Insecticide-Treated Nets, the Key Element for Rolling Back Malaria in North-Eastern India: Policy and Practice

For decades of attempted control using DDT indoor residual spraying and increased allocation of resources, malaria continues to deter the socio-economic development in the north-eastern states of India. Focal disease outbreaks are recurring and all death cases are ascribed to Plasmodium falciparum malaria. As an alternative strategy to DDT, vil- lage scale filed trials with insecticide-treated nets (ITNs) were conducted in malaria endemic pocket of Assam during 1988-1990 that were evaluated to be a success story by the Technical Advisory Committee of the National Vector Borne Disease Control Programme of Government of India. Based on the research findings, a pilot project was undertaken under centrally sponsored scheme to assess the operational feasibility and sustainability of this intervention through primary health care services in the northeast sector for which National Institute of Malaria Research of Indian Council of Medical Research served as the nodal agency for technology transfer. Under this scheme, one hundred thousand insecticide-treated nets were distributed gratis beginning1996 in communities living below poverty line that were identified by the respective state health directorate of seven states of the northeast. For reporting states of Assam, Meghalaya and Arunachal Pradesh for which data were analyzed, the results were promising in reducing disease transmission, and public response was over- whelming. The communities clearly preferred ITNs against DDT spraying and reported collateral benefits for decreased nuisance due to other household insect pests. Since then provision of ITNs is a continuing activity including impregnation of community-owned nets. We provide data on technology transfer and transmission reduction, and issues related to chal- lenges and prospects for malaria control using ITNs as evidence-based intervention are discussed.