Quality concerns plague Sh2b mosquito nets

Kenya bought more than eight million mosquito nets worth Sh2 billion that were not treated with the correct amount of insecticide thus putting users at risk of contracting malaria.

The long-lasting insecticidal nets (LLINs) are treated with deltamethrin, a pyrethroid insecticide, to repel or kill mosquitoes. The nets are crucial in the country’s fight against malaria, which is life-threatening to pregnant women and children aged below one year.

Properly treated nets have a three to five-year life cycle, which explains why the Government replaces them after every three years.

If the nets do not have the required amount of insecticide, they are only effective for about 18 months after which they can only provide a physical barrier.

The Global Fund to Fight Aids, Tuberculosis and Malaria issued a public notice in March this year on the quality of LLINs supplied to several countries, including Kenya, and warned they had not met the required standards.

“The manufacturer concluded that majority of nets manufactured between January 2017 and April 2018 were not manufactured according to formulation. The products were therefore not fully in conformity with approved specifications,” reads the notice in part.

DawaPlus 2.0

A Pakistan company first informed the Global Fund’s Sourcing and Supply Chain Department of the quality issues concerning the DawaPlus 2.0 nets, which were manufactured by Tana Netting Company Limited.

But by then, Kenya had already received and distributed the nets.

The Kenya Medical Supplies Authority (Kemsa) procures LLINs directly from World Heath Organisation pre-qualified suppliers by issuing an international tender.

According to Kemsa, Tana Netting supplied 8,278,203 nets at the end of 2017 for mass distribution to malaria-prone regions at a cost Sh2 billion.

“It was a direct delivery, not quarantined. The pre-delivery sample was subjected to inspection before delivery to various posts,” said Kemsa chief executive officer Jonah Manjari.

The pre-delivery inspection by Kemsa and the National Malaria Control Unit’s quality assurance team gave the nets a clean bill of health and they were issued with a certificate of conformity.

The inspection involved checking for physical parameters like colour, type, shape and size of the nets as per the order.

But at the division of National Malaria Control Programme (NMCP), the information given is that only 1.6 million nets were procured (and not 8.2 million) through the President’s Malaria Initiative (PMI).

According to the NMCP, the nets were to be distributed to 36 counties.

A chemical analysis done on selected LLINs found they had less than 1.5g/kg of deltamethrin, which is the minimum threshold of insecticide required.

This finding confirmed what The Global Fund notice had warned about the nets failing to meet the required standards.

There were more conflicting figures given by Kemsa and the division of malaria control, with the drugs distributor saying only 100,549 nets were left in its warehouse while the NMCP division said 300,000 nets are yet to be distributed.

An official aware of the matter said the nets that have been distributed will not be recalled because it will be impossible to trace any quality issues back to the manufacturing process.

“Upon realisation of this problem, there was an extensive discussion between the Ministry of Health’s division of malaria control, WHO, The Global Fund and PMI. It was agreed that in order to protect the vulnerable population, the nets should still be distributed since they also act as a mechanical barrier against mosquitoes. They will be replaced during mass distribution campaigns in 2020.”

Malaria coordinators

The county directors of health and county malaria coordinators in the 36 counties were informed of the quality concerns.

Health Cabinet Secretary Sicily Kariuki was not available to comment on this issue.

The Standard could not immediately establish whether LLINs distributed by Kemsa were part of the batch that had failed the quality test. It was also not clear whether the quality assurance team okayed their distribution despite knowing that their insecticide levels were below the recommended figure.

Further, there was no word whether the chemical analysis on the batch of 1.6 million nets was done before or after The Global Fund notice.

“Despite this, the nets will still work as a barrier and people should continue using them,” said Amref programme director HIV/TB, Malaria and NCDs Bernard Lang’at when asked about the quality issue.

According to Kemsa, no nets manufactured by Tana Netting are expected this year for the next cycle of mass distribution campaigns.

The quality concerns come when Kenya recently rolled out a malaria vaccine - RTS,S - as part of a pilot introduction programme in selected regions, as well as in Ghana and Malawi.

The vaccine is meant as a complementary malaria control tool to be added to the core package of WHO-recommended preventive, diagnostic and treatment measures. LLINs form a key part of the preventive measures.

The Global Fund allocated the Kenya malaria programme $63 million (Sh6.3 billion) for the period between January last year and December next year.

In line with the requirement for counterpart funding, Kenya contributes 20 per cent of the total amount (Sh1.2 billion) to the programme.