Treated mosquito nets are vital in the fight against malaria. But the average lifespan of a net is about four years. The Conversation Africa’s Health and Medicine Editor Joy Wanja Muraya asked Dr Lydiah Kibe to explain how old and torn bed nets are being reused in coastal Kenya.
Why are treated bed nets a critical protective barrier against mosquitoes?
Mosquitoes are a nuisance and cause irritation. On the public health front, they transmit diseases such as malaria, Rift Valley Fever, Dengue fever, Zika virus and Chikungunya, yellow fever, filariasis among others. One of the key ways mosquitoes are controlled is through the use of insecticide treated nets which are hung over beds, especially at night. Insecticide treated nets reduce illnesses and deaths from malaria. It can reduce deaths in children by a fifth and episodes of malaria by half. Since 2002 about 30 million nets have been distributed in Kenya to high risk groups especially pregnant women and children under five years. In 2006, about 3.4 million Long Lasting Insecticides Nets were given at no cost to children under five in malaria endemic areas in Kenya. Six years later, 11.5 million treated nets were distributed in the 87 malaria prone regions in the western, coast and parts of eastern Kenya. Furthermore, a mass distribution campaign is underway in Kenya to provide 15 million treated nets in 23 malaria prone counties. The aim is to achieve universal coverage, targeting one treated bed net per two household members. Other interventions used to control mosquitoes include; aerosols- a spray that contains a natural active ingredient that kills mosquitoes, repellents- applied to skin, clothing, or other surfaces to discourage mosquitoes from landing or climbing on that surface, screening windows and eaves- netting material mostly on windows that prevents entry of mosquitoes, larviciding- an insecticide that specifically targets the larval life stage of a mosquito.
What motivated your study into how old nets are being used?
Our study was done in 888 households in Malindi, coastal Kenya. It was motivated by a lack of guidelines on disposing old, expired and torn mosquito nets especially after a mass distribution. We investigated the reuse of bed nets, particularly those that were old, torn and expired bed nets. The nets are made of polyethylene or polyester materials which are strong and long lasting. There are no official guidelines to follow, but we found that residents had devised imaginative, creative and innovative ways of recycling them. The most popular reuses we found were: a quarter of the respondents had used them to reinforce fences and shelters, as net ropes for tying animals, building and furniture materials (23%), protecting seedlings (17%), as chicken coops (13%), as window screens (11%), covering wells and water containers (4%), to scrub utensils, and as a sponge for personal hygiene during bathing. Children also put them to use. We found that they had been fashioned into goal posts, strings and jumping ropes as well as swings.
We also found that women liked to use the material to make a traditional attire known as hando – a short skirt made of a long material, preferably cotton, folded into gathers. These are usually made from old clothes or material made from sisal.
What reasons were given for the disposal of the bed nets?
Nets eventually become ineffective. This happens when they are old, worn out and insecticidal activity is reduced. Residents dispose them once they’ve been repaired them many times or the holes have become too big and numerous. Damage to nets is often caused by tin lamps, friction from a mat or edge of the bed, sparks from a fire and children playing with them. They were also often washed frequently.
This is what some respondents had to say about why they disposed of the nets: My net had big holes like the size of my fist and mosquitoes were entering through these holes. I had to buy another net to replace it. Our houses are like you can see them (referring to mud thatched houses). We sleep with our chicken and goats inside the house. This makes the nets get dirty very fast as the goats sometimes urinate on the nets. You have to wash it regularly and this makes it get torn very fast. Sometimes you repair the holes until the net cannot be repaired anymore. You repair it today, after a week you find another bigger one. If it’s old you throw it away in the trash and get a new one or stay without one.
It’s time that alternative uses of old and worn out nets wasn’t interpreted as misuse but seen as an innovative way of using them. However, health promotion officers should provide guidance on alternative uses. For example, people could be encouraged to use them in a way that compliments malaria control efforts such as using them as window screens and covering water wells.
In addition, efforts should be made to involve communities in viable and realistic ways of reusing old nets. This could be done without compromising the overall goals of malaria control initiatives. For example, they could serve as alternative sources of income by encouraging collection, sorting and making ropes which could then be sold.