OPERATIONAL ASPECTS OF BEDNET IMPREGNATION FOR COMMUNITY-BASED MALARIA CONTROL IN NICARAGUA, ECUADOR, PERU AND COLOMBIA

Community intervention projects with pyrethroid (permethrin and lambda cyhalothrin) impregnated bednets and an accompanying community educati on programme were carried out in 6 malaria endemic areas on the Pacifi c coast of Nicaragua, Ecuador, Peru and Colombia as well as in the Per uvian Amazon basin. In this paper the operational aspects are analysed : bednet coverage, results of promotional activities for increased bed net use, the sale of low-cost bednets, techniques and difficulties wit h impregnation, acceptance of the programme (including washing of impr egnated nets), side-effects, residual concentrations of the chemical i n the nets, costs of the impregnation programme and insecticide resist ance of the malaria vectors. We found that the local manufacture of be dnets and their sale through village health workers, even in communiti es with low cash income, is a viable way of increasing bednet coverage ; the impregnation of bednets is well accepted if villagers perceive a direct benefit; pretesting of the soaking capacity of different net m aterials should be done at central level; the instructions for the imp regnation procedures of different net materials (cotton and synthetic) should be simple and unambiguous; very cheap thin net materials shoul d be avoided, particularly in the case of lambdacyhalothrin impregnati on; educational methods and/or promotion of dark-colour nets should be further tested in order to decrease the washing frequency of bednets at household level; in areas with early-biting mosquitoes further stud ies on the protective efficacy of bednets are necessary; careful monit oring of side-effects, particularly those of last-generation pyrethroi ds, is necessary; and the community-based impregnation programme is a powerful tool for strengthening community involvement in health action s.