Buying the best?

Household malaria prevention in The Gambia

More effort is being made to promote the large-scale use of insecticide treated nets (ITNs) for malaria control. Yet many households still invest in other costly mosquito protection products instead of ITNs.

Funded by the Gates Malaria Partnership, research by the London School of Hygiene and Tropical Medicine and the UK Medical Research Council aimed to provide a better understanding of (1) how much households in The Gambia spend on malaria prevention, (2) how household expenditure fluctuates throughout the year and (3) why households spend what they do.

Studies show that poor people often spend a larger proportion of household income on malaria prevention than richer people do. Some experts say that malaria prevention methods can give some protection and may be of considerable health benefit. However, the scientific evidence to support these claims is sparse.

1,700 households were interviewed about their expenditure on malaria prevention over a two weeks period. Interviews were staggered over 12 months. Expenditure was compared across several forms of prevention including bed nets, treating and repairing bed nets, aerosols, coils, indoor spraying, smoke and other prevention strategies such as drinking herbs and cleaning the outside of homes.

Significant findings include:

• Households spent an average of 23.11 Dalasi (US$0.83) on malaria prevention fortnightly.
• Mosquito coils are the most common product and dominated expenditure all year round (see Figure 1 below).
• Mosquito coils, indoor sprays and aerosols represent 81 percent of total fortnightly health-related expenditure.
• Total expenditure on nets constitutes ten percent of total fortnightly expenditure.

Figure 1: Monthly expenditure on malaria prevention (Larger version)

The inability to afford an ITN is in some cases due to lack of financial resources and in others may relate to the low value people place on ITNs compared to their market price. In this sense, two thirds of people without an ITN could not afford to own one. These households, spent on average 18 Dalasi (US$0.65) a fortnight on other forms of malaria prevention. In four months, households spend around 140 Dalasi (US$5) on products such as mosquito coils and aerosols; the price of one ITN.

Why don't households choose to buy ITNs? The most commonly provided reason was that some families can't afford them (64 percent). Secondly, many households believe they do not need one (12 percent). In addition, other products and medicines are more accessible and affordable and in some cases considered more effective at preventing malaria and/or nuisance biting.

What influences expenditure on mosquito prevention?

• Wealth - wealthier households spend significantly more on prevention than poorer households.
• Age - households with children aged five to nine and adults aged 20 to 29 spend more on prevention than other age groups including those under five years.
• Occupation - household heads who were 'retailers' or 'businessmen' spent more on prevention.
• Location of residence - households in peri-urban areas spend significantly more on malaria prevention than those in rural and urban areas.
• Season - expenditure is 42 percent higher in the wet season (September to November).

Understanding the factors affecting household consumption choices as well as the actual amounts spent can inform the effective take-up of ITNs. It also shows how limited family resources could be used more effectively for better health.

Appropriate strategies are needed to encourage ITN use:

• Barriers to purchasing ITNs, such as their relative high initial cost, need to be addressed by the use of targeting, subsidies or voucher schemes.
• Households should be better informed about the health gains and potential savings from ITNs. Appropriate targeting strategies supported by government and at the local level can encourage ITN use, especially in children under five.

Households who cannot afford ITNs are nonetheless gaining at least partial protection from others products seen as more accessible and affordable.

Lesong Conteh
Gates Malaria Partnership, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
T +44 (0) 20 79272939
F +44 (0) 20 76375391
Lesong.Conteh@lshtm.ac.uk

See also

'Malaria prevention in The Gambia: patterns of expenditure and determinants of demand at the household level', Tropical Medicine and International Health 11(4), pages 419-431, by Virginia Wiseman et al, 2006

Views expressed on these pages are not necessarily those of DFID, IDS, id21 or other contributing institutions. Copyright remains with the original authors but (unless stated otherwise) any article may be copied or quoted without restriction, provided both source (id21, insights) and authors are properly acknowledged and informed. Copyright © 2006 id21. All rights reserved.