Insecticide-Treated Net Retreatment
Situation:
Recent years have seen a shift of focus by malaria control partners ensuring that net distribution programmes now almost exclusively use long lasting insecticide-treated nets, which do not require retreatment, rather than conventional Insecticide-Treated Nets (ITNs). Despite this there remain large numbers of conventionally treated nets, or untreated nets in use in the region, in particular as families buy the cheap untreated nets now increasingly available. Mass retreatment of nets in areas with good existing untreated net coverage is a way of rapidly scaling up coverage of ITNs.
Net ownership has been steadily increasing over the years due to several factors, such as: advocacy and sensitisation of communities on the importance of ITNs; the waiving of taxes on mosquito nets in some countries; the increased availability of nets (bundled, long-lasting and untreated) in the formal and informal commercial sectors and; ITNs distributed through projects (e.g. distribution during emergencies, through mass campaigns or through ANC services).
However coverage of treated nets remains low, in some places as low as 3%, largely due to the expense of retreating, availability of re-treatment packs, lack of awareness of the importance of retreating and community distrust in insecticide.
Large-scale net retreatment campaigns in Africa have usually achieved low retreatment rates (<20%) that have proved expensive. One approach often used is to send insecticides to districts and then request net owners to bring their nets to health facilities for mass retreatment. Often distance and poor mobilisation has meant low uptake of such a service. Moreover, mass drying of nets is extremely difficult. Another approach has been to give retreatment kits to net owners so they can treat their nets at home. This approach can result in kits not being used or re-treatment being done poorly. Generally, if retreatment is paid for by the net owners, there is poor uptake and inequality.
Response: 
The Malaria Consortium works in partnership with the Ugandan Ministry of Health which recognises the need to establish a national net retreatment system which will be simple, convenient and cheap for net owners.
One such partnership is the UPHOLD programme in Uganda, which is funded by USAID and JSI, and looks at many issues concerning malaria control, including net retreatment campaigns.
A model for a national campaign of free net retreatment was designed by the Malaria Consortium in partnership with the Ministry of Health and has now been carried out for three rounds with funding from DFID and USAID, most recently under the US President's Malaria Initiative (PMI) with around half a million nets treated in each round. The innovative plastic bag method was chosen for retreatment which involves the net being treated in a plastic bag by a trained dipper at a village dipping point and being taken home by the net owner to dry. This pioneering method was easy to carry out, allowed high volumes of nets to be treated, ensured privacy for the net owner, and guaranteed the insecticide got onto the net.
In Mozambique, as part of a USAID funded programme marking the launch of the PMI, the Malaria Consortium and other NGO partners initiated a retreatment campaign in five provinces on 9th November 2006 - SADC Malaria Day. Over 45,000 nets were retreated in the 4 districts of Inhambane province.
In both Mozambique and Uganda a new long lasting insecticide is being tested to determine its residual life in field use. So far, three months on, the insecticide is still working well. The project still has another 21 months of testing to go through.
Points to Note:
Experience from elsewhere in Africa (e.g. Gambia, Tanzania) indicates that if the net owner is expected to pay for the insecticide, only low net retreatment rates will be achieved. In contrast, when net retreatment is offered for free, high retreatment rates can be achieved (e.g. Eritrea). It should also be noted that with the advent of long lasting nets, the problem of retreating the existing net crop will be finite in nature. Within 3 to 4 years it is expected that the majority of the net crop will be made up of long lasting nets and net retreatment services will no longer be necessary.
Links to relevant pages:
Mass campaign for insecticide net re-treatment
Photos: Malaria Consortium