Millions of Africans go to sleep at night at risk of being bitten by a malaria-carrying mosquito. They could also become one of more than one-million in the region to die each year of the disease. But the risk can be reduced significantly.
Tests show that in Africa, insecticide-treated mosquito nets, known as ITNs, can curb up to 35 percent of all child deaths. They have also been shown to curb cases of severe malaria by nearly half.
The chemically-treated polyester nets are just one of several preventative measures that include using a combination of treatment drugs that include the Chinese substance artemisinin, rapid diagnostic tests to detect malaria in the field, and insecticides to treat the walls and ceilings of homes where the mosquitoes may land.
At least three factors - cost, availability, and public education - keep people from getting the nets.
Malaria advisor Dr. Michael MacDonald, with the USAID Global Health Bureau in Washington says despite the proven effectiveness of ITNs, public education about malaria and its prevention is still needed.
He says some people may not realize that a malaria-carrying insect is behind their fever, chills, and other symptoms. Or, he says, a family may not appreciate the cost effectiveness of purchasing a three-dollar net, which can last for years, versus paying 15 cents for a daily coil to repel mosquitoes.
MacDonald says it is important for the family to see the importance of buying an ITN.
"They will save money later on drug treatment, (and) hospitalization and indirect costs on productivity [such as days of work lost due to illness]," he said.
He says it is also important for families to use the nets consistently.
"The particular mosquitoes that cause malaria are late night biters, between 22-hours and four-hours in the morning - at times when people may not perceive a big mosquito problem. So it is important, even if they do not think there are a lot of mosquitoes, that they use (the nets) all year round," he said.
Efforts are also being made to make the nets locally available on a continuing basis.
Dr. David McGuire is the director of USAID's NetMark Project, which promotes the use of bed nets and helps African businesses distribute them. He says NetMark is partnered with nearly 40 companies in eight countries (Ghana, Nigeria, Mali, Senegal, Zambia, Uganda, Ethiopia and Zimbabwe), which in turn sell more than 15 brands of ITNs.
McGuire says that in these countries, the price of the nets is up to 70-percent less than what people were paying for untreated ITNs. He notes that a commercially available insecticide-treated net runs from roughly four-dollars to eight-dollars.
"There is a significant market that varies from country to country that would prefer to walk into a retail outlet close to home at their convenience and have a choice - the color, size, shape net that suits them. And it is surprising how many people are willing to pay for that," he said.
In the past few years, NetMark's partners have sold more than 19-million insecticide-treated mosquito nets.
For those cannot afford the nets, NetMark has created a solution that still engages the private sector. Under the plan, antenatal clinics and other groups give pregnant women and the poor vouchers to acquire for free or at a highly discounted rate a net from a nearby store.
The project and other donors still offer nets for free to those who do not have a market nearby, or who can not afford to buy a net.
Health experts say there are many advantages to such private-public partnerships; donors are able to stretch their dollars by taking advantage of the private sector's efficient distribution network, stimulate the local business community in high unemployment areas, and create competition among venders to keep prices low.
The involvement of the private sector has also led to the creation of Africa-based factories, including several in Tanzania, that can manufacture the nets, rather than relying on imports. Research and development by multi-national corporations have led to improved nets, including those that can retain effectiveness after up to 20 washes.