The impact of charging for insecticide on the Gambian National Impregnated Bednet Programme.

Insecticide for the treatment of bednets was provided free of charge to half of Gambias primary health care (PHC) villages during the first year of the Gambian National Impregnated Bednet Program (NIBP). A high level of coverage was obtained and overall mortality among children aged 1-9 years was reduced 25% in villages where insecticide was provided. During the second year of the program charges for insecticide of $0.50 per net were introduced to the 221 PHC villages which had previously received free insecticide while the remaining PHC villages received free insecticide. In villages where insecticide was provided free during year 2 77% of nets were treated with insecticide far higher than the 14% coverage achieved in villages where fees were charged. During the first year of the NIBP mortality in children was significantly lower in villages where insecticide was provided free compared to that in the control villages. Introducing a charge for insecticide in the first group of villages and providing free insecticide in the latter abolished that difference. Additional education on the benefits of net treatment and/or the provision of cheaper insecticide will be needed before the full benefits of net treatment can be fully realized in the Gambia.