Claims about the Misuse of Insecticide-Treated Mosquito Nets: Are These Evidence-Based?

Nearly all experts agree that insecticidetreated mosquito nets (ITNs) are a lifesaving intervention, supported by strong evidence from carefully conducted trials that show ITNs to be efficacious at preventing all-cause child mortality and malaria morbidity in children and pregnant women [1,2]. Under program conditions, ITNs have also been associated with significant reductions in malaria morbidity and all-cause child mortality [3–6]. However, there are a number of potentially damaging misconceptions about ITNs in Africa that have been propagated in media reports. One example is the recent Los Angeles Times article on the potential pitfalls of relying on ITNs to combat malaria across Africa: ‘‘While we see the treated nets as a lifesaving gift, they see them as a discomfort that provides only partial protection against a trivial illness. Is it any wonder that many use their nets to catch fish or as wedding veils or room dividers—all documented uses of insecticide-treated bed nets?’’ [7] Other examples of widespread ITN misuse have been reported by the media over the past 10 years and include claims about the use of nets as wedding veils in Uganda and Tanzania [8,9], for fishing in Kenya and Zambia [10–13], as protection of plants/ crops in Sierra Leone [14], as chicken coops in the Democratic Republic of Congo [15], and general misuse in Nigeria [16]. While it is clear there is room for improving the level of ITN use among those who have them [17], and that misuse of nets occasionally occurs [18,19], we found very little evidence to support claims of widespread misuse. Unsubstantiated reports about widespread misuse of ITNs may undermine public and donor confidence in a life-saving intervention. With Global Fund replenishment pledges falling short of targets and a generally constricting donor picture, such inaccurate media articles could have the potential to do lasting damage to a global malaria control effort that is at a tipping point. While the media is often driven by negative news and controversy, when lives are at stake we should demand better.