DAKAR, 7 June 2011 (IRIN) - The post-election violence in Côte d'Ivoire delayed by several months a distribution of mosquito nets - a pillar of the country's strategy to combat malaria, a leading killer of children.

Some communities must wait even longer as hundreds of thousands of nets were looted during the unrest.

This is just one example of how the recent conflict has disrupted health services, which were already fragile after nine years of a north-south split.

"This sets us back in our malaria prevention efforts. We were supposed to have done this distribution in December," said San Koffi Moïse, head of the national malaria control programme (PNLP). The project - funded by The Global Fund to Fight AIDS, Tuberculosis and Malaria - aims to cover all households across the country, he told IRIN.

Health workers, along with NGOs Population Services International (PSI) and CARE, on 3 June began handing out insecticide-treated nets in the northwest and in one southern department. A team with The Global Fund is currently in Côte d'Ivoire to meet with PNLP officials and aid workers to discuss how to proceed.

"We are evaluating the situation to see in what regions we can do distributions," San said.

More than 100 containers of mosquito nets were pre-positioned throughout the country prior to the October 2010 presidential election. In western Côte d'Ivoire - one of the regions hardest hit by post-election violence - entire containers were carted off and scores were broken into and emptied.

In Duékoué IRIN saw several empty containers next to the government health services building; most state health workers abandoned their posts during the violence and hospitals and offices were also looted. Mosquito nets like those destined for free distribution were for sale in the Duékoué market.

"We don't know the motive for the looting but it appears the thefts were organized, not just simple acts of vandalism," PSI representative Rambeloson Lalah told IRIN. "In Toulepleu [near the border with Liberia], entire containers were taken away."

When things began to heat up before the election, NGOs insured the nets against "political violence", so they expect to replenish stocks so as to cover the entire country as planned.

Vouchers

The rains have started in much of the country, and with that comes malaria. Ivoirians told IRIN they received vouchers for the nets months ago and are still waiting.

"The people really need mosquito nets right now," said Miagnet Fatou, nutrition expert at the main hospital in the western town of Danané. "It's mango season and malaria is hitting hard." Mango season corresponds with the rains so people commonly associate mango season with the disease.

Miagnet said most of the malnutrition she sees in Danané is linked to malaria.

"People received vouchers a long time ago but they are still waiting... Now they're seeing nets for sale in the market; they're not sure what to think." She said nets sell for up to 1,000 CFA francs (US$2.23) in the market - unaffordable for most families.

"I use mosquito nets to protect my children," said 32-year-old mother of four Affissatou Diakité in the main city Abidjan. "I got a voucher about six months ago... but then the crisis [stopped the process]."

How many needed?

But even as distribution gets under way, there is uncertainty over the number needed in many areas, as tens of thousands of people throughout Côte d'Ivoire have yet to return home after fleeing violence, said Kouyaté Karim, departmental health director in the centre-north city of Bouaké.

"And some people have told me they've lost their vouchers. I'm not saying we'll have to make a new count from scratch, but this is something we have to be aware of as we proceed."

He added: "The conflict has brought considerable disorder to the health system and it will take time to get back on track."

While mosquito nets are not a panacea, their use has repeatedly been shown to reduce severe disease and mortality due to malaria in endemic regions, according to the World Health Organization (WHO). Bednet distribution is one part of Côte d'Ivoire's control strategy, along with prevention measures for pregnant women and ensuring access to malaria drugs.

During 2006-09 PNLP distributed about 2.1 million treated bednets, according to a government report on progress on the millennium development goals. But that is about 10 percent of the number of people at risk, according to WHO's 2010 World Malaria Report.

Source: The Integrated Regional Information Networks (http://www.irinnews.org )