Most nets catch and contain – think of fish and butterflies. Nets for Life puts them to work in a different way: to keep malaria-carrying mosquitoes from spreading the biggest killer in sub-Saharan Africa. This New York-based non-profit, with a regional office in Ghana, distributes many tens of thousands of malaria nets to some of the most vulnerable people in the war-ravaged Democratic Republic of Congo (DRC) – as well as to sixteen other vulnerable African countries. Their plans for expansion are aggressive - they intend to distribute an average of 1.7 million nets a year going forward.
All malaria nets are not created equal, however, even to the world’s most destitute people. In its pursuit of disease prevention and economic development, Nets for Life has learned to embrace the importance of design.
Mosquito nets are usually made of lightweight, tightly woven polyester hung from either one hook or four, depending on the style. At night, the edges of the net are tucked underneath a mattress where a person sleeps, hopefully inaccessible to mosquitoes carrying malaria.
But when white nets were distributed in Ghana, Malawi, parts of Nigeria and Sierra Leone, villagers shunned their use. What at first appears to be nothing more than a clean, white, universally pleasing mosquito net actually resembles a funeral shroud. Throughout western Africa, especially in Islamic areas, the custom of sheltering a recently deceased body under a tent made of white fabric makes sleeping under these ubiquitous white mosquito nets less than appealing.
“How can you hand us white nets if we are not dead?” Stephen Dzisi, Technical Director for Nets for Life in Ghana, was startled by this question. He then asked why the villagers accepted the nets in the first place if they weren’t going to use them. Those questioned merely shrugged: “It is impolite to refuse a gift.”
On a positive note, although many nets were packed up in suitcases and boxes, some industrious minds refashioned the nets for fishing or as coverings for vegetable gardens. Others used the nets to create makeshift enclosures for newly hatched chickens. The nets were certainly being used, but for anything other than protection from the malaria-carrying mosquitoes.
So Stephen was left to wonder. What color would be okay?
Green or blue nets work. So does any color other than white. For practical purposes, villagers also recommended avoiding light, bright colors that easily get dirty, requiring frequent washing and increasing likelihood of debilitating tears. When nets are treated with insecticide, washing also shortens their potency.
On World Malaria Day Stephen’s Nets for Life group will be distributing 30,000 plain green-colored nets; a green the color of a basic Crayola crayon.
But successful net design for development doesn’t stop with color. Many villagers also clamor for cone-shaped nets because most rural African houses are round. This is especially true in Angola and Mozambique. But there is a catch. Conical nets cost twice as much to produce than the standard rectangular one since each requires more fabric.
Stephen and his team approached the largest mosquito net producers about this issue. As a potential solution, a new design emerged - a pyramidal shape that uses just one hook and consumes less fabric. Nets for Life will be piloting this new shape later this year to see if villagers actually take to them.
Finally, once color and shape are dealt with, durability of the net material is also critical. Though mosquito nets are designed to last four years in normal conditions, they are quite fragile in the hands of rural villagers. Many locals sleep on wooden and straw mats that lay close to the ground. The rough edges easily tear at the net, creating holes and rendering the net useless. Cost-effective efforts to reinforce the base of the nets with more fabric or thicker cloth are ongoing.
Worrying about the color, shape, and overall design of mosquito nets is part of a highly focused profession that most in the developed world know little about. But for Stephen Dzisi, the ambition to fight malaria was sparked early in life when he lost his younger sister to malaria growing up in rural Ghana. Today, well-designed nets are essential to Stephen realizing his most rewarding moments, mainly testimonies from mothers who properly use mosquito nets. “It’s incredible to hear a mother tell you how a child - who is now 2 years old - never had a single episode of malaria after having to bury two children taken by malaria before reaching one year of age. To her, it is a miracle.”
Stephen’s goal is to grow Nets for Life beyond just identifying the best design for widespread net usage. He hopes to broaden the scope and focus of the program into a more comprehensive malaria control initiative. The challenge is in gathering adequate resources, both financial and human. The trust, he says, is already there in the communities served. “Programs like this must be community driven,” he insists. “It is the only way toward real ownership and sustainability. It’s a real hidden secret to let villagers prioritize and make homegrown solutions.”
And at times, design falls to the wayside. In northern Ghana, after having addressed various design issues, the dry season blankets the region. With temperatures nearing 100 degrees and perpetually dampening humidity, people sleep outdoors. The nets hang inside the huts - useless. But instead of suggesting solutions, Stephen turns the problem over to the community. “All the nets are hanging inside and you are all sleeping outside. How can you fix this?” The village chiefs convene and deliberate heatedly. Finally, they emerge with a simple solution of taking four empty paint containers and filling each with sand. They would then pack a sturdy stick into each paint can and hang the nets from the makeshift poles. In the morning, nets can be rolled up quickly and the buckets can be pushed away, allowing people to go about their business. It was a perfect solution.
“It was so cool to see the nets hanging outside with mats underneath,” Stephen says, laughing and shaking his head. “It’s amazing how problems can be solved with just a little bit of thinking and asking. But most importantly, by listening to what the people you are trying to help have to say.”
For more information on Nets for Life (R), visit www.netsforlifeafrica.org.