To buy or not to buy?

Communities and bed nets in rural Ghana

In some parts of Ghana, untreated bed nets to prevent mosquito bites are commonly used. Why do some Ghanaians choose these over more effective insecticide treated nets?

Although studies in Ghana have shown that insecticide treated nets (ITNs) are effective, this has not yet translated into an increased supply and use of ITNs across the country. A study in two rural communities, Obosomase (in the forest zone) and Galo-Sota (in the coastal savannah zone), looked at the factors which influence people's decisions to buy and use bed nets. Findings include:

• In Galo-Sota 98 percent of people, compared to only four percent in Obosomase, slept under untreated bed nets.
• Less than three percent of people in both communities used ITNs.
• All but one respondent in Galo-Sota had heard about ITNs on the radio or from clinic staff, and all except one person in Obosomase said they would like to own and sleep under an ITN if they could afford one.
• On average, residents of Obosomase were willing to pay Ghanaian Cedi 25,000 (US$2.75) for a family-sized ITN, while those in Galo-Sota were willing to pay Cedi 40,000 (US$4.37).
• Currently, a medium-sized ITN is sold for between Cedi 70,000 (US$7.64) and Cedi 80,000 (US$8.73) in large town markets. However, they are not available to people living in small rural towns and villages.
• The size of ITNs being sold to pregnant women at selected clinics at a subsidised price of Cedi 20,000 was considered too small as children often sleep in the same bed as their parents.

Whilst insecticides to treat bed nets are available in large towns and cities, they are not available in smaller towns and villagers where they are most needed. No shops in the study areas sold insecticide.

These findings show that residents in these two communities, but more especially those in Galo-Sota, recognise the value of ITNs and are willing to own and use them. However, they continue to face the challenge of where to find the right sized ITNs at prices they can afford. Findings from the study suggest that:

• there is a need to bridge stated willingness to pay and price through identifying further sources of subsidy for ITNs. The Global Fund offers one possible source. It is important that the subsidy is channelled so as not to undermine existing distribution channels, for example through urban shops
• use of ITNs might be increased if they were more accessible for purchase in small rural towns and villages. Strategies involving public and private distribution outlets, such as schools, clinics and small shops should be developed
• local manufacture of ITNs should be encouraged and supported by the government to adapt production to meet the social and cultural needs of local people in terms of the size, shape and colour of ITNs.

The low use of ITNs in Ghana cannot be blamed on whether or not a community accepts their usefulness. Availability, affordability and the match between products offered and cultural factors like local sleeping arrangements influence households' purchasing of ITNs.

Collins Stephen Kwaku Ahorlu
Noguchi Memorial Institute for Medical Research, University of Ghana, P.O. Box LG581, Legon, Accra, Ghana
cahorlu@noguchi.mimcom.net
Collins.ahorlu@unibas.ch

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