Long-Lasting Insecticide-Treated Mosquito Nets as Life Insurance

May 8, 2023
UNDP Guinea-Bissau/Elena Touriño Lorenzo

In 2021, 73,000 free mosquito nets were distributed to pregnant women and children under 5 years old in Guinea-Bissau, to protect them from malaria. Insecticide-treated nets is a WHO-recommended malaria prevention  strategy and the national malaria prevention policy in the country provides for the distribution of free nets to pregnant women during their pre-natal consultations and to babies at their first contact with the health system in all 150 health facilities of the public health and private ecumenical system nationwide.

In the waiting room of the Bairro Militar Health Centre, Chief Midwife Awa Camara conducts sensitisation talks with pregnant women waiting their turn at the Maternity Service. "Pre-natal consultations are free, malaria tests are free, HIV screening tests are free, malaria preventive therapy is free, tetanus vaccines and impregnated mosquito tents are also free," she explains. Preventing corruption also means making citizens aware of their rights, which is why actions like this not only contribute to the well-being of the population, but also to the fight against corruption that UNDP is leading in the country. Camara also informs the pregnant women about the importance of family planning from the first pregnancy, the risks of giving birth at home and the convenience of institutionalised childbirth for the health of mother and baby. Maria Helena Gomes is in the eighth month of pregnancy of her first baby, and she has already had seven pre-natal consultations. She attended her first visits at the hospital in Bubaque, in the Bolama-Bijagós region, and is now being monitored at the Bairro Militar Health Centre in Bissau. On the island she received her free mosquito net during her first visit and has been using it ever since. “I sleep every night under a mosquito net to avoid mosquito bites”, Gomes says with conviction as she proudly shows her health card with all visits and check-ups. 

In the small delivery room of the health centre there is a big revolution happening. Three women are in labour and three new lives are soon to join the world, but the pre-natal consultations don't stop. Soana is 13 weeks pregnant and today goes for her first pre-natal consultation. After seven pregnancies, the ritual is not new to her, and she also receives her free mosquito net and her first free dose of Fansidar. According to Ministry of Health data, 18,000 pregnant women received free preventive treatment for malaria in Guinea-Bissau in 2021. Preventive interventions likely to have a major impact on the health of the population, such as promoting the use and distribution of impregnated mosquito nets during pre-natal consultations, are key to reducing the incidence of a disease that claims over 600,000 lives a year in the world, 96% of which are in Africa.

In Guinea-Bissau, the Global Fund finances the free distribution of tests and drugs for malaria, HIV, and tuberculosis. It also finances mosquito nets. The Ministry of Public Health through the National Malaria Control Programme (PNLP), in collaboration with UNDP, is responsible for the quantification of the target population of pregnant women and newborn children, with an approximate forecast of needs of health products. From there, the number of nets needed for distribution in health facilities is calculated. "Mothers receive the net during pregnancy and the babies at their first contact with the health centre," explains João Paulo Mendes, database manager at UNDP. When the nets arrive in the country, they are stocked at the central medical stores (CECOME), like all medical supplies, except for COVID items which are stored at World Food Program warehouses. "Our supply chain team monitors on a monthly basis what was the initial quantity at the beginning of the month, what has been received during that month, what is the quantity consumed and what we have at the end of the month. In this way, we have an approximate idea of what is needed during the period and of the quantity needed for distribution during the next period”, Mendes says.

UNDP Guinea-Bissau/Elena Touriño Lorenzo

All data are digitalised in the University of Oslo developed DHIS2 (District Health Information System 2), the official health information system used in Guinea-Bissau. Both the PNLP and UNDP know when the supply chain monitors enter data and they can access that information to see what is missing, and if any health facility makes an emergency request. A distribution plan is prepared, and the malaria quantification subcommittee discusses and then analyses the data on what is in stock. Based on the available data on consumption, the needs for the next distribution are evaluated to ensure that no health facility runs out of nets. “If we see that they have less than their needs, then we will send the quantity according to what is in the micro-plan. When we send it to the health facility, they do the dispensing to pregnant women and when they already have low stock, they communicate to the supply chain monitor responsible for the region”, says Mendes. When there are areas far from health facilities, the health facility itself applies the advanced strategy, whose logistics are supported by UNICEF: health workers go to see if there are pregnant women who have not yet received a mosquito net and give it to them on the spot.

One long-lasting insecticide-treated mosquito net lasts for up to 3 years and can protect two people simultaneously. According to the Roll Back Malaria Partnership to End Malaria data, they are also responsible for 68% of malaria cases averted in Africa since 2000, contributing to global efforts that saved more than 7 million lives and avoided more than 1 billion cases of malaria. Whether delivered at the first pre-natal consultation, through the advanced strategy mechanism, or during the baby’s first contact with the health facility, routine distribution of long-lasting insecticide treated nets is the most important malaria prevention strategy and has helped, is helping and will continue to help save lives in Guinea-Bissau.