A massive campaign is underway to distribute at least 8.8 million nets to 16 million residents of Kano State in Nigeria to prevent malaria

Morning sunlight, bright as a dazzling diamond, sets Mazangudu village in Kano, northern Nigeria, awake. Motorcycle rumbles mix with the boom of microphones calling Muslims to salat prayer. A gentle breeze tickles the green leaves of nearby neem trees, easing the rising warmth with its chill.

Behind the curtain of a one-room bungalow, a whisper, a cup of tea, and a smile pass between Yau Mustapha and his wife. Fourty-five-year-old Mustapha gulps the dregs of the tea in his ceramic cup before heading out with his motorcycle. As he rides through Mazangudu, a small farm settlement, mud huts and fumes unfurl behind his stretched shadows.

Thousands of volunteers

The settlement is a blend of mud huts and cement-walled houses. The mud huts are roundly shaped and made of colored clay. Its thatched roof, spread out like a beach hat, is made of dried millet stalks, stringed into a firm shape. 

Once settled, Mustapha consults with the rickshaw puller, the educator, and security, all members of his team. Now, they move from house to house, waking residents with an echo of their greetings and a hard tap at the door. “Peace be unto you,” he shouts routinely. “We are to deliver nets to you and your family, so you are fully protected from malaria.”

Mustapha is not alone. Across Kano, for a period of two weeks, thousands of trained volunteers would distribute insecticide-treated mosquito nets to millions of Kano residents. 

“These nets will help my people; they will protect them,” says Mustapha. Residents in Mazangudu believe the chances of a pregnant woman and her children surviving sudden malaria fever attack at midnight are slim. “Many have died as a result of malaria situations,” says Ibrahim Salie, an herbalist in nearby Gwaza.

Salie says the community sometimes relies on herbs to manage malaria infections, but the outcome is always a gamble. Unfortunately, the nemeses of Gwaza and Mazangudu are not one-offs. Nigeria, with over 200,000 malaria deaths annually, accounts for more than a quarter of all cases in Africa. The highest burden occurs in northern states like Kano, where poverty, combined with widespread apathy and poor sanitation, increases the risk of infection.

Problematic pregnant women?

One sunset in late September, Mustapha’s wife, a health worker in a nearby village, narrated her experiences with malaria infecting pregnant mothers. 

“My wife told me that malaria in pregnant women can be more violent and problematic,” says Mustapha. Many nights later, the burden of that single story remained with Mustapha. After a radio jingle announced the upcoming net campaign a few weeks ago, his wife pursued him to enrol as a volunteer.

This morning, as he sets out to distribute the nets from house to house, a warm goodbye and smile pass between him and his wife, who wore a long yellow veil. Mustapha is expected to distribute at least 2,800 insecticide-treated mosquito nets to hundreds of households within a period of two weeks. In all, more than 8 million nets will be distributed in Kano to at least 16 million residents.

Only two days of the two weeks have passed. However, Mustapha can attest to the dramatic shift in his fame as well as the immediate use of the nets after only two days on duty. “My wife is very happy. She is happy to see her husband greatly involved in an important campaign.”

Better than traditional remedies

Mazangudu’s residents say the nets are twice as helpful to them as they might have been to any other community because there is no single health facility to cater to the many malaria cases. And when these malaria attacks come by midnight, the only option is to offer traditional remedies and pray. In some cases, the infected person dies before dawn.

With financial backing from The Global Fund, this year’s campaign, arguably the largest in Africa, aims to distribute at least 8.8 million nets to 16 million residents of Kano, one of the largest cities in Africa. 

“Kano is crucial because of the size. Kano, because of its population, looks like a country. If you are fighting malaria and Kano is not in the plan, it is a waste of time,” says Ernest Nwaokolo, the project director for the Global Fund Malaria Project of the Society for Family Health (SFH). 

SFH’s John Ocholi, who is the manager of the 2022 nets campaign in Kano, says that the state has 44 local governments and 484 wards. 

“We are working with over 20,000 personnel, which is the most for any Nigerian campaign. It is a large team, drawn from various partners and parts of the country. It takes a lot of experience to pull together to achieve this. We had advocacy visits to the government of Kano State, traditional rulers, and religious bodies in an effort to pull them into the campaign.”

Delivery: from camels to canoes

Educators trained in behavioral change communication work closely with the house-to-house distributor team. Before the nets are distributed to the households, each family has a brief discussion about net apathy, proper use, trading, and maintenance. More so, community and religious leaders, often revered and obeyed, have been engaged as partners in spreading and reinforcing the net-use messages.

Kano has proven to be a bigger puzzle from a logistics point of view. In the absence of precise figures, Chemonics, a global consulting firm that manages logistics for the campaign, says thousands of vehicles and personnel were involved. It is like a pyramid. Nets are moved to local government areas on larger trucks and trailers. Next, the nets are then transported from local government areas in smaller vans and mini trucks. Roads to communities are often narrower and, in some cases, untarred, making smaller vans more suited for moving nets.

As the nets move from house to house, the options for transporting them become more diverse and adaptable. In some desert communities, where the risk of sandstorms is higher, and cars sink in sand, camels, donkeys, and cow-carts have been deployed to move the nets to households and between settlements and communities. In a few riverine areas, canoes and paddlers are used. In areas pockmarked by mountains and hills, engage porters. 

Each distributor is trained and handed a mobile device with an app that allows them to enter records of the number of nets issued per household, the coordinates of the area, and the names of the recipients, often the household head.

Digital tracking

The data is then uploaded to a central database, which is monitored and analyzed every evening to ascertain the number of nets distributed for the day, absentees, and locations covered. Organizers receive real-time updates from all over Kano. 

“There is real-time tracking and monitoring of all data in the field.” It is easier to dictate areas where there are issues that deserve urgent attention. It is also faster than using papers and tally sheets. “It makes it easier to provide evidence and verify the work done,” says Asuni.

The technology is also designed to flag areas where there is unusually dense or sparse net distribution. When such issues are flagged, monitors are sent to the flagged locations to verify the situation on the ground.

On paper, the process sounds smooth, but Asuni says that the Kano campaign presented a couple of familiar issues. Many volunteers are not computer literate and frequently struggle with basic device setup. Secondly, limited network coverage, especially in rural communities, means that data uploads to the central server are delayed and backlogged. Volunteers undergo intense training on device use.

However, not every ambition can be squeezed into the short timeframe of the net campaign. There are still minimal concerns that net collection is rarely equivalent to use. Some residents say the nets restrict their breathing and have limited ventilation. Myths that link white nets to corpses also build stereotypes that hinder net use.

“Fixing these issues can be gradual and long,” says Nwaokolo.

Back in Mazangudu, the fruits of Mustapha’s work are instant. Families, who received the nets a few days ago are already putting them to use. They say these nets, more than ever, will ease their burden. The fame of Mustapha grows with every new inch he covers. “My people see me as a hero,” he says. But it’s not the heroism that makes him happy; it’s the lives that will be saved and the medical bills that will be avoided. “This net distribution has brought excitement. “The people are grateful,” says Mustapha. “And no amount invested in mosquito nets is too big. To save a single life is worth more than millions, for we really do not know what the children we are saving today might turn out to be in the future.”

Better than a wedding

When Aisha Lawal, 35, had to choose between attending a friend’s wedding and staying behind to pick her nets, it was an easy choice. “I didn’t want to miss [the nets],” she says. “If I choose weddings over nets, how would my household sleep peacefully? I have been expecting the new net since two days ago.”

Aisha and her family of eight live at Sabon-Gari, Gabasawa, on the outskirts of Kano metropolis, where malaria is rampant. Long lines form at health centers from time to time, she claims. Her own family is also exposed. The last set of nets that came to them three years ago are discolored, torn, and pockmarked. 

“Receiving these nets feels like I have been given at least 1 million naira (local currency). Everyone craves rest after toiling all day. Without the net here, one can rarely get that desired rest. Mosquitoes are an enemy of good sleep. And without a good sleep, I wake up feeling sick.”

As the interview unwinds, Aisha cuddles her baby, Nasiru Yusuf, closer to her ribs, allowing him to wriggle his feet around her waist. He thumped her blouse, trying to get into her nipple. Seeing his attempts ignored, Nasiru Yusuf, began to sniffle and kick. He is prone to malaria, as are the rest of the kids. She hopes that the new nets will reverse the trend and save on medical bills.

Aisha is impressed by the format adopted in this campaign. She thinks the house-to-house approach is more efficient than the past model of depositing the nets in a pickup center. More than eight million nets are expected to reach at least 16 million residents in this year’s campaign, making it arguably the largest ever in the world.

But she has one bright idea, which might create a bigger impact. Women, she says, are the health managers of their families. In northern Nigeria, where most rural women are uneducated, Aisha says households’ handling of malaria, despite the nets, can be compromised. 

“More mothers need to be educated. The more education mothers have, the more they can play a role in their family’s health. Mothers are the protectors of the family. Once women are empowered, the communities will remain healthy,” she says.

Deadly malaria

Each night, as Yusuf Basira closes her eyes to sleep, she dreams of Maila Baila, her two-year-old child laid to rest a few weeks ago.

“I always remember him,” says Basira, her face lowered to conceal her dark eyeballs, which have grown red and teary. 

In the morning of 25 October, Maila Baila experienced a severe malaria fever, which marked the beginning of his death. Basira took her child to Khalifa Sheikh Isyaku Rabiu Paediatric Hospital after two failed attempts at nearby primary health centers to stabilize him. The pediatrician diagnosed severe malaria, which resulted in multiple convulsions. A few hours after their arrival at the hospital, Maila’s body grew cold, and his eyes lost light. The doctors confirmed his death.

Basira is among the 16 million residents of Kano who will benefit from the 2022 net campaign, which aims to provide more than eight million nets for households in the state. As she receives the nets, nostalgia returns, bringing with it regrets but also lessons.

Prior to Biala’s death, she believed that malaria, though common and costly, was not deadly. Her attitude towards net use was carefree.  She now has a new perspective, both from her past mistakes and the brief pep talk that is offered by the net distribution team.

“I didn’t have much knowledge about malaria prior to the death of my baby. I never expected it to cause the death of a child. I now know that malaria can cause severe fever, even to the extent of killing a child. I take each sleeping child to the net once it’s past 6 pm.

Reporting for this story was supported by the Global Fund.

Image Credits: Global Fund.