Covering Malaria: The Increasing Efforts to Prevent Malaria · Forty percent of the world is at risk for malaria ("Roll Back Malaria Partnership."). It occurs in 109 countries around

Covering Malaria: The Increasing Efforts to Prevent Malaria Globally and how the Textile Industry has Responded

Danielle Plante22 November 2011

COLLST-499: Contemporary PerspectivesPhilip J. Gibbon, Adjunct Professor of History

DEC/ Textile DesignCase Study Country: Tanzania

Section I: The Increasing Efforts to Prevent Malaria Globally

Have you ever been laying in bed on a summer’s night, but can not fall asleep because of

that pesky mosquito that hovers around you, waiting to bite? The obnoxious buzzing sound

forcing you to turn on the lights and search for it only to find that it inconveniently flew to the

ceiling making it impossible to kill? What if that mosquito waited until you were asleep and

vulnerable before biting you, infecting you with a parasite that upon waking up, resulted with a

disease that led to your death? This is malaria, 100 percent preventable, yet one of the worlds

deadliest diseases. Found primarily in developing countries, mainly affecting children and

women who are pregnant, both of whom have vulnerable immune systems. Not only does

malaria bring illness to individuals, but it contributes significantly to a vicious circle of poverty,

ultimately weakening a community, and potentially an entire country’s economy and

government. As awful as this sounds, there is a silver lining. The past decade has brought a

significant increase of efforts to prevent malaria. Preventative methods include insecticide

sprayed bednets, indoor residual spraying, intermittent preventive treatment for pregnant women,

and a vaccine given to children. These prevention methods do not come cheap, and global aid

and funding play a significant role in the fight against malaria. If malaria is to be eliminated by

2015, as Roll Back Malaria’s “The Global Malaria Action Plan” states, funding must increase

and the preventative methods must be utilized. If all goes according to plan, and malaria is

eradicated, that could bring countries set back by the disease on track to achieve stability,

increased health and well-being, and ultimately sustainable economic development.

Malaria is caused by a parasite passed by the bite of an infected Anopheles mosquito

("Malaria"). The parasite travels through the blood stream to the erythrocyte, the red blood cell

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that transports oxygen and carbon dioxide to and from the tissues. The parasite eventually infects

the red blood cells causing a flu-like sickness. high fever, vomiting, head and body aches,

shaking, and chills. Severe cases include cerebral malaria which leads to neurologic defects in

children, causing speech difficulties, deafness, blindness, and trouble with movements (“About

Malaria”).

Malaria has been around for about 4,000 years. It comes from the Italian word “mal” and

“aria” meaning “bad air” ("About Malaria") as it was thought to come from a marsh, but in 1880,

scientists discovered the cause of malaria (”Global Malaria Action Plan”) as a one-cell parasite

called plasmodium. Later, discovering it was transmitted through the mosquito ("About

Malaria"). By the mid-19th century, malaria was present in most countries of the world. It

affected around 90% of the world’s population, even reaching the Arctic Circle. (“Global Malaria

Action Plan”). The first serious efforts to diminish malaria began in 1945. Ten years later, the 8th

World Health Assembly launched the “Global Malaria Eradication campaign” which sprayed

pesticide in designated areas, and successfully eliminated malaria in developed countries, but the

plan was put on hold, and never ended up reaching many developing countries, mainly in Africa

(Global Malaria Action Plan). In the 1980s the death toll from malaria increased due to the

parasite’s resistance to medication and insecticides, and the decrease of malaria control programs

and deterioration of primary health services (Global Malaria Action Plan). This led to a rise in

awareness by the 1990s and programs such as Global Malaria Control Strategy, Roll Back

Malaria Partnership, and the Bill and Melinda Gates Foundation were launched (Global Malaria

Action Plan). In the last ten years, efforts to raise awareness, increase distribution of effective

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preventions, and ultimately eliminate malaria have greatly increased (Global Malaria Action

Plan).

Forty percent of the world is at risk for malaria ("Roll Back Malaria Partnership."). It

occurs in 109 countries around the world, mostly tropical and subtropic climates ("Roll Back

Malaria Partnership."). Of the 109 countries affected by malaria, they are broken up into to high

and low contributers of deaths. 35 countries are responsible for the majority of deaths due to

malaria, and 91 percent of deaths are in sub-Saharan Africa. Other regions include South East

Asia and parts of South America (Global Malaria Action Plan). While the other 74 countries have

malaria present, there is little contribution to the death toll. These countries are currently gaining

control over the problem, and are in various stages of eliminating malaria from their country

completely (Global Malaria Action Plan).

There is a direct correlation between the amount of deaths from Malaria and the economic

development of a country, which leads to the question whether malaria is a cause or consequence

of poverty. Malaria leads to sick people who are unable to work, and unable to contribute to

economic development which leads to a drag on the healthcare infrastructure, and therefore a

drag on the overall well being of the population, resulting in a vicious circle of poverty, putting a

heavy economic burden on people in the developing world. On the bright side, this shows the

possibility that there will be economic improvement in the countries if malaria is eradicated. The

only parts of Africa that are free of malaria are the most northern and southern parts, which

coincidentally are where the richest countries on the continent are located (Gallup and Sachs 85).

Malaria related-illnesses and mortality cost $12 billion per year on just the African continent

("Roll Back Malaria Partnership."). The cost to treat malaria impose costs to both the individual

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and the government. Individual costs include the money for medication, travel to clinics, absent

days from work or school, money toward prevention, and burial expenses if it leads to death

("About Malaria”). Government costs include the upkeep of health facilities, the purchasing of

medication, the distribution of bednets, loss of income from people missing work, decreased

agricultural production, and decreased opportunities for tourism and foreign investment ("About

Malaria”).

In Africa, malaria is the leading cause of death for children under five ("Roll Back Malaria

Partnership”). Infants and young children are a risk because of their vulnerable immune systems

(“Global Malaria Action Plan”). One in five childhood deaths in Africa is the result of malaria

(“Global Health Efforts.”). Pregnant women are also at high risk of malaria due to decreased

immunity from the pregnancy. Malaria is found primarily in developing countries, which

incidentally have the highest population growth. Each year approximately 50 million women

living in malaria endemic countries throughout the world become pregnant (“A Strategic”) The

risk of pregnant women developing severe diseases due to the malaria infection is two to three

times higher than that of women who are not pregnant but living in the same area (Luxemburger,

et al. 460). The parasite can also be found in the placenta which results in low birth weight

leading to infant and childhood mortality. (Luxemburger, et al. 460).

While malaria is one of the deadliest diseases in the world, it is entirely preventable. All

the tools and resources to prevent and treat malaria are in existence. The next step is to put these

tools and resources into effective, efficient practice. If used early enough, anti-malarial drugs like

artemisinin and other combination therapies can treat malaria once it is contracted (“Malaria

Kills”). The anti-malarial treatments are given only after there is a confirmed case of malaria.

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This ensures that the amount of treatments needed is reduced, lowering the cost (Global Malaria

Action Plan). Regardless of the existence of these available treatments, the goal should focus on

preventing malaria, then the middle step of providing treatment can be eliminated. The primary

preventative methods include insecticide sprayed bednets, indoor residual spraying, intermittent

preventive treatment for pregnant women, and, just recently, a vaccine given to children.

Between 2000 and 2006, there was a 50 percent decrease in malaria in several countries in Africa

such as Botwana, Cape Verde, Nambia, South Africa, and Swaziland ("World Malaria Report”

42) just by using these prevention methods.

The Anopheles mosquito has nocturnal feeding habits, so most malaria transmissions occur

between dusk and dawn. The insecticide-treated bednets form a protective barrier for people

while they are sleeping and most vulnerable. The insecticide sprayed on the nets not only repels,

but kills the mosquito. If there is a significant number of bednets within a community, almost all

members are protected regardless if they have a bednet or not (“About Malaria”). Bed nets are

simple to use, and an inexpensive form of protection. They are also easy to deliver, ensuring

wide distribution.

Indoor residual spraying is another type of prevention. A coating of insecticide is sprayed

on the walls inside the house. In order for this method to work, 80 percent of the house must be

sprayed. The insecticide does not directly repel the mosquitoes, but will kill them if they land on

the sprayed surface (“About Malaria”). Not until recently has malaria prevention and control

during pregnancy received support. Challenges occur by the small amount of antimalarial drugs

that are known to be safe and effective during a pregnancy (“A Strategic”) Intermittent

preventive treatment is a common treatment used, women receive at least 2 doses in the 2nd or

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3rd trimester. The cost for malaria prevention during pregnancy is anywhere between US $12-

$21, which is very cost effective (“A Strategic”).

Just recently The Centers for Disease Control and Prevention announced that a vaccine

was tested that cut back half the malaria outbreaks. In April 2011, children ages 5-17 months

were given the vaccine at 11 sites in 7 African countries (Center for Disease Control and

Prevention). There was a decrease in half the amount of malaria cases in that group of children in

comparison to a group that was not given the vaccine (Center for Disease Control and

Prevention). Dr. Christian Louqc, who is leading the final phase of the clinical trial states that

several thousand children received the “control” vaccine, a prevention against rabies or

meningitis, of those children, there were 1,500 cases of malaria (Knox). For every 1,000 children

who got the experimental malaria vaccine, only 750 cases of malaria were found (Knox).

Considering that malaria kills about 800,000 people a year, a reduction of 50% is extremely

significant (Center for Disease Control and Prevention). It is important to note that this vaccine is

given in a setting that uses other prevention methods such as the indoor residual spraying,

bednets, and anti-malaria drugs. But in a couple of years, scientist will be able to tell whether the

vaccine has lasting results. It has taken a decade and over half a billion dollars to develop this

vaccine. Certainly with all the money spent developing the vaccine, it will be costly, however

Andrew Witty, the chief executive of GlaxoSmithKline, the sponsor of the drug, says they have

no intention of making a profit, and are “committed to achieving the lowest price

possible” (Knox). The vaccine would eliminate many variables that occur with other form of

prevention, such as people not sleeping under bednets every night or getting their homes re-

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sprayed. The vaccine is an added protection and will certainly be a key component in eliminating

malaria.

Everything to prevent, diagnose, and treat malaria is available, however in order to fight

and eliminate malaria globally, it is estimated that 4.2 billion dollars a year is needed ("Roll Back

Malaria Partnership."). Awareness of malaria has grown significantly over the past decade. It is

now acknowledged as a contributer to global poverty, but how much money is actually available

during this global economic downturn to be put towards fighting malaria? Funding from

international donors has increased from $50 million (U.S.) in 1997, to $800 million (U.S.) in

2007 ("Progress against Malaria."). Organizations such as Roll Back Malaria, The Global Fund

to Fight AIDS, Tuberculosis, and Malaria, and the Bill and Melinda Gates Foundation are large

contributers to global funding toward malaria.

Roll Back Malaria, has come up with a plan entitled “The Global Malaria Action

Plan” (GMAP). Working with development partners, private sectors, non governmental

organizations, community- based organizations, foundations, and academic institutions, on a four

part plan to fight malaria. The goal by 2015, is that malaria is “no longer a major cause of

mortality and no longer a barrier to social and economic development and growth anywhere in

the world” (Global Malaria Action Plan). Long term goals state that malaria will never rise above

the 2015 level. Countries and partners will sustain political and financial commitments to keep

the conditions in control, and ultimately the eradication of Malaria in all countries (Global

Malaria Action Plan).

The Global Fund to fight AIDS, Tuberculosis, and Malaria was established in 2002. It is a

partnership of private and public stakeholders, and demand driven, where countries apply for

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grants in order to pay for their fight against malaria. The Global Fund provides two-thirds of all

malaria funding, currently supporting 78 countries, totaling about 6.6 billion dollars since 2002

("Progress against Malaria."). The United States Institute of Health and the Bill and Melinda

Gates foundation account for around 40 percent of research and development funding, 60 percent

of that going towards drugs and vaccines (Global Malaria Action Plan). Although it seems like a

lot of money already towards malaria, funding will need to increase four times what it is now, in

order to reach Roll Back Malaria’s final goal of eradication (Global Malaria Action Plan). A goal

seemingly overwhelming, but entirely possible. If accomplished the results will be remarkable.

Not only will the death toll in many developing countries drop significantly, the population will

be healthier, allowing for better education and job opportunities leading to a better life for the

individual and economic sustainability for the country.

Section II: How the Textile Industry has Responded to the Problem of Malaria in

Developing Countries

While there exists a number of preventions used to combat malaria, the simplest one may

just be the most effective. Insecticide-treated bednets can reduce malaria transmissions as much

as 90 percent in areas with high coverage rates (“About Bednets”). The nets are inexpensive; in

comparison to indoor residual spraying, long-lasting insecticide-treated bednets are 4-5 times

cheaper. The initial price is higher, however the useful life of a net last longer than the spray, so

the longer the net remains effective and in use, the cheaper it becomes (“Insecticide- Treated

Mosquito Nets” 4). One net can protect a family of four, generally last between 3-5 years, and

there are no harmful effects to humans or the environment. Textile designers are challenged with

designing insecticide treated bednets that have the durability to last, hold insecticide, provide no

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harm to the user or the environment, and be comfortable to sleep under, all while keeping it

cheap so people can afford to buy them.

Questions that need to be asked by textile designers are: what are the nets going to be

made of? How will this material hold up in climate conditions? How will the net hold up to

everyday activity? What is the hand of the fabric, will it be soft to sleep under, or rough and itchy

to the touch? How well will the insecticide bond to the fabric? Will the spray lead to any new

problems like health issues for humans or an increase in flamibility? These questions are all

addresses by the World Health Organization’s (WHO) Technical Consultation on Specifications

and Quality Control of Netting Materials and Mosquito Nets, which is a list of specifications to

be followed when designing the bednets. The bednets must not allow the insect to penetrate, they

must be strong and durable, keep their dimensions after washing, and be safe for the user

(“Technical Consultation” iv).

The netting construction is a warp knit in order to reduce the number of runs after minor

damage. The WHO specifies that there is a mesh count of 156, meaning that there are 156 holes

per square inch (“Technical Consultation” 3). In order to provide the appropriate barrier to the

Anopheles mosquito, the holes must be irregular in shape and no larger than 2 mm (3). Netting

can be sensitive to the temperature at which it is washed, so dimensional stability, which

calculates shrinkage or expansion is tested. Shrinkage or expansion in the warp or weft direction

should be no more than five percent according to WHO standards (5). The durability of the nets

shows how the nets hold up to common wear and tear from everyday use. Due to the fiber’s

degradation over time, any fabric is expected to loose strength. The netting should last between

4-5 years (“About Bednets”).

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Cotton, polyethylene, and polyester yarns are used. Filament yarns provide increased

strength. Using a texturized filament yarn as oppose to a flat or round yarn provides a lower level

of shrinkage, and a softer feel to the netting (“Technical Consultation” 9). Most nets are made of

polyester. Not only is polyester durable, but it has low water uptake making it ideal for

insecticides that are diluted with water. The insecticide will bond to the fabric, while the water

will not (9). Polyester is also a non flammable fabric, it will self-extinguish if approached with a

flame. The netting itself will not be a fire issue, what may change that is the insecticide sprayed

on the netting. But according to the net manufacturers, there is an additive in the nets that

decreases any fire hazards (“About Bednets”). This is important since places where malaria is

found are often hot and dry climates, there would be a higher chance of flammability.

Given the fact that insecticide-treated bednets not only repel, but kill the mosquitoes, the

effect that the insecticide has on human safety should be questioned. Currently, bednets are

treated with pyrethroid insecticides. Pyrethroids are a group of synthetic pesticides. They are

made similar to the natural pesticide called pyrethrum, which is produced by chrysanthemum

flowers ("Pyrethroid Insecticides”). There is very little risk to humans and other mammals as

well as the environment when used appropriately, any pyrethroids that enter the body will leave

through the urine, and sunlight and atmospheric chemicals break down pyrethroids within one to

two days ("Pyrethroid Insecticides”).

A study conducted in Senegal shows that mosquitoes are developing a resistance to the

long lasting deltamethrin-treated bednets. Deltamethrin is a common form of pyrethroid

insecticide. When the nets were first distributed, there was a decrease in malaria attacks, over the

course of two years, after the nets were given out, the malaria attack increased to higher levels

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than before (Kelland). While the nets could be re-sprayed with updated insecticides, at this time

there are few alternatives that are as cheap and safe for humans as deltamethrin (Kelland). This

introduces new challenges to scientists, textile designers, and textile engineers to tackle this

problem before the resistance spreads to more mosquitoes.

While the death toll from malaria in Brazil is low in comparison to countries in Africa, it

is not yet eliminated so prevention is necessary. Almost every case of malaria is restricted to the

Amazon Basin due to the climate and extensive water sources, which provide a prime location

for malaria-carrying mosquitoes to live and breed (Oliveira-Ferreira, et al 10). In the Brazilian

community of Jobote, malaria is as common as a cold. BASF, one of the world’s leading

chemical companies, partnered with the Foundation for Health Surveillance in Amazonas to

conduct a study analyzing how well BASF’s insecticide bednets work in Jobote.

The Jabote project started in 2008, Interceptor nets were placed in all the homes, and the

residents were taught the purpose of the nets and how to use them properly. The Interceptor nets

are made with a polymer binder combined with odorless Fendona® insecticide, and applied

directly to the fibers of the net. Fendona® is slowly released, repelling, knocking down, and

killing any mosquitoes that comes into contact with it ("Interceptor® - Long-Lasting...”). Since

the insecticide is released slowly, long term effectiveness is guaranteed ("Interceptor® - Long-

Lasting...”). Results were monitored monthly, In 2007 before the nets were being used, there was

an infection rate of 3.52 cases per person, by 2010, after using the nets for two years, only 1 in

12 people contracted malaria ("Interceptor Bednets Key Factor...”). To note an important

outcome, the literacy rate rose in those two years due to the increased rate of children being able

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to attend school since they were not burdened with malaria ("Interceptor Bednets Key Factor...”).

This provides clear evidence that a healthy, educated population is key for poverty reduction.

South East Asia contributes to 2.5 million cases of malaria, India alone contributes to 76

percent of these cases (Kumar et. al.). With over 1.1 billion people living in India, 80 percent of

the population is at risk for malaria, mostly in rural areas (Kakkilaya). The Malaria Research

Center estimates that US $1.5 billion of economic loss including medicine, hospitalization,

absence from work etc. in comparison to US$76.2 million spent for control, saving an estimated

US$1.4 billion in India (Kakkilaya). The money saved by preventing malaria allows for new

economic opportunities. This however only works when there is coverage of preventative

methods like insecticide treated bednets, coverage that does not exist in India, where there is

only an estimated twenty percent coverage of insecticide-treated bednets in the malaria risk areas

(Korenromp 7). The low amount of coverage could result from many factors, perhaps the nets are

not easily accessible, the cost is too high, or people do not have any knowledge on how to use a

bednet, and what purpose it serves.

A survey conducted in 2007 covered 150 villages in India, over 10,000 people. 55 of the

households reported at least one case of malaria within the six months preceding the survey. The

number of insecticide treated bednets was extremely low, only 0.04 net per person. (Mahajan et

al. 6). 10 percent owned a mosquito net, 9.5 percent said they had seen one, but never owned

one, and 80.3 percent said they had never seen a mosquito net (Jambulingam et al. 167). The

people who did own nets lived near roads with easy access to nearby towns (Jambulingam et al.

167). The fact that 80 percent of people had never seen a mosquito net is the most shocking.

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Certainly malaria has no chance of being eradicated if preventative methods are not accessible to

the people.

The connection between malaria and mosquitoes is not always understood. 38.8 percent

of people said mosquito bites led to malaria, while 38.1 percent did not know the two had any

connection (Jambulingam et al. 167). Some people bought a bednet for a better night sleep from

the annoyance of mosquitoes rather than a preventative method (Mahajan et al. 2). 40 percent of

people in the survey said they did not sleep under the nets regularly due to feeling too hot under

them (Jambulingam et al. 167) Seeing as there is a direct correlation between hot weather regions

and malaria, the nets being too hot to sleep under provides challenges to textile designers to

make the fabric more breathable. The technology and skills exist, now they need to be integrated

into the net design without raising the cost.

Orissa, India accounts for only 4 percent of India’s Population, however it has a quarter

of India’s malaria cases a year (Mahajan et al. 5). The Department for International Development

(DFID) is a United Kingdom government department whose goal is "to promote sustainable

development and eliminate world poverty" ("About Us”). They have contributed £100 million to

Orissa’s state health program to eradicate malaria, distributing 1.2 million bednets plus education

and awareness of malaria to rural villages ("Battling Malaria in India”). One of the health

workers, Suhasini Behera, explains the challenge in convincing people to use bednets. The

people of the village believed the bednets to be poisonous, because there have been reports of

rashes and itching due to insecticide. By visiting the people’s homes, she sought to get rid of

these misconceptions ("Battling Malaria in India”). The distribution of nets is changing people’s

view’s about them. Once considered poisonous, the nets are now viewed as protection. After

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being informed on the bednets, 37 percent of the people said they were interested in buying a

bednet but at a subsidized rate (Jambulingam et al. 170). Having knowledge and easy access to

bednets is what it will take to get people to buy and use them.

The preventative method of insecticide- treated bednets is certainly effective, as seen in

the Jabote project. However this means nothing when a community has never seen a bednet, or

understands what purpose it serves. Challenges have arisen with mosquitos developing a

resistances to the insecticide and the bednets being to hot to sleep under. Textile designers must

stay up to date and continually better the nets with new insecticides, more durable and breathable

fabric, and other adjustments based on context. The textile industry is helping to save lives by the

manufacturing of bednets. But why stop there? Currently more and more nets are being

manufactured locally in areas that are highly affected by malaria, stimulating local economies,

increasing the employment rate, and raising awareness and knowledge of the bednets.

Section III: How the Textile Industry has Responded to the Problem of Malaria in

Tanzania

In the East African country of Tanzania, 100,000 deaths are attributed to malaria a year

("Tanzania's Successful") and nearly 35 million people (93 percent of Tanzania’s population) is

at risk for malaria (Karugu and Mwendwa 5). That said, Tanzania is generating its own solution

to eradicate malaria. By opening four bednet manufacturing companies, Tanzania has a

prosperous domestic market and export industry. The nets become widely accessible, lowering

the number of malaria cases. Local businesses become sustainable, and individual workers gain

new skills, instilling confidence. The change is coming from the people living in the country. The

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opportunity presented allows the chance for not only malaria to be combated leading to better

health and health care, but the country to achieve stability and economic development.

Tanzania, is primarily an agricultural based economy, but is known for growing cotton

and for having a vibrant textile industry that has developed since the 1970s. Tanzania’s textile

industry was the first to industrialize on the continent, and other manufactures have followed

("Tanzania’s Textile"). As textile mill ownership eventually shifted from the public to the private

sector, many were forced to close as a result of intense competition ("Tanzania’s Textile"). As an

added obstacle for the success of indigenous production, over 40,000 tons of used clothing is

shipped to Africa every year (Heierli and Lengeler). The second-hand clothing is much cheaper

for people to buy, so the demand of African produced textiles decreased. Yet second-hand

clothing did not singularly lead to the downfall of the Tanzania’s textile industry. The downfall

was a result of the Asian textile industry (Heierli and Lengeler), much greater than Africa’s and

more competitive. However, by the end of the 1990’s, Tanzania textile factories recognized a

new market opportunity in manufacturing mosquito nets, and started to produce bednets on a

small scale (Heierli and Lengeler). Most traditionally recognized as an Asian business, there are

now four major bednet manufacturers in Tanzania, (Heierli and Lengeler), which has lead to the

revival of the Tanzania textile industry.

Making the bednets in Tanzania meets the high demand of the local market, and creates a

thriving export industry. It is a labor intensive process that includes weaving, sewing, and

finishing, generating over 3,000 new jobs for local people ("Jeffrey Sachs Controversy").

Manufacturers have brought textile factories that manufacture bednets to countries like Tanzania,

Nigeria, and Ethiopia, all of which have high infection rates of malaria, Nigeria and Ethiopia

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being in the top three (“Roll Back Malaria Partnership”). Establishing the factories in countries

that need them most benefits low income people, while still allowing profit-oriented businesses

to make money, and non- profit organizations to reach goals. While it is not perfect, it is a triple

win situation.

A to Z Textile Mills, located in Arusha, Tanzania, is the sole African producer of long-

lasting insecticide treated bednets (Karugu and Mwendwa 2). A loan from Acumen Fund, a non-

profit organization that invests philanthropic resources to entrepreneurs with the goal of social

change, allowed A to Z Textile Mills to buy the required machinery to manufacture the nets. The

Japanese company, Sumitomo, transfered the technology and chemicals to A to Z. Exxon Mobil

sells them the resin for the nets (Karugu and Mwendwa 7). The nets are sold locally, then

UNICEF, the Global Fund, and other aid agencies buy the rest for global distribution (8). A to Z

Textile Mills are also creating netting for doors and curtains, an alternative to the traditional

bednet, and cheaper for people to buy (8). This is not a charity, it is a business. The entire

concept is based on small scale market economics. Maximizing profits and reaching goals is

expected. Through the Tanzania National Voucher Scheme, the government subsidizes the cost of

bednets for pregnant women and young children, ensuring a wide distribution of nets to the most

vulnerable demographic segments in Tanzania. A voucher is given to pregnant women at health

clinics, which is then redeemed for a bednet, providing protection from malaria for her and her

children (12). The best part of A to Z Textile Mills is the opportunity it opens for the individual

and the local community.

It takes 18 people to make one bednet (Jennings 4). And there are about 3,400 employees

(Karugu and Mwendwa 8). Most of the workers are not previously trained in textile

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manufacturing, but rather new skills are taught on the job. Beyond specific job training,

employees are trained for broad life skills such as saving money, and how to spend it sensibly,

language classes, and management skills (Jennings 6), all important for people seeking to expand

their on-the-job knowledge and skills set.

Ninety percent of the workers are women (Karugu and Mwendwa 8). In Tanzania, 81.4

percent of women are economically active ("Tanzania Status of Women”) meaning they supply

labor for the production of goods and services. This number is a great deal higher than developed

nations. Tanzania ranks 42nd out of 80 on the Gender Empowerment Measure ("Tanzania Status

of Women”). Certainly the high number of women employed through A to Z textile mills

empowers women by enabling them to have an income. By increasing the family income, allows

the opportunity for an education for her children, better housing, and better healthcare.

The public health of the country is also improved. Lowering the amount of money spent

on malaria treatments, and shifting resources towards the fight against AIDS and Tuberculosis.

The community where the factory is located has benefited from a better developed infrastructure,

including roads, water, electricity and bus service (Jennings 3). The factory also supports local

farmers by buying large quantities of food for the canteens (Jennings 2). With the installment of

one factory, the community is given the chance to transform in substantive, significant, and long

lasting ways. Since there are four major textile factories like A to Z in Tanzania, the effect these

mills have on the country as a whole is remarkable.

Herman Kimambo is a shopkeeper from Morogoro, Tanzania, his experience

demonstrates how directly selling bednets to the community can sustain the local economy. The

walls of Herman’s shop are covered with posters of bednets, and long-lasting insecticide nets as

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well as re-treatable nets line the shelves, available in four colors. Herman has been selling nets

since 1996, and has participated in the Tanzania National Voucher Scheme, collecting the

vouchers which he then gives to the net manufactures in exchange for more bednets ("Nets Make

Good”). Herman’s business has increased significantly due to the voucher program, with his

monthly sales escalating 75-100 percent. He sells about 2,000 nets a month, with about half

associated with the voucher program ("Nets Make Good"). Herman explains “Families and

communities must understand the importance of using bednets – for the program to be

sustainable, the demand for nets has to come from them” ("Nets Make Good"). There are now

over 7,000 retailers and wholesalers like Herman throughout Tanzania selling bednets ("Nets

Make Good"). Local businesses selling the nets become sustainable, while malaria decreases as a

result of the bednets becoming more accessible to the local people. People like Maimuna, a 25-

year-old woman with three children. When she was pregnant with her first two children,

Maimuna did not have a bednet. She was sick with malaria for most of her pregnancy. When she

become pregnant a third time and went to the health clinic for her prenatal check up, they gave

her a voucher. Maimuna purchased a bednet using the voucher at a local store. She never

contracted malaria during her third pregnancy. When she brought her son to the health clinic for

vaccination against measles, she received another voucher to buy a second bednet for her

children ("Tanzania National Voucher"). Incentives and motivation work, the vouchers give

women like Maimuna an initiative to visit the health clinics earlier in their pregnancy (“Roll

Back Malaria Partnership”) ensuring that she will have a healthy pregnancy for both her and her

baby.

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Jeffery Sachs, an American economist, is more skeptical about the voucher scheme,

arguing that the Tanzania National Voucher Scheme is a social marketing failure ("Jeffrey Sachs

Controversy"). The process is too slow, and the delay in delivering bednets is “one of the

shocking crimes of our time” ("Jeffrey Sachs Controversy"). Sachs argues that only when there is

full community participation in using bednets, can malaria be eradicated from an area. This can

only be accomplished if mass distributions are given out as quickly as possible. Sachs

undoubtably makes valid points. It is true that the longer it takes to get nets to everyone in a

community, the longer it will take to get rid of malaria, and there is no time that can be wasted

when there are 100,000 deaths a year from malaria in Tanzania alone ("Tanzania's Successful").

Clearly, there are flaws in the Tanzania National Voucher Scheme, especially since the program

targets primarily pregnant women and young children; they will be protected, but what about

everyone else? What about the elderly, who also have a high risk of contracting malaria,

shouldn’t they be given a discounted price to purchase bednets too? These concerns must be

acknowledged, addressed, and dealt with effectively.

A mass distribution of bednets may be the best way to eradicate malaria, but are hand-

outs the best way to eradicate the path malaria leaves, sustaining a community into the long

term? The biggest problem with Jeffery Sachs’s critique is that the people for whom the nets are

manufactured have little to no say in the process. The community is not involved, and that

counters all arguments that change must come from within. By having a greater part in the

manufacturing, selling, and buying of bednets, individuals gain a greater knowledge base on the

importance of the nets. Bednets have already proven a great economic success in the Tanzania

textile industry. Thousands of women are given jobs in the textile factory, which effects not just

Plante 19

them, but the lives of their families. Thousands of shopkeepers have also benefitted from selling

nets. Giving the bednets for free would dismiss any reason for a person like Herman to sell them.

Local vendors selling the nets allow a wider distribution to rural villages, making nets more

accessible. Confidence is instilled in the person, high expectations are set, and trust is fostered.

They are given the chance to do something to change the condition of their lives rather than

waiting for someone else to help them out.

A simple weft knit net is hanging from the ceiling. It is made from polyester, nothing

special, nothing revolutionary. It is enveloped with a spray so poisonous that it kills one of the

world’s most prevalent killers, yet it so safe a newborn can sleep under it. This simple piece of

fabric has the ability to save millions of lives, to change millions of lives, and to change the

health, well-being, and economic sustainability of a country burdened with malaria. In order to

eliminate malaria by 2015, bednets must be distributed to all areas of the world plagued with the

disease, especially the most rural places, where residents have never seen a bednet. This can be

done by finding a balance of handing out the nets, and creating a social marking program that not

only brings money to individuals, but also knowledge of bednets to the people in a community.

Foreign aid and funding from international donors and organizations play a significant role in

eradicating malaria and it must increase. Yet as seen in Tanzania, sometimes the best way to help

a country is to give them the opportunity to help themselves. There is an Ethiopian proverb that

says, “When spider webs unite they can entangle a lion” ("Quotable Quotes"). There is no doubt

that malaria will be conquered if people’s talents and efforts are combined, a great change will

occur.

Plante 20

Works Cited

"About Bednets." Nothing But Nets Campaign. 2009. Web. 31 Oct. 2011.

<www.nothingbutnets.net>.

"About Malaria." Centers for Disease Control and Prevention. 8 Feb. 2010. Web. 18 Oct. 2011.

<www.cdc.gov>.

"About Us." Department for International Development. 2011. Web. 7 Nov. 2011. \

<http://www.dfid.gov.uk/>.

Anti-Malaria Bednets to the Poor | Growing Inclusive Markets." Growing Inclusive Markets.

2008. Web. 01 Nov. 2011. <www.cases.growinginclusivemarkets.org>.

"Battling Malaria in India." Department for International Development. 19 Apr. 2011. Web. 7

Nov. 2011. <www.dfid.gov.uk>.

Center for Disease Control and Prevention. "CDC Statement on Results from RTS,S/AS01

Malaria Vaccine Trial." Health News Digest. Com. 18 Oct. 2011. Web. 18 Oct. 2011.

<www.healthnewsdigest.com>.

Gallup, John L., and Jeffery D. Sachs. "The Economic Burden of Malaria." The American

Society of Tropical Medicine and Hygiene 64 (2001): 85-96. The American Journal of

Tropical Medicine and Hygiene. Web. 18 Oct. 2011. <www.ajtmh.org>.

"Global Health Efforts." Insect Sheild. 2010. Web. 18 Oct. 2011. <www.insectshield.com>.

"Global Malaria Action Plan." Roll Back Malaria Partnership. Web. 18 Oct. 2011.

<http://www.rbm.who.int>.

"Global Malaria Control and Elimination: Report of a Technical Review." World Health

Organization 17-18 (2008). Jan. 2008. Web. 18 Oct. 2011. <www.whqlibdoc.who.int>.

Plante 21

Heierli, Urs, and Christian Lengeler. "Should Bednetsbednet Be Sold, Or Given Free? The Role

of the Private Sector in Malaria Control." Swiss Agency for Development and

Cooperation SDC (2008). Web. 8 Nov. 2011. <www.poverty.ch>.

"Interceptor Bed Nets Key Factor for Decrease in Malaria Infection." Fiber2Fashion. 20 Apr.

2011. Web. 19 Nov. 2011. <www.fibre2fashion.com>.

"Interceptor® - Long-Lasting Insecticidal Nets." BASF The Chemical Company. Web. 19 Nov.

2011. <www.publichealth.basf.com>.

"Insecticide- Treated Mosquito Nets: a WHO Position Statement." World Health Organization.

16 Aug. 2007. Web. 29 Oct. 2011. <www.who.int>.

Jambulingam, P., K. Gunasekaran, S. Sahu, and T. Vijayakumar. "Insecticide Treated Mosquito

Nets for Malaria Control in India- Experience from a Tribal Area on Operational

Feasibility and Uptake." Mem Inst Oswaldo Cruz 103.2 (2008): 165-71. Mar. 2008. Web.

7 Nov. 2011. <www.scielo.br>.

"Jeffrey Sachs controversy: give them free or selling them?" Market Approaches to

Development. Swiss Agency for Development and Cooperation, 2011. Web. 8 Nov. 2011.

<http://www.poverty.ch>

Jennings, Michael. "Economic Impact of Local Manufacturing of Bednets A Survey." SOAS

University of London (2011). Web. 9 Nov. 2011. <www.olyset.net>.

Kakkilaya, B. S. "Malaria in India." Malaria Site. 26 Mar. 2011. Web. 7 Nov. 2011.

<www.malariasite.com>.

Karugu, Winifred, and Triza Mwendwa. "A to Z Textile Mills: A Public Private Partnership

Providing Long-Lasting Anti-Malaria Bed Nets to the Poor." Growing Inclusive Markets

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(2007). United Nations Development Programme. Web. 9 Nov. 2011.

<www.growinginclusivemarkets.org>.

Kelland, Kate. "Mosquito Resistance to Bednets Fuels Malaria Worries." Reuters.com. 18 Aug.

2011. Web. 29 Oct. 2011. <af.reuters.com>.

Knox, Richard. "Experimental Malaria Vaccine Slashes Infection Risk by Half." 18 Oct. 2011.

Web. 18 Oct. 2011. <www.npr.org>.

Korenromp, Eline. "Malaria Incidence Estimates at Country Level for the Year 2004." World

Health Organization, Roll Back Malaria,, 11 Mar. 2005. Web. 14 Nov. 2011.

<www.rbm.who.in>.

Kumar, Ashwani, Neena Valecha, Tanu Jain, and Aditya P. Dash. "Burden of Malaria in India:

Retrospective and Prospective View." The American Journal of Tropical Medicine and

Hygiene. 23 Mar. 2007. Web. 7 Nov. 2011. <www.ajtmh.org>.

Luxemburger, Christine, Francois Nosten, Dominque Raimond, Saw Bathet, and Nicholas J.

White. "Effects of Malarai during Pregnancy on Infant Moartality in an Area of Low

Malaria Transmission." American Journal of Epidemiology 154 (2001): 459-65. Web. 18

Oct. 2011. <aje.oxfordjournals.org>.

Mahajan, Aprajit, Alessandro Tarozzi, Joanne Yoong, and Brian Blackburn. "Bednets,

Information and Malaria in Orissa." 21 July 2011. Web. 7 Nov. 2011.

<www.stanford.edu>.

"Malaria Kills." Nothing But Nets Campaign. United Nations Foundation, 2009. Web. 18 Oct.

2011. <www.nothingbutnets.net/>.

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"Malaria Prevention Shows 'stunning Gains'" CBC News. 18 Oct. 2011. Web. 18 Oct. 2011.

<www.cbc.ca>.

"Malaria." PubMed Health. 9 June 2011. Web. 19 Oct. 2011. <www.ncbi.nlm.nih.gov>.

"Nets Make Good Business in Tanzania." The President's Malaria Initiative. Oct. 2006. Web. 9

Nov. 2011. <www.pmi.gov>.

Oliveira-Ferreira, Joseli, Marcus CV Lacerda, Patrícia Brasi, José LB Ladislau, Pedro L. Tauil,

and Cláudio T. ClDaniel-Ribeiro. "Malaria in Brazil: an Overview." Malaria Journal

(2010): 1-15. Malaria Journal. 30 Apr. 2010. Web. 19 Nov. 2011.

<www.malariajournal.com>.

"Progress against Malaria." Gates Foundation. Sept. 2009. Web. 18 Oct. 2011.

<www.gatesfoundation.org>.

"Pyrethroid Insecticides." Illinois Department of Public Health. June 2007. Web. 31 Oct. 2011.

<www.idph.state>.

"Quotable Quotes." Africa Action: Activism for Africa Since 1953. Web. 4 Dec. 2011.

<www.africaaction.org>.

"Roll Back Malaria Partnership." Roll Back Malaria. 2011. Web. 18 Oct. 2011.

<www.rbm.who.int>.

"A Strategic Framework for Malaria Prevention and Control During Pregnancy in the African

Region." World Health Organization (2004). Web. 18 Oct. 2011. <whqlibdoc.who.int>.

"Tanzania National Voucher Scheme (TNVS) Protects a Mother and Her Children." The

President's Malaria Initiative. Mennonite Economic Development Associates, Aug. 2008.

Web. 9 Nov. 2011. <www.pmi.gov>.

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"Tanzania Status of Women." CountryWatch. 2011. Web. 20 Nov. 2011.

<www.countrywatch.com>.

"Tanzania's Successful Malaria Bednets Programme." Market Approaches to Development.

Swiss Agency for Development and Cooperation, 2011. Web. 8 Nov. 2011.

<http:// www.poverty.ch>.

"Tanzania’s Textile and Apparel Industry." Tanzania Cotton Board. 2011. Web. 8 Nov. 2011.

<www.cotton.org>.

"Technical Consultation on Specifications and Quality Control of Netting Materials and

Mosquito Nets." World Health Organization. 2 Dec. 2005. Web. 29 Oct. 2011.

<www.who.int>.

World Malaria Report 2009. World Health Organization, 2009. Google Books.

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