Introducing insecticide-treated nets in the Kilombero Valley, Tanzania: the relevance of local knowledge and practice for an Information, Education and Communication (IEC) campaign

Since 1997 the WHO has been recommending an integrative strategy to combat malaria including new medicines, vaccines, improvements of health care syst ems and insecticide-treated nets (ITNs). After successful controlled trials with ITNs in the past decade, large-scale interventions and research now f ocus on operational issues of distribution and financing. In developing a s ocial marketing approach in the Kilombero Valley in south-east Tanzania in 1996, a combination of qualitative and quantitative methods was employed to investigate local knowledge and practice relating to malaria. The findings show that the biomedical concept of malaria overlaps with several local il lness concepts, one of which is called maleria and refers to mild malaria. Most respondents linked maleria to mosquitoes (76%) and already used mosqui to nets (52%). But local understandings of severe malaria differed from the biomedical concept and were not linked to mosquitoes or malaria. A social marketing strategy to promote ITNs was developed on the basis of these find ings, which reinforced public health messages and linked them with nets and insecticide. Although we did not directly evaluate the impact of promotion al activities, the sharp rise in ownership and use of ITNs by the populatio n (from 10 to > 50%) suggests that they contributed significantly to the su ccess of the programme. Local knowledge and practice is highly relevant for social marketing strategies of ITN's.