Northern Nigeria: distributing mosquito nets – in pictures

In northern Nigeria, a child is treated for malaria and his mother waits by his side. The classic symptoms of malaria consist of bouts of fever, chills, sweats, headaches, muscle aches, nausea and vomiting. Once contracted, it can mean death in just a few days for a young child. Malaria, a largely preventable disease transmitted by infected mosquitoes, kills hundreds of thousands each year. Most deaths occur among children living in Africa where a child dies every minute from malaria. In Nigeria alone, WHO estimated that over a quarter of a million people died from malaria in 2012.

A crowd of women wait outside the LLIN collection point with their vouchers in hand. Across Nigeria, SuNMaP has procured and distributed approximately two million LLINs as part of its contribution to the national LLIN campaigns.

A young boy peers through the window to where long-lasting insecticide treated nets (LLINs) have been stocked before distribution. In areas where malaria is highly prevalent, an unprotected person can contract the disease up to five times a year. LLINs, when used properly can dramatically reduce the risk of contracting the disease. LLINs also provide a chemical barrier: the insecticide in them kills the mosquito upon contact with it, helping to bring down the mosquito population. The Federal Ministry of Health reports that up to 30 percent of under-five deaths in Nigeria are attributable to malaria.

Nigeria, a vast country, is the most populous in sub-Saharan Africa. Getting nets to communities in remote parts of northern Nigeria, where transport links and roads are often poor, is one of the many challenges that Malaria Consortium and the SuNMaP partners face in mass distribution campaigns.

Mass distribution of LLINs alone is not sufficient to combat the disease. The lack of education about the disease at community level is a major challenge in malaria control. The WHO recommends that net distributions are systematically accompanied with information on why and how to use the net. SuNMaP holds events, such as this one in Kano, northern Nigeria, to raise awareness of malaria and educate communities of the importance of sleeping under LLINs each night.

As community members gather round, a SuNMaP representative demonstrates how to hang a net. Unlike many treated nets that are dipped in insecticide, LLINs are made with netting material that has insecticide incorporated within or bound around the fibres. That means that LLINs are highly resistant and don’t need to be retreated each year.  An LLIN properly cared for can last up to three years before it needs replacing.

Through SuNMaP distribution campaigns, vouchers are distributed in advance of the distribution to community members, each voucher entitling them to collect two free nets. SuNMaP has helped the Nigerian National Malaria Control Programme to develop standard operating procedures for LLIN mass distribution campaigns.

Over 500 languages are spoken across Nigeria. Leaflets such as this one on malaria and LLINs – why and how to use them – are translated into local languages to ensure that all community members can access the information they need. The leaflet explains the importance of sleeping under the net each night. Diagrams show how to hang and maintain it, and use the net correctly.

Women and children gather under a tree after collecting their LLINs from the distribution point. Young children and pregnant women are the most at risk of severe malaria. Severe malaria occurs when the infection is complicated by serious organ failures or abnormalities in the patient’s blood or metabolism. Symptoms of severe malaria can include severe anaemia, fever and convulsions, problems with breathing, extreme weakness, circulatory collapse, swollen legs, blood infection and occasionally kidney failure and coma. Even of those who have made it to hospital, around one fifth of patients die of severe malaria.

A man and young boy transport LLINs through fields in northern Nigeria to a remote community. People from remote and rural communities are often able to purchase LLINs easily. Mass distributions of either free or subsidised nets are therefore extremely important to ensure that cost is not a barrier for those most at risk. By preventing malaria, LLINs help reduce the demand for treatment, which in turn lifts the pressure on health services and cuts down health-related spending for low-income families.

Back at home, a group of boys gather next to their new net. SuNMaP and other international partners have reached many at-risk communities in Nigeria through mass net distributions but it is imperative that the international community continues to support Nigeria in its efforts to prevent malaria deaths. Mass net distributions are excellent for bringing protection from malaria to a rapid high across the country, but it is what happens after the distribution has ended that will show whether or not there will be a long term positive impact.