Every 30 seconds a child in Africa dies of malaria. Health care workers report a drop in malaria rates with bed net use, but in the tiny central African nation of Burundi a controversy has arisen because the government cannot afford to distribute free nets to everyone.
The Ndava health center, located about an hour's drive north of Bujumbura, is packed with people from the nearby village.
As they watch health care workers set up a mosquito net on the health center's veranda, some of the people yell out questions or comments about the net and the disease it is trying to prevent: malaria.
All across the tiny Great Lakes nation of Burundi, bed nets are being touted as an effective weapon in the fight against malaria, the leading cause of death among children five years and under in Burundi and the rest of sub-Saharan Africa.
Up to two million of Burundi's seven million people fall sick each year from malaria. Symptoms of the disease include fever, muscle aches and headaches. Health officials estimate that up to 80 percent of Burundi's population live in areas where they are at risk of getting the disease. However, the government lacks the resources to supply nets to all those in danger. In fact, it has to struggle to provide them to pregnant women and young children, the two groups most vulnerable to malaria.
Since the end of 2003, the government has given away more than 260,000 insecticide-treated bed nets to pregnant women and young children.
At the Ndava health center, which serves more than 17,000 people, health care workers have been distributing an average of 200 free bed nets each week since August 2005.
Nurse Jacky Nyavyinshi is enthusiastic about the difference the nets have made.
She says ever since the clinic introduced the free nets, and people began sleeping under them, fewer people are coming to the center with malaria. Before the nets were introduced, she explains, more than 60 people came every day with malaria; now it is down to 40 a day.
Malaria is caused by a parasite prevalent among female mosquitoes in sub-Saharan Africa. When an infected mosquito bites, a small amount of blood is taken in that contains the microscopic malaria parasites. The parasites grow and mature for a week or more, then travel to the mosquitos salivary glands. When the mosquito next takes a blood meal, these parasites mix with the saliva and are injected into the bite.
Those Burundians not eligible to receive free bed nets are able to buy them for two dollars a piece from an American organization called PSI, which sells health care products at heavily subsidized rates and trains people on health issues. So far the group has sold about 120,000 nets since the end of 2003.
Isabelle Walhin is PSI's country representative for Burundi. She explains why she believes it is important to sell, rather than give away, the bed nets.
"We think that people value the product and would be more likely to use it. We've seen in several occasions that people who receive nets or anything for free, some of them are likely to re-sell them on the market because they have other priorities like feeding, etc., but if we sell them, then they feel like it's their own good, and so they will be more likely to use them," she said.
But PSI and the government have come under criticism for selling bed nets, or restricting the availability of free nets, in a country where almost 90 percent of people live on less than two dollars a day.
Ernest Ndizeye lives a stone's-throw away from Ndava health center. He shares his small mud house with five other people and says he would love to sleep under a mosquito net but cannot afford to buy one and is not eligible to receive a free net from the government.
He says he and his family members cannot sleep at night because the mosquitoes disturb them so much. The family is poor and the parents are gone; there is no money for food. He says he would like someone to help them get nets.
For its part, the government says that it is doing the best it can with its bed net program, given its limited resources.
"Here in Burundi we are targeting the most vulnerable groups that are children below five years and pregnant women. So the National Malaria Control Program has to ensure that all these categories are getting nets, either free or to buy. For PSI, nets are not free, however these nets are highly subsidized. However, I cannot guarantee if all these nets are affordable for rural people," explains Dr. Baza Dismas, a top malaria official in the ministry of public health.
The Burundi government purchases bed nets with money from the Global Fund to Fight AIDS, Tuberculosis, and Malaria, an initiative created by U.N. Secretary General Kofi Annan that dispenses funds to countries worldwide to fight the three diseases.
Burundi has received more that $17 million from the Global Fund since 2003 to buy drugs and mosquito bed nets, train health care workers, purchase equipment, and take other measures to combat malaria in the country.
The Global Fund is meeting this week to determine the next round of funding for programs in Burundi and elsewhere.