of several reasons. Since its installment in 2008, it has reduced the national morbidity and mortalilty rate to 50% and 75% respectively. Irrespective of this fact, places with poor access of health services still suffer from high mortality and morbidity of malaria. Because this program is initiated by the central government, the implementation depends on their pace. Often the distribution is not spread evenly because of the bureaucracy politics. Another reason is, these ITNs are inproperly used in the communities. Although, it is well distributed, if it is not properly used, the ITNs will not provide a significant advantage.
The argument for weaker policies
The “3M” (menguras, mengubur, menutup) program was once a very effective measure to reduce malaria vectors. Recently, it’s implementation is continue to fade because of poor compliance of the households. They do not really think it is important because they do not consider the mosquitoes as the source of transmission. Because it depends most on self-awareness of malaria, the evaluation will be vague and prone to manipulation. We can’t count the real households which implement this program properly.


The indoor residual spraying (fogging) activity is a good measure but is not a popular choice. It can be initiated by the local government. But some households are reluctant to use this kind of intervention because of its inconvenience. Before the spraying is begun, they have to cover everything that could be exposed to the insecticides. The smell of the spray is also disrupting. It is ineffective because most people will reject even if it’s free of charge. It is applied better in an outbreak management, not as a regular management. Occasionally, it is used in reducing malaria transmission in highly endemic areas.
Does this policy effective?
This policy has not been evaluated since its implementation whether it is really effective in reducing malaria cases. ITNs have the property of killing and excito-repellant for malaria vectors. It was also concluded that ITNs reduce clinical episodes of malaria caused by P. falciparum and P. vivax infections by 50% on average (range 39-62%). But recent studies have shown that high usage of ITNs (especially the newest one Long-lasting Insecticide-treated Nets/LLINs) can dramatically alter vector populations so that predominantly indoor transmission is replaced by residual transmission which mostly occurs outdoors. This residual transmission could probably give rise to resumption of malaria incidence in the future. In conclusion, this policy is still the most effective prevention measure to reduce malaria because of its simplicity, convenient, and cost-efficient properties.
Does the root of the problem appropriately addressed?
Possession and appropriate use of ITNs are not automatically owned by the recipents. Most endemic areas of malaria inhabited by people from the middle-to-low socio-economic class. And because they get this ITNs for free, many people who received ITNs do not use it but re-sold them. Many of them also do not understand how to hang, use and maintain them properly. As a result, it will reduce the efficacy of ITNs through inappropriate washing practices.
If this policy is meant to be improved, there are some suggestions. First, the government should inform the threats of malaria. Many people from middle-to-low socio-economic class need to be scared of so the urgency will be raised. And also they have to be informed about the importance of ITNs and how to use and maintain it properly in a language that will be easily understood. Also, the policy should be integrated with other prevention measures that do not use insecticides to avoid vector resistance and resumption of malaria incidence in the future.


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