When it comes to controlling malaria transmission, insecticide-treated nets (ITNs) are perhaps the most often used tool in sub-Saharan Africa. ITNs are distributed by health agencies during campaigns to control the disease in endemic regions and countries. They do this by blocking mosquitoes biting humans, and they have proven to be effective. But what happens to ITNs at the end of their mosquito-controlling life?

 It is estimated that about 2.9 billion ITNs were distributed in malaria endemic countries between 2004 and 2022 – 2.5 billion of them in sub-Saharan Africa. That is a lot of netting to dispose of at the end of their usable life, and could  potentially have significant environmental and public health consequences.

Aristide Hien and colleagues looked specifically at the fate of bednets in Burkino Faso by conducting a quantitative survey of 3780 households across three climatic areas in the country: Sahelian, Sudan-Sahelian and Sudan. 

67% of the households were in rural areas, and the average age of participants was 32.5 years.  The head of households were predominantly male (between 73 and 85% depending on the climate area they were from), and just over half of the participants had no formal education. For the purposes of their study, Aristide Hien and team defined old ITNs as “a net that has been used for a considerable period and may no longer be effective in providing protection against mosquitoes.”

Of all the surveyed households, 87.4% disposed of their ITNs once they were no longer effective in providing protection against mosquitoes, but worryingly 12.6% of households still used old ITNs as mosquito nets. The study  team defined disposal as: “the methods and practices used to manage insecticide-treated nets that are no longer useful for their intended purpose, such as preventing mosquito bites.” So they do not necessarily mean ‘thrown away’. In fact, of  those that ‘disposed’ of their ITNs, the vast majority of the ITNs were either thrown in the garbage OR an alternative use was found for them. A very small proportion of nets were buried in the ground or burned, and there was a small proportion whose disposal method did not fit one of the defined modes of disposal listed by the study team and were termed ‘other uses’.

 The Alternative uses of nets showed the ingenuity of people surveyed, and they clearly see the value of nets beyond their intended ‘usability’ (to stop mosquitoes biting). The graph below, taken from Aristide Hien and colleagues’  paper, shows the many uses that fall under the term ‘Alternative uses’ . For example nets were used in fencing for crops and seedlings; ropes for tying items such as pots and pans together; animal protection fencing; house fencing; bed covers; fishing and dry fishing; covering pots and pans; and curtains for doors or windows.

Across the three climatic areas covered in the household surveys, there were variations in the disposal methods, for example in the Sudan climatic zone, the vast majority of respondents would bury or burn their nets as opposed to throwing them in the garbage. There were also variations in the alternative uses of nets. For instance those households in the Sahelian climate zone were more likely to use the old nets for fishing, whilst in the Sudan-Sahelian zone would mainly use them as bed covers and those in the Sudan zone would use the nets as ropes for tying or as house fencing.

Reading the paper, I found the direct quoted statements from the participants much more insightful in understanding why and how the nets are used in different ways than just solely looking at the numbers:

“Most people sell their old ITNs to wood sellers, gardeners, or livestock farmers”  

“Women repurpose old mosquito nets to tidy up their homes by using them to tie up their own items such as crockery and clothes”

Here, people tie them up to keep hay for the animals”

“Old ITNs are used by motorbike taxis to cover cabbages during transport”

“They also use the nets to cover food and vegetables when transporting them to sell at the market”

“People in our community use these old ITNs to cover their granaries”

“We use these old nets to wash our dishes and ourselves. Sometimes, during the rainy season, the children use them to catch small fish and bring them back for us to cook”

And one of the ‘other'  uses for nets was rather macabre, but shows really the extent to how useful nets can be ( beyond their intended purpose of reducing malaria transmission, of course):

“We use these old mosquito nets to cover corpses”.

Aristide Hien and colleagues conclude that there are diverse uses of old nets. The study highlights the need for strategies and guidelines to manage the safe disposal or repurposing of ITNs. This could help improve the environmental and public impact of old nets.

(Poster image credit:Image by RobertoVi from Pixabay)