A stitch in time saves lives. A community intervention in The Gambia

Abstract

Malaria is a major cause of infant and child mortality in Africa. Bednets are currently the best means of protection, especially those treated with insecticide. However, untreated bednets offer no protection if they have five or more finger-sized holes, are not long enough to be tucked in under the mattress or are badly torn. Despite the long tradition of using bednets in The Gambia, around 42% of nets in rural Gambia are in poor condition or used incorrectly (Clarke et al, 2001). This six month study (July to December 2002) set out to examine whether villagers could be encouraged to change their behaviour and repair holes in and use their bednets correctly through an intervention developed through community participation. Through focus group discussions and interviews, culturally compelling interventions developed were health education songs composed and sung by the villagers with complementary posters displayed in the two study villages. The songs were recorded on cassette tapes and were sung at formal and informal village gatherings. The success of this intervention was quantified by bednet surveys, where the condition of 554 nets was recorded before and after the intervention. To measure the impact of people’s behaviour, mosquitoes were collected from under bednets, pre and post intervention, and general mosquito levels were monitored throughout the study using light traps. Data analysis showed a significant increase in the proportion of repairs post intervention compared to pre-intervention (paired T-Test, P=<;0.001). However, the overall number of holes remained the same due to constant wear and tear of the bednets and so there was not a significant reduction in exposure to mosquitoes. Nevertheless, these results show encouraging signs of enabling a behaviour change towards improving existing bednets using participatory methods.