Samuel Lowenberg - Independent Journalist biography articles articles

Niger welcomes largest bednet distribution in history

The Lancet  May 6, 2006

Malaria claims the lives of one in four Nigerien children younger than 5 years old. A new initiative has delivered free bednets to millions of families by capitalising on the infrastructure set up to fight polio. But, says Samuel Loewenberg, low useage rates are jeopardising the programme's success.

Hundreds of mothers have been lined up for hours under the scorching sun. But they don't seem to mind. One by one, the women enter a concrete room where they must show one of their hands to a Red Cross volunteer, displaying the ink mark they received when their children were vaccinated against polio a few weeks earlier. It was at this time they were told where they could come to pick up the special insecticide-treated bednets. The nets are designed to safeguard a mother and her children for up to 3 years.

Halatu Kalla, a 26-year-old mother of two is waiting with her 1-year-old baby, Abdura. Recently, she says, her older child was hospitalised with malaria for 2 months. “"I will use the net for my children to protect them," she says.

Malaria is one of Niger's biggest killers. The land-locked nation is in the middle of the so-called Malaria belt. Nearly one in four children die before they reach the age of 5 years. Until now, only a few Nigeriens had access to bednets. But a US$15 million initiative, sponsored by the Red Cross, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, WHO, and the Niger Ministry of Health, is now mounting the largest bednet distribution in history, capitalising on the infrastructure put in place to distribute polio vaccine.

Although the programme is one of the most successful antimalaria efforts, surmounting the difficulties of implementing public-health programmes in one of the world's poorest countries has been a struggle.

The main problem for the net-distribution scheme was logistics—not a small problem in a nation twice the size of Texas and perched on the southern edge of the Sahara. With so many hard-to-reach villages, the project needed 25 camels, 45 donkeys, and more than a dozen boats in the net distribution, as well as the services of nearly 4000 paid volunteers.

The biggest innovation was using an already existing public-health programme to spread the word about the free bednets. This was done by working with the Niger Ministry of Health to attach the net distribution scheme to a polio vaccination programme that had already been knocking on the doors of village huts for nearly a decade.

“We used the captive audience to tell them where to pick up the service”, says Stefan Hoyer, WHO's adviser on malaria for Africa, who was one of the principal architects of the effort. By “piggy-backing” the well-established polio campaigns, the organisers were able to reach a vast population extremely quickly.

Other malaria campaigners, however, had hoped for an even bigger success. While around 90% of families with children younger than 5 years have recieved nets, only about 20% are using them. That proportion is substantially less than in distribution programmes in smaller countries, although the organisers say they expect useage to rise once the rainy season begins.

A Red Cross expert involved in the campaign, who spoke on condition of anonymity, pointed out that utilisation rates in other countries, such as Togo in 2004, were more than twice as high as the Niger campaign. This, said the expert, was because in the Togo effort there was significantly more attention given to public education on how to use the nets than was done in Niger.

There is also a culture factor. According to the Red Cross expert, up until now, when these nets existed in Nigerien culture, they were used by the fathers for privacy. The danger is that these new, specialised antimosquito nets will be taken from the mothers by their husbands, who often have up to four wives.

Free bednets have been given to 90% of families with children younger than 5 years

Hoyer responded that it was still too early to be judging the net distribution programme's success. Once the rainy season comes in July, he expects net use to be more than 80%, and he notes that villages close to a river, where malaria is a problem throughout the year, are already using the nets more readily.

Meanwhile, the toll of the disease can be seen in the malaria ward of the National Hospital in Niamey. It is a small room with five beds, each of which holds an infant lying thin and glassy-eyed with tubes running out of their noses. Their mothers sit next to them, with little to do but hope.

Copyright by Samuel Loewenberg and/or the publication in which it first appeared
Do not reprint without permission