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BMJ 2008; 337 doi: (Published 25 November 2008) Cite this as: BMJ 2008;337:a2681

Slow progress with bed nets hampers malaria control

Bed nets treated with insecticide are one of the best ways to protect children from malaria in endemic parts of Africa. Distribution across the continent has been slow, however, with almost 90 million children under 5 years still without them. Recent estimates suggest that although coverage increased from 1.8% to 18.5% between 2000 and 2007, 89.6 million children remain unprotected and at risk from falciparum malaria. Researchers estimated coverage from local and national surveys in 40 countries and projected likely coverage for 2007.

Their study suggests that more than half of the children without bed nets (48.3/89.6 million, 54%) live in seven countries—Nigeria, Democratic Republic of Congo, Uganda, Sudan, Mozambique, Côte d’Ivoire, and Cameroon—where coverage was less than 15% in 2007. International efforts to control malaria should focus on these countries first, say researchers. About a quarter of unprotected children live in Nigeria alone.

Experts are still debating how best to get bed nets to those who need them most. In this study, countries that gave away free bed nets seemed to make better progress than those relying on full cost recovery schemes or routine subsidies from the public sector.

Intensive psychotherapy improves diabetic control, but not much

Poor control of diabetes can be psychological as well as physical, so researchers designed a randomised trial to find out if the combination of motivational therapy and cognitive behavioural therapy might help adults with a long history of badly controlled type 1 diabetes. The effects were modest. Four sessions of motivational enhancement therapy over two months, followed by eight sessions of cognitive behavioural therapy over four months reduced glycated haemoglobin by a small but significant 0.46% (95% CI 0.81% to 0.11%) compared with usual care. Four sessions of motivational therapy alone had no effect on diabetic control, and even the combined treatment made no difference to half a …

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