Objective: While increased efforts are being made to promote the large-scale use of Insecticide Treated Nets (ITNs) as a strategy for malaria control, many households in malarious areas continue to invest a wide variety of mosquito protection products that absorb a significant amount of their income. This study provides a better understanding of the amounts households in The Gambia spend on these different measures, how expenditure fluctuates throughout the year and the main determinants of expenditure. Methods: 1700 households from the Farafenni region were interviewed about their expenditure on malaria prevention over the past 2 weeks. Interviews were staggered over 12 months. Expenditure is 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 outside environment. Findings: Expenditure on bed nets including treatment and repair, constituted only 10% of total expenditure on malaria prevention. The main forms of prevention expenditure were coils 8.40D;: indoor sprays 4.20D;: smoke 3.09D and aerosols 3.06D;: making up 81% of total fortnightly expenditure. Of the 442 households that did not own a net, 68% said it was because they could not afford one. The same households spent an average of £2.60 every 2 months on other forms of prevention. Total expenditure was found to be 42% higher in the wet season than for the rest of the year. For every month of the year, coils were the dominant form of prevention expenditure. Wealth, age, occupation of household head and whether households lived in communities where the main road was impassable at any time of the year were significant determinants of prevention expenditure.
Conclusions: Households in The Gambia spend considerable amounts on a variety of malaria prevention products and activities throughout the year. Bed nets represent a relatively small proportion of this expenditure even though they are perceived to be the most efficient and effective method of controlling mosquitoes and in turn preventing malaria. A more concerted effort is needed to develop appropriate targeting strategies to encourage bed net use especially in the under five age group. Equal emphasis should be given to addressing other barriers to purchasing nets such as their relative high upfront cost.
Tropical Medicine & International Health (2006) 11 (4) 419 - 431