Around 1.3 million treated mosquito nets are suspected of having been distributed in Cameroon despite not meeting the global standards set out by the World Health Organisation (WHO).
A notice of concern was published in February this year by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), stipulating that treated nets – known technically as Long-Lasting Insecticide Nets (LLINs) – of the brand Dawa-Plus 2.0 should be subject to further scrutiny and testing prior to mass distribution.
GFATM, one of the leading international donors in the field of combating malaria, has shared these concerns with almost two dozen countries in Africa and Asia. Cameroon is one of the recipients of the controversial Dawa-Plus 2.0 nets, manufactured between January 2017 and April 2018 by Tana Netting, a dissolved company which rebranded as Moon Netting in an effort to clear its name.
An investigation carried out by independent journalist Comfort Mussa for our newspaper has revealed that health authorities in Yaounde have looked into the allegations before eventually deciding to give the go-ahead for the distribution of the nets.
Asked about the circumstances and arguments which led to clearing the controversial nets for deployments to households, the Permanent Secretary of the National Malaria Control Programme (NMCP) Dr. Dorothy Kah Fosah Achuconfirmed thatCameroon was indeed a recipient of the suspected substandard Dawa-Plus 2.0 nets. “There was an information notice from Global Fund [GFATM] saying there was a batch of mosquito nets suspected to have quality problems and it went back for quality control”, stated Dr Fosah Achu.
Elaborating further on steps taken by the Cameroonian authorities, NMCP permanent secretary advanced that recommendations of donors were followed to establish a final verdict on the specific batch of Dawa-Plus 2.0 LLINs Cameroon has received. “The nets were quarantined, we investigated and got the results, which showed that they are of good standard and within the acceptable norms. WHO Prequalification unit carried the tests”, added Dr Fosah Achu.
Commenting on the same dossier, Malaria Control Officer at WHO’s representation in Cameroon Dr Alexis Tougordi revealed that a meeting was called between WHO – as the global organisation which sets quality compliance and standards for LLINs – and Cameroon’s Ministry of Health as the institution which encompasses NMCP. “The meeting was held once the results of testing the quarantined batch came out. It was then decided by both parties that distribution should go ahead”, said Dr Tougordi.
According to NMCP, a distribution campaign of free treated nets is currently ongoing, with seven out of ten regions in Cameroon already covered while three are yet to go. The three brands currently being distributed are Olyset, Duranet and Dawa, say NMCP officials, maintaining that they have all gone through adequate quality controls.
Nonetheless, wash resistance of treated nets is an area of compliance which experts believe it gets sometimes overlooked despite its vital importance in ensuring that insecticide efficiency is indeed long lasting. Commenting on this feature, NMCP Permanent Secretary pointed to post-distribution tests carried to check whether treated nets still preserve their attributes after being washed by users.
“The protocol is to carry tests six months after distribution to make sure that efficiency is still upheld. In one past distribution for insance, we’ve had to go beyond this time frame, and we were only able to test two years after distribution. We found out that there was a degradation in quality of nets due to use of detergent in washing the products. We therefore mobilised our resources to advise households on methods of cleaning and washing nets to avoid less efficiency and prevent higher insecticide resistance by mosquitoes”, explained Dr Fosah Achu, adding that post-distribution testing for the most recent batches hasn’t taken place given that the six months window hasn’t expired yet.
Insecticide resistance is also a major concern in the global fight against malaria. Researchers in Cameroon like Professor Charles Wondji have flagged that the insecticide currently used in the mosquito nets distributed in Cameroon is not very effective in the face of increasing spread of insecticide resistance by mosquitoes.
Reacting to these fears, NMCP Permanent Secretary, Dr Fosah Achu, acknowledges that the insecticide currently used in some of the nets distributed faces resistance in several regions. Nonetheless, she insisted that studies also show that even in case of resistance, if well used, these nets can still be effective as a physical barrier. “If the insecticide built into the nets doesn’t kill mosquitoes, it would at least repel them. Despite the emergence and spread of mosquito resistance to pyrethroids, insecticide-treated nets continue to provide a substantial level of protection in most settings”, stressed Dr Fosah Achu.
Insecticide resistance when it comes LLINs distributed over the past few years is indeed a growing worry amongst the community of specialists working on combating malaria across Cameroon. Taking on this matter, Dr Tougordi says discussions are ongoing regarding future distribution campaigns of free mosquito nets up and down the country. According to a WHO note published in 2018, a freshly developed technology of nets which includes the chemical piperonyl butoxide (PBO) has been found to provide improved protection in geographic areas with high resistance. Dr Tougordi has suggested that PBO and other types of prequalified nets are being considered for future deployments in Cameroon.
Another product known as ‘New Nets’ has also been put forward by the global community of scientists as an even better solution compared to LLINs or the more efficient PBOs. Reacting to these recommendations, NMCP Permanent Secretary Dr Fosah Achu agrees that the recommended New Nets can improve the killing of mosquitoes, “but these New Nets are two or three times more expensive and if we decide to get them, we will only cover a third of the population in the mass coverage we are doing. For now, the cost remains a challenge.”
On the same thread, Dr Fosah Achu added: “We have however introduced PBO nets in the East Region where the burden of malaria is very high. It is better than the other nets we currently have in the field, but we know it is not as ideal as the New Nets recommended by scientists. Still, PBO nets are more expensive than standard nets, they are not the New Nets technology, but they provide improved protection against malaria in places known to endure high mosquito resistance”, concluded NMCP Permanent Secretary Dr Fosah Achu.
Meanwhile, day-to-day reality continues to bite, along with mosquitos. As night falls in the city of Yaounde, the Mbah’s like most families in Yaounde carry out routine measures to keep mosquitoes out.
The residence of the Mbahs has mosquito nets on all windows and treated nets around their beds. In spite of this double-layer of protection, mosquitoes still find a way into the interior of their home. In the evening, they close their windows and doors and use rub repellants before bedtime.
Nevertheless, this household of 6 has an average of 6 malaria episodes per year. Mr Mbah (44) says “I always believed that hanging the mosquito nets around my bed at night was enough to keep mosquitoes and malaria away but it is not the case. I even have nets around the windows and use repellents as well. In spite of these measures, I have had malaria twice this year and other members of my family have also had it in 2019. I wonder why mosquitoes still enter our homes and bite us through the nets as we sleep. I don’t understand, we are strictly following recommendations, but it doesn’t seem to be enough”, complained Mr Mbah.
Insecticide resistance and substandard nets are interlinked topics which are increasingly on the minds of Cameroonians. In July 2019, Mme Rosine Désiree Chougouo – Pharmacist, Researcher and Lecturer at Université des Montagne in Cameroon – warned in an article about what she considers a flagrant and burning issue: the ongoing manufacturing and distribution of substandard and non-compliant nets, and how this practice according to her research is aggravating the already-dire impact of insecticide resistance.
According to most recent data made available by WHO reports, Cameroon’s entire population of over 24 million people is exposed to malaria infection, with 71% at high risk. Yet, Cameroon spends just above 4% of GDP across all sectors of public health, highlights Mme Chougouo. “This makes the percentage dedicated towards malaria prevention fractional. These capacities need to be urgently boosted, and donors and all stakeholders should take serious note that part of funding treated nets is also ensuring that substandard ones do not end up in Cameroonian cities, towns and villages”, she protested alarmingly.
*Comfort Mussa is a prolific, multi-award-winning journalist with a keen eye for stories that expose social injustice.