Malaria prevention in the age of climate change: A community survey in rural Senegal
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Background
Malaria results in over 600,000 deaths per year, with 95 percent of all cases occurring in sub-Saharan Africa. Despite significant steady reductions from 2000 to 2015, there has been a recent resurgence. The estimated 2025 Africa death rate was recalculated to be 51.8 people per 100,000, whereas the previous estimate was 15.9. A potential explanation for this very significant setback is that increasing temperatures associated with global warming have made it more difficult to use insecticide treated mosquito nets. This study evaluated a rural west African population to determine barriers to mosquito net use, including heat and outdoor sleeping.
Methods
This study used a social ecological framework used by the Peace Corps to determine this community’s barriers to malaria prevention. We practiced community-based participatory research by developing and implementing a survey in rural southeast Senegal. Local village health workers were trained specifically to implement this survey. Observations of the mosquito nets and sleeping spaces were performed by surveyors. 164 households in 20 villages were surveyed from October to November of 2012.
Results
164 of 164 selected households were surveyed, giving a 100% response rate, representing 21% of this local population. For the 1806 family members, respondents assessed a total need of 1565 nets, implying that each individual in this area needs 0.86 nets (95% CI: 0.77-0.95). The main reasons for not using an available net were heat and fragility of the nets. This population had very positive attitudes regarding mosquito nets and appreciated the work of local malaria educators.
Conclusions
The estimated need of 0.86 nets per person is 54% higher than the World Health Organization recommendation. Heat was found to be a major barrier in using a mosquito net, causing more people to sleep on outdoor structures. This study’s findings suggest the ratio of nets to people may need to be adjusted for the substantial increase in outdoor sleeping. Head of household responses in this population were found to have no systemic bias and would be an accurate way to assess a family’s need of nets. Deploying more malaria educators to this area would be appreciated and beneficial.
