A top health ministry official has confirmed that Zambia was a recipient of alleged low quality Long-Lasting Insecticide Nets (LLIN).

He said the approximately 2.7 million DawaPlus 2.0 nets arrived in the country around July 2017.

This brand of controversial nets was manufactured by Tana Netting, a foreign company which ceased to exist before rebranding itself last year as Moon Netting to continue receiving international donor funds. It is, however, alarmingly unclear whether Zambian authorities and their global partners in the fight against malaria have placed the needed mechanisms for inspection and testing, to avoid falling victim, again, to the 2017 poor-quality nets scenario.

Commenting on this episode from two years ago, the source, who asked to remain anonymous, said no tests were done before or after distribution of Tana Netting nets. He said the Zambia National Malaria Elimination Centre (ZNMEC) – which is part of the Ministry of Health – is aware of the nets, which were short in size and of poor finishing, but did not point to the most questionable aspect, which is the inappropriate dosage of insecticide which makes them even less effective.

The Health Ministry spokesperson, Dr Abel Kabalo, who said the Ministry is not aware of the matter, asked for more time to establish the true facts behind Dawa nets.

A query had previously been sent to the Ministry’s public relations officer, Stanslous Ngosa, who acknowledged receipt and promised to pass it on to ZNMEC to act on it. Nonetheless, to date, there has been no follow ups.

Meanwhile, ZNMEC is yet to confirm whether it’s hierarchy is aware of the fact that the LLINs were of substandard quality, and whether similarly deficient ones could end up being distributed again to Zambians. When one of ZNMEC communication officers was approached to clarify the matter, she advised that an official interview clearance with a senior director is required to discuss such matters. To date, the clearance has not been granted.

Allegations on treated nets produced by Tana Netting – currently Moon Netting – are that the doses of insecticide mixed to the polyester are not of the correct proportions, and that their efficiency is below global standards set out by the World Health Organisation (WHO).
The issue was made public in 2019 when a donor, The Global Fund, wrote to affected countries, including Zambia. The communique advised countries that nets under the brand name DawaPlus 2.0, produced between January 2017 and April 2018, did not meet WHO specifications. Produced by Tana Netting – now renamed Moon Netting, DawaPlus 2.0 does not have the required level of deltamethrin, the insecticide that kills mosquitoes; thus, rendering the product ineffective.

The Quality Assurance information notice states, “Information have been forwarded to WHO Prequalification for further investigations and advice. In a letter addressed to procurement agencies dated 8th February 2019, WHO PQ Control recognized the uncertainty regarding the quality of products produced between January 2017 and April 2018.” At the time of writing, WHO country office had not responded to a query sent to them.

Meanwhile, Dr Kabalo said tests of any products, including nets, that are brought into the country are done by the Zambia Bureau of Standards.

He said, the US government, World Health Organisation, the Global Fund and the United Nations Children’s Fund (UNICEF), are helping to fund the programme, suggesting there might be steps towards adequate inspection and testing, yet, falling short from confirming any timetable for introducing and enforcing these much-needed safeguards.

It is worth highlighting the following crucial fact: when treated nets meet required standards, they constitute 68 % of all effective malaria prevention solutions according to data gathered and studied carried since year 2000. Infected mosquitoes die due to mere contact with adequately treated nets, providing as a result a solid prevention solution for the individual, the family and the larger community.

As matters stand, this public health reassurance isn’t yet provided, and Zambians nationwide remain in the dark when it comes to the effectiveness of the mosquito nets distributed to them.

At Lwabwe rural health post outside Kasama town 900 kms north of the capital Lusaka, dozens of women gathered for antenatal services. They also went home with a net. Like many other Zambian villages, Lwabwe lies in a malaria-endemic area – which prompted the decision to provide free Long-Lasting Insecticide Nets (LLIN) to the women. Supported by donors, the Zambian government programme aims to provide nets to millions of people in order to eliminate malaria by 2021. 

Nonetheless, while this advanced new target is welcomed by the community, skepticism remains rife. Thirty-three-year-old Mary Bwalya, a mother of three received two nets from Mulenga Hills Health Post in Kasama over a year ago. One was for the couple and the other for their children. To her dissatisfaction, few days of hanging it on the beds, they were inefficient.

“Whenever I switched off lights, mosquitoes began buzzing as usual, I would switch on the light, only to find them swamped inside and outside the net. I thought the insecticide on the net would keep them a bit away, but that wasn’t the case” she recalls. Weeks later, her two-year old daughter fell ill and was diagnosed with malaria.

This is when she suspected the mosquito nets were not treated. To date, Mary and fellow Zambians await clear assurances from health authorities that they are getting genuine treated nets from now on.

Doctors say bringing in untreated nets makes the fight against malaria even more uphill. It means those who access such nets are less protected from the parasite, and stand higher chances of falling sick from malaria, infecting others and making it very hard to reduce the impact of the disease on the community.

A senior nurse at Kasama General Hospital explained that the use of insecticide treated nets is one of the crucial preventive measures deployed to control malaria not only in Zambia but globally.

“Untreated mosquito nets provide limited physical barrier between a mosquito and human being, protection becoming minimal and can still bite through the net or get inside the net due to improper use,” she said.

Asked whether she is aware of the controversial Dawa Plus nets, the nurse at Kasama Hospital said there haven’t been any directives from NMEC office in the capital Lusaka.

Malaria continues to be the leading cause of sickness and death in Zambia. According to the National Malaria Elimination Centre, more than 16 million people are at risk of malaria in Zambia.

“Though major achievements have been made in malaria control, the disease remains a significant cause of illness and death in Zambia, with one in five children under age five infected with malaria parasites, and other vulnerable population groups at high risk,” say the NMEC on their website.

The recent WHO report revealed that global efforts in fighting malaria have hit a snag as it showed that there were more cases of the killer disease in 2017 than previous years.