Technical Bulletin No.7

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MOSQUITO NETS AND INSECTICIDES FOR MALARIA CONTROL

Background

Malaria is a serious public health problem, causing an estimated one million deaths each year, predominantly among young children. In addition to child mortality, malaria can also cause severe anaemia and cerebral complications in young children. This may have serious consequences for the long-term survival of children, as well as hinder educational and social development.

Roll-Back Malaria (RBM) is a global partnership, founded in May 1998 by the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), the United Nations Development Programme (UNDP) and the World Bank. Its goal is to facilitate country action to reduce significantly the global burden of malaria. The major focus of UNICEF malaria strategies is at the community level, concentrating particularly on malaria prevention through the use of insecticide-treated nets, community awareness, social mobilization and improved access to quality treatment.

Business Plan

UNICEF is already a major purchaser of insecticide-treated nets and insecticides through its Supply Division in Copenhagen. Via its country programmes, UNICEF intends to stimulate demand for insecticide-treated nets to a level where market involvement becomes attractive for private enterprise. In the short term, UNICEF will act as a procurement arm for its own programme needs and for partners who request assistance. Bulk orders of insecticide-treated nets and insecticide treatment kits will reduce the price level considerably, thus improving the overall economics and sustainability of the RBM Initiative.

In order to scale up the provision and use of long-lasting insecticidal nets (LLINs) and stimulate the transfer of LLIN technology in Africa, the Roll Back Malaria partners, in collaboration with the Rockefeller Foundation, have engaged the Management Sciences for Health (MSH) to develop a business action plan. This business plan includes a market and producer analysis, a review of processes and technologies, mechanisms for funding, and partnership opportunities. The plan is to be launched in early 2004 at a meeting of donors, suppliers and other partners.

Technical support

UNICEF Supply Division can offer technical support in the following areas:

• Assessing and analysing national needs for mosquito nets and insecticides in the context of malaria control programmes.
• Assessing logistics and advising on distribution components.
• Specifying and procuring the most suitable nets and insecticide for malaria control programmes.

In close cooperation with WHO, minimum standards have been developed for mosquito nets and insecticides, to ensure that sufficient efficacy against mosquito bites is achieved at minimum cost, and that contact with the insecticides is harmless to humans.

1. Insecticide-treated nets

Insecticide-treated nets (ITNs) are a powerful public health tool in the fight against malaria. Regular use by young children can reduce their overall risk of mortality by 20 per cent and the number of clinical malaria episodes by 50 per cent.

An insecticide-treated net consists of an untreated net and an insecticide treatment kit. This type of net requires regular re-treatment. The importance of regular use and re-treatment must be stressed.

a) Nets

Standard specifications exist primarily to protect and benefit users. However, certain qualities are culturally-specific and attempts to standardize all features of ITNs would be inadvisable. To make the procurement of ITNs as efficient as possible and minimize lead times, UNICEF procures a range of these nets in the most popular sizes, shapes and colours.

Standards are essential for quality control, and UNICEF follows WHO specifications for netting materials strictly. The quality of yarn is important as it affects the net's ability to absorb sufficient insecticide during re-treatment.

b) Insecticides

Insecticide-treated nets should be regularly treated with one of the insecticides currently recommended by WHO. The most popular method is to use treatment kits.

Insecticide can be ordered in bulk, as a single dose presentation or in a treatment kit.
The following insecticides and insecticide treatment kits can be ordered through UNICEF Supply Division.

A treatment kit consists of a single dose of insecticide, sufficient for the treatment of one net, together with protective gloves, a measuring bag, and instructions in French and English. For instructions in other local languages, a special request should be addressed to Supply Division. UNICEF recommends the use of treatment kits, and the following kits have proved popular:

2. Long-lasting insecticidal nets

Long-lasting insecticidal nets (LLINs) have been developed in response to the low re-treatment rates of conventional insecticide-treated nets, especially in Africa. A long-lasting net is a ready-to-use pre-treated mosquito net, which requires no further treatment during its expected life span. This is the preferred choice of mosquito net for UNICEF-supported programmes.

It is UNICEF policy to follow the testing and approval process developed by the WHO Pesticide Evaluation Scheme (WHOPES). This means that potential long-lasting insecticidal nets, which are being tested by WHO, should be classed as ordinary pre-treated nets until WHOPES approves them.

Long-lasting nets are now becoming available in large numbers, and global production capacity and accessibility to them is expected to increase even more in 2004. Information on the availability of long-lasting insecticidal nets from WHOPES-approved suppliers is available from UNICEF Supply Division.

The following LLINs are procured regularly by UNICEF. A broader range of long-lasting insecticidal nets can be procured through UNICEF Supply Division upon request.

3. Pre-treated nets

The use of pre-treated nets is NOT recommended. This is because:

• Concentrations of insecticide in the nets are extremely variable and would be rejected under normal quality controls.
• Users do not recognize the need for re-treatment.
• It is almost impossible to ascertain if re-treatment has been undertaken with an insecticide that meets WHO specifications.

UNICEF warehouse planning

Due to the unpredictability of institutional purchasing of mosquito nets, UNICEF has taken the initiative to pre-position untreated nets and insecticides, as well as long-lasting insecticidal nets, in various warehouses around the world, in order to provide support where forecasting is unreliable, and to assist in emergencies.

Supply standards for mosquito nets

UNICEF applies strict quality assurance criteria to ALL producers of insecticide-treated nets, long-lasting insecticidal nets and insecticides. A producer’s social conscience and accountability towards its workers’ safety and the working environment are also appraised.

The stringent evaluation by Supply Division of every mosquito net supplier that UNICEF does business with, has led many manufacturers of nets to raise their own standards. A joint plan of action ensures that all the products procured meet UNICEF quality requirements.

In order to ensure that producers continuously adhere to the stringent standards set, UNICEF performs:

• Periodic assessments of the manufacturing quality of products, and follows up with producers.
• Pre-shipment inspections.
• Reviews of worker safety, environment considerations and the manufacturer’s social accountabilities.

UNICEF has facilitated good working relationships with a number of global producers of mosquito nets and insecticides and has established Long Term Arrangements with these producers.
This gives UNICEF the advantage of lower negotiated prices, and ensures that quality remains constant. These arrangements also provide UNICEF with access to the large quantities of mosquito nets that are needed to implement effective programmes and reach women and children who urgently need these supplies.

For more details, please contact UNICEF Supply Division, at customer@unicef.org.

Copyright © the United Nations Children Fund (UNICEF), Supply Division, January 2004.