FAQ: Refugees, Bed Nets and Malaria

Nothing But Nets™ supporters submitted their questions about refugees, malaria and nets and our experts answered them. Check out the questions and answers below. This list will be periodically updated, so come back now and again to see what's new!

1.   I would like to donate nets. I want to know where these nets were produced and what type of material is used in these nets?
2.   How long will a net last before it is no longer effective or needs to be replaced?
3.   How do the nets protect the families? What helps protect them during the day when they are outside of their homes? 
4.   Are the nets flame retardant?
5.   What is the useful life of a net?
6.   Is there a way for the people to notify someone when they need another net to replace a damage one?
7.   Does the mosquito repellent have to be re-applied and is it safe for the children?
8.   How is the development of a vaccine to prevent malaria coming along? I have heard it said that it will take much more than bed nets to really take care of this problem.  
9.   How was malaria eradicated from the United States?
10. What happens with the refugees after they return to their country/home but find everything burned down?
11. Who systematically coordinates malaria control for refugee/complex emergency situations?
12. Are nets standard items to deliver to refugee/complex emergency situations? Studies, such as Dr. Porter's dissertation, he's with CIDA, show serious impact of malaria in complex emergency situations. If not, how to add nets? 
13. How do you do follow-ups? Do you ever go back to same areas after a certain time? How do people get a replacement net?
14. This campaign is great in two ways: a very reasonable donation does measurable good and a catchy phrase to help keep it in mind. Is there another basic need that could be as economically viable to donors in these times that could do such obvious good?
15. How do you ensure that the nets sent to refugee settlements are used by the refugees themselves and not sold on the black market?         
16. Our church is participating in the Nothing But Nets™ Campaign and we would like to buy two nets for display purposes at our church or where ever we do fundraising activities. Please let me know how I might do this.
17. What else can we do to help our friends? How do I get involved and help not just by sending money?
18. What is a usual response to receiving a net? How do you decide which persons receive the nets? 
19. Where is your work focused? What is the most effective tool you use to educate people you help? Do the people you are helping have access to specific books they want and can read? Can you develop a "wish list" of the books people may want and in what languages?
20. How do you ensure that these nets do not end up in the hands of corrupt government officials?
21. Do people have to ask for the nets? What populations are served? Can they be from any country and/or ethnicity? Are they given any other preventative measures besides the nets?
22. There has been discussion that our efforts are destroying the business of local net makers. Are we using as many local resources as possible?
23. How often are nets distributed in country?
24. Do net recipients use the nets more if they receive them for free or at cost (no profit)? Also, are nets more effective in urban or rural areas depending on population pattern?
25. What countries are these nets sent to?
26. Is billion dollar anti-malaria effort still "flying blind" without required $10 million/yr for surveillance efforts or has someone come up with this $ described as crucial by the Global Fund's Malaria manager in a 2/08 Nature article?
27. How many nets will you have to buy to put yourselves out of 'business'?

1.   I would like to donate nets. I want to know where these nets were produced and what type of material is used in these nets?
The nets purchased and distributed by Nothing But Nets™ are long-lasting insecticide-treated bed nets that have been approved by the UN World Health Organization (WHO) for safety, quality, and efficacy. The five companies that are currently producing these WHO-approved nets include: Vestergaard-Frandsen, Sumitomo Chemical, A to Z Textiles, Woinu Curtain Trade and BASF.  Vestergaard-Frandsen, a Dutch company, produces a LLIN called “Permanet.” Sumitomo Chemical, a company based in Japan, produces a LLIN called “Olyset Net.”And BASF, a German company, produces a LLIN called “Interceptor.”

While the major net development and production companies are internationally based, many are moving towards partnering with in-country manufacturing companies in order to stimulate employment and local economies.  In 2003, Sumitomo granted a Tanzanian-based manufacturing company, A to Z Textiles, the right to manufacture Olyset Net in their country. The 50/50 venture created more than 4,000 jobs and is now producing 20 million Olyset Nets per annum – approximately 50% of global Olyset Net production. As part of its commitment to ensuring that Olyset is “made in Africa, by Africans, for Africans,” Sumitomo Chemical has also established a net sewing operation in Ethiopia. Operated by the Ethiopian textiles business Woinu Curtain Trade, the facility produces nearly three million nets per year and employs more than 300 people.  Sumitomo Chemical has also recently committed to establishing a Nigeria-based factory.

The material used in the long-lasting nets differs depending on the manufacturer. For instance, The Permanet is made of Polyethylene and Polyester.
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2.   How long will a net last before it is no longer effective or needs to be replaced? 
The long-lasting insecticide-treated bed nets distributed by the Nothing But Nets™ campaign are impregnated with insecticide and are made with durable materials.  They remain effective for 4 to 5 years (and up to 20 washes).
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3.   How do the nets protect the families? What helps protect them during the day when they are outside of their homes? 
There are many different ways to prevent malaria. Bed nets, indoor residual spraying, and water treatment are all important tools. A long-lasting insecticide-treated net is one of the most effective tools to prevent malaria. Studies show that the use of insecticide-treated bed nets can reduce transmission as much as 90% in areas with high coverage rates. Bed nets prevent malaria transmission by creating a protective barrier against mosquitoes at night, when the vast majority of transmissions occur.

The malaria causing parasite – Plasmodium – is transmitted by the female Anopheles mosquito, which is nocturnal. That is, she only bites at night, generally between 10:00 p.m. and 4:00 a.m. As such, bed nets are an extremely effective prevention tool. 

A bed net is usually hung above the center of a bed or sleeping space so that it completely covers the sleeping person, or family. A net treated with insecticide offers about twice the protection of an untreated net and can reduce the number of mosquitoes that enter the house and the overall number of mosquitoes in the area.
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4.   Are the nets flame retardant?
According to the net manufacturers, there is an additive in the nets that decreases any fire hazard. 
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5.   What is the useful life of a net?
The long-lasting insecticide-treated bed nets distributed by the Nothing But Nets™ campaign come already impregnated with insecticide and are made with durable materials.  They remain effective for 4 to 5 years (and up to 20 washes).
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6.   Is there a way for the people to notify someone when they need another net to replace a damage one?
The continued distribution of bed nets depends on the country. Some countries will have bed nets stocked on health clinics and hospitals, where individuals can request replacements.
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7.   Does the mosquito repellent have to be re-applied and is it safe for the children? 
The long-lasting insecticide-treated bed nets distributed by the Nothing But Nets™ campaign come already impregnated with insecticide and are made with durable materials. The insecticide is woven into the fabric of the net, making them long-lasting and effective for 4 to 5 years (and up to 20 washes). Thus, they do not need to be re-treated.

The nets purchased and distributed by Nothing But Nets™ are long-lasting insecticide-treated bed nets (LLINs) that have been approved by the UN World Health Organization (WHO) for safety, quality, and efficacy.

The materials used and the type of long-lasting insecticide woven into Permanets, Olyset Nets and Interceptor nets, the nets approved by the WHO, have been rigorously tested for safety and efficacy and approved under strict standards. These standards ensure that the children and families sleeping under these bed nets won’t get sick from the insecticide woven into the fabric of the net.
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8.   How is the development of a vaccine to prevent malaria coming along? I have heard it said that it will take much more than bed nets to really take care of this problem. 
A malaria vaccine that has been shown to be partially effective is in late stage (Phase 3) clinical trials in Africa at this moment. If these are successful, the vaccine will likely be licensed by the FDA within several years. Many feel that although there is great hope for this vaccine, it may prove to be only partially effective and so we will have to continue to rely on other preventive measures such as insecticide-treated nets, household spraying for mosquitoes, and anti-malarial drug treatment. One of the reasons that it has taken so long to develop a highly effective malaria vaccine (unlike effective vaccines that are in routine use today, such as a measles vaccine), is that natural infection by malaria does not generate substantial protective immunity in those who survive. This is unlike the case with measles where natural infection results in lifelong immunity. Thus, while it was relatively “easy” to mimic protective immunity with a measles vaccine, it is very difficult to generate immunity to the malaria parasite. 
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9.   How was malaria eradicated from the United States?
Malaria was eradicated in the United States between 1947 and 1951 through the National Malaria Eradication Program; a cooperative undertaking initiated by the state and local health agencies of 13 Southeastern states and the Center for Disease Control and Prevention (CDC). On July 1, 1947, the program began to systematically apply DDT to the interior surfaces of rural homes or entire premises in counties where malaria was reported to have been in recent years. This initiative proved successful, by the end of 1949, more than 4,600,000 DDT house spray applications had been made. However, total elimination of transmission of malaria in the US took longer to achieve. In the year 1951, malaria was considered eradicated from the United States. 
  * CDC website (www.CDC.gov)
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10. What happens with the refugees after they return to their country/home but find everything burned down?
Refugees are being assisted by the UN Refugee Agency (UNHCR) and partner organizations to rebuild their livelihoods when returning to their home country. UNHCR assists returning (repatriated) refugees with transportation and delivers assistance for a minimum of two years in their place of origin/return. Refugees are only repatriated when it is safe for them to return home.
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11. Who systematically coordinates malaria control for refugee/complex emergency situations?
UNHCR coordinates malaria control for refugee and complex emergency situations with support from the “malaria in complex emergencies network” and other technical partners and donors such as the UN Foundation. In emergencies with internal displacement, UNHCR supports the humanitarian community through the cluster mechanisms, namely the health cluster response, in most cases led by the World Health Organization.
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12. Are nets standard items to deliver to refugee/complex emergency situations? Studies, such as Dr. Porter's dissertation, he's with CIDA, show serious impact of malaria in complex emergency situations. If not, how to add nets? 
Nets have become a standard item in malaria endemic settings. However, until 2005-2006 the nets that were provided to refugees used to be conventional mosquito nets without insecticide protection, or were treated with insecticide repeatedly. Since then, UNHCR has changed its policy to provide only long-lasting insecticide-treated nets. In addition, with the support of the UN Foundation, UNHCR was able to ramp up its target coverage from providing two nets per family (approximately one net for 3-4 people) to providing one net for every two people. This is important in terms of community-level coverage. If only 60% of the refugee community sleeps under a net, mosquitoes can still bite many people and continue to transmit malaria. But, if that coverage is increased to above 80%, the individual protective effect (for the person(s) sleeping under the net) extends to a community-level effect, because the mosquitoes cannot find enough biting sites.
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13. How do you do follow-ups? Do you ever go back to same areas after a certain time? How do people get a replacement net?
UNHCR projects contain a monitoring and evaluation component that is in fact very important. Mosquito nets are being distributed with an accompanying sensitization campaign to make sure people understand the benefit of sleeping under a net. To ensure the message is delivered, UNHCR does retention surveys. These are usually done from 6 to 12 months after a distribution of nets. We then select random households and check the homes to see if people still have the nets, learn how the nets are being used, and determine condition of the nets.
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It is important to organize ways to replace the nets as they tend to wear out more rapidly, given refugee living conditions. For the most vulnerable people, UNHCR usually replaces the nets when people come to them. For instance, when pregnant women come for antenatal clinics or mothers and children for immunization, UNHCR gives them nets. Two tothree years after a general distribution as UNHCR is doing now with Nothing But Nets™ support, the agency distributes replacement nets. This could be organized such that people bring in their worn-out nets to get a new one.
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14. This campaign is great in two ways: a very reasonable donation does measurable good, and a catchy phrase to help keep it in mind. Is there another basic need that could be as economically viable to donors in these times that could do such obvious good?
There are many needs that require the support of donors. With small donations, many things can be achieved. UNHCR is trying to address many problems they see in the refugee communities. Many children and women suffer from anemia and other deficiencies that are caused by a lack of micronutrients or diseases that can be avoided, for instance, by improving the water quality. One phrase that UNHCR used for this year's World Water Day was: Walk for Water, Walk for Life. This phrase was particularly aimed at refugee children, as it is often the children that are walking long distances to fetch water, and by doing so, not attending school.

Immunizations are critical to reaching our global health goals and to significantly reducing child mortality as stated in Millennium Development Goal 4. Though not all diseases are vaccine-preventable, some of the top killers of children under five – pneumonia, diarrhea, and measles – can be averted with an immunization. Vaccines have consistently proven to be the most cost-effective method for preventing diseases worldwide. To date, vaccines are responsible for eradicating smallpox, are bringing us to the brink of polio eradication and have reduced global measles deaths by 74% between 2000 and 2007.

  • It costs just $1 to vaccinate a child against measles
  • Polio, which can cause lifelong paralysis, can be prevented with a vaccine that costs only $.60

To learn how to help, visit http://www.unfoundation.org/global-issues/childrens-health/
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15. How do you ensure that the nets sent to refugee settlements are used by the refugees themselves and not sold on the black market?  
To minimize misuse and selling of nets and to ensure continuous usage, UNHCR organizes IEC (information, education and communication) activities in which they ask the refugee community to actively take part. In these campaigns UNHCR creates the awareness that a net can save a life, but only when properly used.

In addition, when refugees live among or close to their host communities, UNHCR provides nets to the host communities. That ensures that the need for nets among the hosting communities is less of an incentive for refugees to sell their nets. In many countries we are now also advocating for the governments to include refugees and internally displaced persons in the general distribution of mosquito nets. Such general distributions are taking place more often and are organized at the national level by national malaria control programmes and funded by the Global Fund to Fight Aids, Tuberculosis and Malaria (GFATM), among others.         
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16. Our church is participating in the Nothing But Nets™ Campaign and we would like to buy two nets for display purposes at our church or where ever we do fundraising activities. Please let me know how I might do this.
Unfortunately, Nothing But Nets™ does not store bed nets, either to use for personal distribution or for display purposes, in the campaign office. If you are looking for a bed net for display, we recommend purchasing them at a general camping goods store, such as The Great Outdoors Depot or The Outdoor World. Although these nets are not what Nothing But Nets™ sends to Africa and they are not insecticide- treated, they can be similar in size and shape and work well for display purposes.
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17. What else can we do to help our friends? How do I get involved and help not just by sending money?
We need your help to spread the word that malaria is preventable and $10 can save a life. Even if you are not interested in just sending a contribution, or you want to go above and beyond, we welcome your support. Raising awareness is crucial to our ability to help end malaria deaths. There are many ways you can raise awareness and fundraise among family, friends, and in your community. Here are some of our suggestions on how to spread the word:

Take the Initiative

Recruit Team Members

  • Use your networks: send messages and announcements about Nothing But Nets™ to your friends and family through NET-Raiser.
  • Link to us on your Facebook and MySpace pages.
  • Go to meetings of any groups that may support Nothing But Nets™ and educate them about the effort. Local religious institutions, clubs, and community service groups are great options.
  • Create fliers and distribute them at events, meetings, classes, etc.
  • Display a poster at a local café, community center, student center, YMCA, etc.

Hold Regular Meetings

  • Once you've gotten a team together, start a series of regular meetings.
  • Use these opportunities to educate your team, inspire and renew enthusiasm in the effort, check in on progress and share successes!

Start Fundraising
There are many innovative ways that you can drum up support for Nothing But Nets™:

  • Add links to your blog and MySpace or Facebook pages
  • Put together a yard sale
  • Create an online email campaign
  • Organize a concert with local musicians
  • Hold an auction with items donated by a local business
  • Hold a sporting event/competition
  • Organize a 5K race
  • Put together a charity formal or theme party
  • Hold a movie night
  • Get your school involved
  • Have a dance-a-thon
  • Come up with your own great idea!

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18. What is a usual response to receiving a net? How do you decide which persons receive the nets? 
Upon receiving the nets, people are generally quite grateful. As community health workers provide important information about the importance of the nets, mothers, fathers, sisters and brothers understand that this simple tool can help protect their family from dying from malaria.

Nets are distributed to the most vulnerable populations first. Thus, children under the age of five and pregnant women are the first to receive the bed nets. In working with UNHCR, Nothing But Nets™ is able to provide one net per every two people.  Thus, every person in a household will be able to sleep under the net.
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19. Where is your work focused? What is the most effective tool you use to educate people you help? Do the people you are helping have access to specific books they want and can read? Can you develop a "wish list" of the books people may want and in what languages? 
Currently we are focused on protecting refugees living in malaria endemic areas. This has focused us on 15 countries across Africa, including: Sierra Leone, Liberia, Guinea, Côte d’Ivoire, Burundi, Democratic Republic of Congo (DRC), Central African Republic, Chad, Ethiopia, Rwanda, Djibouti, Uganda, Tanzania, Kenya and Sudan.

The most effective tool to educate the individuals receiving the nets is a community health worker – a trained health worker provides recipients with crucial information, including the symptoms of malaria, and the importance of using a bed net each night.
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20. How do you ensure that these nets do not end up in the hands of corrupt government officials?
Bed nets are delivered directly to the communities in need. Whether by truck, bike or boat, community health workers, international donors, observers and the UN agencies ensure that the nets are delivered to the populations in need.
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21. Do people have to ask for the nets? What populations are served? Can they be from any country and/or ethnicity? Are they given any other preventative measures besides the nets?
People do not need to ask for the bed nets. With our current focus on protecting refugees in Africa from malaria, we are focused on serving the refugee population in target countries. In some instances, individuals may need to bring their children to receive other immunizations, such as for measles, in order for the child to receive a net.
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22. There has been discussion that our efforts are destroying the business of local net makers. Are we using as many local resources as possible?
The nets purchased and distributed by Nothing But Nets™ are long-lasting insecticide-treated bed nets that have been approved by the UN World Health Organization (WHO) for safety, quality, and efficacy. There are only a handful of manufacturers that have been approved by WHO, two of which are based in Africa – A to Z Textiles and Woinu Curtain Trade. We do work closely with A to Z Textiles – in fact many of the Olyset nets purchased for distribution in refugee camps are being sourced by A to Z Textiles.
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While the major net development and production companies are internationally based, many are moving towards partnering with in-country manufacturing companies in order to stimulate employment and local economies. In 2003, Sumitomo granted a Tanzanian-based manufacturing company, A to Z Textiles, the right to manufacture Olyset Net in their country. The 50/50 venture created more than 4,000 jobs and is now producing 20 million Olyset Nets per annum – approximately 50% of global Olyset Net production. As part of its commitment to ensuring that Olyset is “made in Africa, by Africans, for Africans,” Sumitomo Chemical has also established a net sewing operation in Ethiopia. Operated by the Ethiopian textiles business Woinu Curtain Trade, the facility produces nearly three million nets per year and employs more than 300 people.  Sumitomo Chemical has also recently committed to establishing a Nigeria-based factory.
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23. How often are nets distributed in country?
Country-wide net distribution campaigns generally happen once every few years in a given country. With that, countries may also distribute nets in a phased approach – such that one part of the country receives bed nets once a year, and another part of the country the next year. This is often dependent on the level of funding available.
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24. Do net recipients use the nets more if they receive them for free or at cost (no profit)? Also, are nets more effective in urban or rural areas depending on population pattern?
In 2007 the World Health Organization put out a position statement on the use of insecticide-treated mosquito nets (http://apps.who.int/malaria/docs/itn/ITNspospaperfinal.pdf). In it, the WHO ascertains that in order to make strides in the control and, ultimately, elimination of malaria, rapid scale up is needed. This can be achieved most efficiently through the distribution of free bed nets. Specifically, “long-lasting insecticide-treated nets should be considered a public good for populations living in malaria-endemic areas.

Distribution of nets should be systematically accompanied by provision of information on how to hang, use and maintain them properly.” As such, the majority of nets being distributed are free in an effort to make big gains in the fight against malaria.

Nets are most effective in any community where they are used properly and at high rates.  Studies show that the use of insecticide-treated bed nets can reduce transmission as much as 90% in areas with high coverage rates, whether rural or urban.
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25. What countries are these nets sent to?
The Nothing But Nets™ campaign is currently sending nets to refugees living in 11 countries: Sierra Leone, Liberia, Guinea, Côte d’Ivoire, Burundi, Democratic Republic of Congo (DRC), Central African Republic, Chad, Ethiopia, Rwanda, Djibouti. 

We’ve already sent 275,100 nets to 27 camps in Uganda, Tanzania, Kenya and Sudan.  In past years, Nothing But Nets™ provided nets to Mali, Nigeria, Côte d’Ivoire, Zimbabwe, Gabon and Congo-Brazzaville.
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26. Is billion dollar anti-malaria effort still "flying blind" without required $10 million/yr for surveillance efforts or has someone come up with this $ described as crucial by the Global Fund's Malaria manager in a 2/08 Nature article?
Surveillance is a key piece of any large scale health effort. We are fortunate in places like the U.S, where we have sophisticated health surveillance systems that can monitor disease outbreaks, measure the effects of health interventions, and determine the health of populations. Unfortunately, in many places in the developing world where basic infrastructure such as roads and power are not robust, where many who suffer from malaria and other diseases often do not make it to health care facilities for diagnosis and treatment, and where country’s health budgets barely cover the costs of the vaccines and drugs, these surveillance systems are not well established. However, donor agencies recognize the importance of monitoring and evaluation of their programs with surveillance being key. Efforts are being made by funders such as The Global Fund, PEPFAR, the President’s Malaria Initiative, and others to strengthen these monitoring efforts.
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27. How many nets will you have to buy to put yourselves out of 'business'?
The United Nations and the global community has set a goal to reach universal bed net coverage by December 31, 2010. Despite funding pledges through 2010, there is an estimated gap of 150 million bed nets to reach universal coverage. The UN Foundation and its Nothing But Nets™ campaign are working with many partners to help achieve this goal, including the President’s Malaria Initiative, the Global Fund to Fight AIDS, TB and Malaria, etc. Every bed nets counts!  
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Buzzkill Facts

Each year, malaria afflicts approximately a half-billion people (roughly the population of the United States, Canada, and Mexico combined).

  • Malaria kills more than a million people per year; 90 percent of those who die are African children.
  • Every 30 seconds in Africa a child dies of malaria.
  • Malaria incapacitates people, keeping countries poor. In addition to the health burden, malaria illness and death cost Africa about $12 billion per year.

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