Almost all the bed nets on the commercial market in Tanzania, designed to protect sleeping people from malaria-infected mosquitoes, are not treated with a long-lasting insecticide, a crucial component to protecting individuals and communities from the deadly disease.
That’s according to new Johns Hopkins Center for Communication Programs-led research published this month in Malaria Journal. The main reasons, the research suggests, is that gold-standard treated bed nets are more expensive to buy, due to taxes, tariffs, regulations and accessibility challenges caused by red tape. While treated nets are uniform, untreated nets come in a variety of colors, shapes and sizes that are more appealing to consumers.
“People are willing to buy treated bed nets, but they don’t have the range of options they can find in untreated nets,” says Benjamin Kamala, the monitoring, evaluation and learning director for the CCP-led Tanzania Vector Control Activity. “And while untreated nets offer some protection as a physical barrier to mosquito bites, they don’t kill the mosquitoes, meaning they only solve part of the equation.”
Insecticide-treated bed nets are considered one of the best ways to protect people from malaria, which killed 620,000 people in 2021, the last year for which there is global data. Malaria mostly kills children under the age of 5 and pregnant women in sub-Saharan Africa.
Tanzania’s National Malaria Control Program wants treated nets to get an increasing share of the market. Outlets selling nets in urban and suburban areas were surveyed in 2021 and again in 2022 to understand landscape. The researchers also conducted interviews with wholesalers and retailers.
Typically, people who live in countries where malaria is endemic are provided bed nets paid for by international donors such as the U.S. President’s Malaria Initiative and the Global Fund. These are distributed during mass campaigns, in schools and in clinics that treat pregnant women and babies. These nets are designed to be useful for an average of 2.5 years before new nets are provided. The free nets are just one barrier to creating a robust marketplace for treated nets.
Also, Kamala says, not everyone who is provided a government-issued treated bed net wants one. People with higher incomes perceive those nets as inadequate and want to buy their own. The choices they have in buying untreated nets are many. In 2021, his research found, only two legitimate brands of treated nets were available for purchase in the marketplace; in 2022, there were zero.
More than 96 percent of nets sold in both years were untreated, they found.
“We wanted to understand why people are not buying the treated nets,” Kamala says. “We determined that treated nets are more expensive compared to untreated nets. Also, for treated nets to be approved, they must follow a number of steps because they are categorized as chemical-containing products, which is a lengthy regulatory process by the Tanzania Plant Health and Pesticide Authority. It makes it complicated to sell a treated net.”
The large market share for untreated nets may also reflect, interviews suggested, a desire for larger or more decorative nets, nets that don’t provoke itchiness, that have a conical shape that is easier to hang, or that have different sizes to fit a variety of beds.
Some nets on the black market in 2022 were insecticide treated, mostly spilling over from the border with the Democratic Republic of Congo, where government-issued nets had recently been distributed.
The Tanzania Vector Control Activity is using the data collected to advocate to reduce financial and regulatory restrictions that make untreated nets the norm in the commercial market, even though the ones treated with insecticides are more effective.
“Tanzania is unlikely to see increased retail sales of long-lasting insecticide-treated nets without significant changes in distribution policy and national regulatory processes for the treated nets,” Kamala says. “It appears that manufacturers are not finding it worthwhile to promote and sell retail insecticide-treated nets. Manufacturers should be encouraged to have additional options so that people can get varied sizes, colors, mesh size, and shape with a net with insecticide.”
“Trends in retail sales of insecticide-treated nets and untreated nets in Tanzania: cross-section surveys” was written by Benjamin Kamala, Deo Mwingizi, David Dadi, Dana Loll, Peter Gitanya, Charles Mwalimu, Frank Chacky, Stella Kajange, Sara Malima, Mwinyi Khamis, Raya Ibrahim, Naomi Serbantez, Lulu Msangi and Hannah Koenker.
This work supported by the United States Agency for International Development (USAID) and the President’s Malaria Initiative (PMI) under the terms of USAID/JHU Contract number 72062120C00001.