MALARIA: African Countries Debate Using DDT in Anti-Malaria Efforts

July 12, 2011 : Sanday Chongo Kabange : Lusaka, Zambia

African Countries Debate Using DDT in Anti-Malaria Efforts : Some propose using pesticide in tightly controlled conditions

Photo: VOA - A. Fortier

African children watch a play on malaria prevention at the Mbosse health clinic.

The chemical pesticide DDT has been banned by most countries for use in agriculture, but some continue to use it indoors to kill insects that carry malaria.
In Zambia, it’s an important part of the government’s malaria control program, and the controlled use of DDT spray has led to a reduction in malaria cases over the years.
Other African countries are facing a rise in the number of cases and several African governments are considering the carefully monitored use of DDT as part of their strategy against the disease.
In Malawi, for example, the Department of Health may undertake a DDT spray program in malaria prone-areas.
There is no doubt that DDT is very effective in killing mosquitoes. The problem lies in what other effects DDT may have on human health, wildlife, environment, horticulture and crops.
Malawi’s secretary of health, Chris Kang’ombe, was part of a delegation that visited Zambia to learn how the use of DDT has helped reduce malaria there.
Kang’ombe is convinced that DDT can help reduce the spread of malaria in Africa -- if handled under controlled conditions by trained personnel and monitored by government agencies.
He says, “DDT is used for indoor spraying. It is used to only spray within, inside the house, dwelling houses. What we have learnt (from Zambia) and we know from our experience here (in Malawi), the other chemicals [are active for] up to about two or three months, whereas with DDT you are talking of six months plus. So in terms of “residue effect,” it (DDT) is better, and also eventually the cost of indoor spraying…will be much cheaper, more cost effective than using other chemicals. “
While authorities in Malawi are still considering using DDT in malaria control, a thorny issue has arisen.
The Tobacco Control Commission is against the idea of using the pesticide. Tobacco is the mainstay of Malawi’s economy, and there’s fear that Western consumers will not buy it if there are any traces of DDT on the crops. So the commission will likely require careful monitoring if Malawi is to start using DDT in malaria control.
Similar views are shared by Uganda’s Network on Toxic Free Malaria Control. The network is against the use of DDT as a malaria control strategy.
“We have no law specifically for DDT,” says Network Secretary General Ellady Muyambi . “ We have no trained manpower. We do not have equipment in terms of transportation facilities, in terms of storage facilities, in terms of disposal facilities, in terms of laboratories for chromatography. We do not have the capacity. We are still relaying on donor funding and we are saying why can’t our country use its own resources to deal with its own problems, especially these ones like malaria.,” says Muyambi.
Also involved in the DDT debate is Kenya, another country debating whether to use the pesticide.
Shrikant Bhatt professor of medicine at the University of Nairobi in Kenya explains why the controlled use of DDT should be reintroduced. “We are almost getting defeated by the pandemic that is occurring due to malaria. [Anti-malarial] drugs are gaining resistance [to the parasite]. You know we have very few drugs which we can use as effective means of controlling malaria. So, I think we do not have any option but to reintroduce DDT in a limited way, [like] spraying DDT indoors or using it in endemic areas we should be able to contain the malaria pandemic,” he explains.
The International Centre for Insect Physiology and Ecology (ICIPE), also based in Kenya, is taking different approach.
John Githure a researcher at the centre says “ICIPE is largely concentrating on how we can come up with innovative ways or even using available products to kill the mosquitoes at larval stage. “
One such product uses soil-dwelling bacteria called bacillus thuringiensis, or BTi.
Githure says ,”we are trying to introduce that in Africa and ICIPE have of course gone ahead to construct a demonstration factory that will be able to at least make the product BTi available, affordable and accessible to the community to use for mosquito control.”
Meanwhile, the government and various organizations including Melinda and Bill Gates Foundation are encouraging free distribution of insecticide-treated mosquito nets and sleeping under bed-nets as short term measure for malaria control.
http://www.voanews.com/english/news/africa/pan/African-Countries-Debate-Using-DDT-in-Anti-Malaria-Efforts--125426193.html

MALARIA: Uganda: DDT Spraying Costly for Country

Raymond Baguma and Gerald Kawemba : 5 July 2011
Indoor residual spraying as a strategy to control malaria in Uganda is too costly and has affected the programme countrywide.
According to Dr. Seraphine Adibaku, the head of the Malaria Control Programme, this is why other malaria control strategies such as use of insecticide-treated nets and Artemisinin-based combination therapy are considered to be ahead of indoor residual spraying.
The Government is implementing the indoor residual spraying using pyrethrum-based and carbon-based insecticides in 10 malaria-endemic districts in the northern and eastern regions.
They include Amolatar, Apac, Kitgum, Kumi and Bukedea.
"About three million people in the 10 districts have been covered. We have reached over 90% of the population," Adibaku said.
She added that under the Presidential Malaria Initiative, the budget for indoor residual spraying is sh4.5b per district each year.
Adibaku said it would be much cheaper if the ministry distributed insecticide-treated mosquito nets.
She, however, said indoor spraying has an advantage of delivering immediate impact compared to treated nets.
Adibaku disclosed that the health ministry is re-evaluating the effectiveness of using DDT for malaria control.
Dr. Joaquim Saweka, the World Health Organisation (WHO) resident representative in Uganda, said indoor residual spraying is highly effective and has been successful in Zanzibar and Rwanda.
He, however, added that it is capital intensive and needs a lot of money for each application done twice a year.
Saweka cited his previous posting in Ghana during which a town of 300,000 inhabitants required $3m for spraying each year.
He said with the high cost of spraying and low financial resources available, Uganda needs to prioritise usage of insecticide-treated mosquito nets.
Saweka added that Uganda is on the right path to eradicating malaria with efforts in prevention, diagnosis and treatment as well as universal coverage of insecticide-treated nets.
Health minister Dr. Richard Nduhura yesterday kicked off a nationwide programme to distribute 11,000 bicycles to health volunteers who will diagnose and treat malaria in homes. The programme is supported by the Global Fund.
It is part of the Government's home-based management of malaria, which is part of a larger national strategy to deliver treatment to children within 24 hours after diagnosis

http://allafrica.com/stories/201107061302.html

MALARIA: Precaution and funding of vector control must be based on evidence

Richard Tren & Donald Roberts : 18 May 2011
Malaria Journal
In their paper "Status of pesticide management in the practice of vector control: a global survey in countries at risk of malaria or other major vector-borne diseases," van den Berg et al. make some generally accepted and valid arguments about the need for improved management of public health insecticides (PHIs). Given the importance of vector control, it would be beneficial for malaria control program managers and staff to be trained in proper insecticide use and management, if only to slow the spread of insecticide resistance. However the authors reveal an anti-insecticide bias and an ideological approach to disease control that could potentially undermine disease prevention efforts.
In stating "All chemical pesticides are inherently toxic to humans and precaution is required to minimize exposure and adverse health effects," the authors are creating opportunities for scaremongering. The needs for research and for improved procedures to minimize exposures to both disease-carrying insects and insecticides are self-evident. Yet, invoking "precaution" at the level of warning residents their houses are being sprayed with a harmful chemical to minimize adverse health effects should be based on proof of such adverse effects. Such proof does not exist, as exemplified by the circular logic displayed by the first author in another paper in which he and co-authors argue residents should be warned of possible harm from DDT exposures. In that paper the authors trumpeted "precaution" by justifying a claim of adverse health effects with the statement, "The very fact that there are so many precautions built into the WHO guidelines shows that IRS chemicals are considered hazardous." Such rationalizations reveal clear intent to expand the precautionary principle to restrain PHI use in disease control programs. Reasonable people know existence of safety measures (which often result from mere claims of potential dangers) does not imply IRS chemicals are dangerous. On the other hand, reasonable people accept that prudent safety standards are important. Warning residents that DDT and other PHIs are dangerous is neither prudent nor good public health policy because it would result in spraying refusals, an outcome that would increase risks of malaria transmission.
The authors conclude with the statement that support for vector control by donors and funding agencies should be contingent on them pursuing an IVM approach. We disagree strongly. Support for vector control programs should be based on the evidence of disease control efficacy. If a program that relies heavily on IRS delivers the best results in terms of disease reduction, then that is what should be supported. Though IVM should embrace effective methods of malaria control, such as IRS, we believe that IVM is far too often interpreted as adopting any and every vector control method except the spraying of insecticides. This is proven by the highly biased track record of funding malaria control programs without PHIs by the UN Environment Programme and Global Environment Facility. Making IVM a condition of funding elevates ideology above evidence and has no place in disease control programs.
In summation, the authors reveal intent to invoke the precautionary principle over disease control programs and use power of the purse strings to pressure governments away from critically important uses of PHIs to control malaria and other insect-borne diseases. The disease control community must continue to resist the anti-PHI agenda.
http://www.malariajournal.com/content/10/1/125/comments#506690

MALARIA: As DDT Makes a Comeback, Uganda Must Weigh Its Costs

JOSH KRON : May 18, 2011
 Marc Hofer for The New York Times
Bosco Acope and his family tend their farm in Atek, Uganda, where the government's use of DDT has threatened their livelihood.

Growing up as a child here along the muggy, isolated plains of northern Uganda, life was not easy. His parents were poor. He did not attend secondary school. Many of his friends died from bouts of malaria, a scourge that has plagued this agrarian society.
Mr. Acope, 49, survived. At 19, he became a small-time farmer, with one acre of land. He married. He sowed. “I have been a farmer in this life,” he said.
When the American government, a generous and close friend to Uganda, began an organic-farming program to help rural economies here, Mr. Acope expanded, selling a wide variety of commodities at good rates.
His one acre became seven. Mr. Acope fathered 11 children. Uganda was developing, and Mr. Acope was one of many who were riding high, he said.
But the very next year came winds of change. Faced with unrelenting malaria, which threatened both lives and livelihoods, Uganda’s government teamed up with the United States to use chemical insecticide sprays — including DDT — to try to eliminate the disease. Mr. Acope’s home district, Apac, which has some of the highest malaria rates in the world was chosen for spraying in early 2008.
Mr. Acope said an official from the organic-farming company he sold to, which was also supported by the United States, warned that the sprays were dangerous. Mr. Acope’s produce would no longer be guaranteed to be organic — especially since many crops were stored indoors, where the spraying occurred — nor would it be bought at a lucrative price.
“I was told to protect my market, to try to stop the spraying,” Mr. Acope said. “But the whole village was sprayed.”
One morning, he recalled, he watched a group of men in gas masks who were carrying metal canisters pass through the village, and just like that, Mr. Acope’s organic-food market was gone. He said he had to pull three of his children out of school. Furthermore, the chemicals in the insecticide lasted so long that the organic-farming companies said they would not be back for 15 years.
So Mr. Acope is helping to take his government to court.
Once condemned as poisonous and inhumane, DDT has staged a recent comeback. In 2006, the World Health Organization strongly endorsed the chemical’s use on indoor walls as a cheap and long-lasting weapon in the fight against malaria. The United States also sanctioned DDT to combat the disease in African countries with “a high burden of malaria,” including Uganda.
The United States sprayed DDT to eliminate the last remnants of malaria across North America. The disease’s eradication was a milestone in public health and development. Malaria almost thwarted construction of the Panama Canal and “influenced to a great extent human populations and human history,” the Centers for Disease Control and Prevention says.
But the United States banned the use of DDT in 1972 over the chemical’s hazardous environmental impact. Studies have also linked DDT to diabetes and breast cancer. One examination of the consequences of using DDT to fight malaria in sub-Saharan Africa, conducted by the National Institute of Environmental Health Sciences, said the chemical might have increased infant deaths.
Still, the risks of not spraying are clear as well. In Africa, malaria kills 2,000 children each day, according to Unicef, and costs approximately $12.5 billion in lost incomes each year, the Malaria Consortium says.
“It really affects the whole fabric of the economic system in Africa,” said Dr. Patrick Lukulay, a consultant to a United States Agency for International Development initiative to treat malaria. “It prevents people from being productive citizens.”
In the Apac region of Uganda, the United States focused on two conflicting agendas: developing organic farming and eradicating malaria, ultimately affecting the livelihoods of tens of thousands of farmers.
U.S.A.I.D. “has supported agricultural development in Uganda for many years, including the promotion of organic farming in Northern Uganda,” said Michael Brander of BioVision, a Swiss organization focused on eco-friendly economic development. “Organic farming provided a good price at low production costs for farmers; however, it was exactly in those areas they also supported spraying of DDT.”
Now Uganda’s constitutional court is expected to hear a case brought by a Ugandan environmental organization against the government that asserts that officials failed to meet W.H.O. standards for using DDT, including failure to properly prepare the local population.
But given the prevalence of the disease, “chemical spraying with strict monitoring and supervision is one of the most effective measures to control malaria in high-risk areas,” said a United States Embassy official, who was not authorized to speak publicly.
The village of Atek is a place where mangoes can be eaten directly from trees and children walk to school shoeless. Farming is a way of life, and the American aid agency’s organic-farming program gave the village a competitive edge.
When the DDT was sprayed, organic-farming companies say they lost the bulk of their supply immediately. An American-owned company, Dunavant, had 50,000 certified organic farmers in areas affected by the spraying, according to the Uganda Network on Toxic Free Malaria Control, the organization taking the government to court. Shares, another farming company, said at least 16,000 of its suppliers were affected.
“All that got lost,” said Jan-Alex Fokkens, the director of Shares. “It was game over.”
The organic-farming companies sued the Ugandan government after the first rounds of spraying, and a high court issued a temporary injunction on the use of DDT in 2008, but the case was later dismissed.
The American government says it has not returned to using DDT in Uganda since the court ruling, even though the Ugandan government has made numerous references to reinstituting the chemical. Now, the main chemical being used in the insecticide-spraying program, bendiocarb, has also been discontinued in the United States, and it is considered to be more expensive and less efficient than DDT.
“At a certain point bendiocarb will fail,” said Richard Onen, a field coordinator for Abt Associates, a business contracted by U.S.A.I.D. to carry out its indoor spraying program. “I cannot rule out the possibility of using DDT. It is cheap.”
But there are questions as to how well DDT worked in Uganda in the first place. “Mosquitoes had become resistant to the DDT,” said Kale Dickinson, a nursing officer at a local health center. “DDT was not effective.”
For Lillian Etime, Mr. Acope’s neighbor and a mother of six, the death of her chickens during the first round of spraying set off alarm bells. “We feared that the children could touch the wall,” where spray was administered, “and they could die,” said Ms. Etime, 32. Ultimately, it was business that suffered the most, she said, with her revenue reduced by more than half. “The problem I experience is the problem of money,” she said.
Underneath a mango tree nearby, Mr. Acope lamented his own reversal of fortune, but remained stoic. “I am now working on my own,” he said. “Still growing.”
http://www.nytimes.com/2011/05/19/world/africa/19uganda.html?_r=1&pagewanted=all

MALARIA: Southern African Development Community says it will begin producing DDT to combat malarial mosquitoes

Roger Bate and Richard Tren : 28 Apr 2011
GENEVA—Two weeks ago the Southern African Development Community (SADC), a bloc of 15 African nations, said it would begin producing the insecticide DDT to combat malarial mosquitoes. This is a necessary reaction to damage caused by the illogical, misguided, and often untruthful campaign against DDT run by the United Nations Environment Program (UNEP). This disagreement is set to enliven the UNEP meeting on insecticide use this week in Geneva.
For the past 15 years SADC, ably supported by Western donors and notably the United States, has significantly reduced the prevalence of malaria. It has done this by deploying medicines to treat patients and bed nets to protect children. But, overwhelmingly, the success is due to indoor insecticide spraying. Several insecticides have been used, but the cheapest, most effective, and most widely deployed insecticide across the region is DDT.
Malaria kills hundreds of thousands of children across Africa, and tens of millions who survive are left with impaired learning due to the disease. It is difficult to overestimate the importance of combating malaria.
Yet while one arm of the United Nations (UN), the World Health Organization, struggles with limited budgets to help developing nations eradicate malaria, another branch, UNEP, pushes to eradicate DDT.
UNEP obviously is concerned about environmental contamination, and has every right to remind malaria control entities to limit environmental harm when using insecticides. But UNEP has gone a lot further than that.
Under the mandate of UNEP's Stockholm Convention on Persistent Organic Pollutants, which regulates DDT use, in the past few years UNEP has established experiments to demonstrate that malaria can be controlled without insecticides and then ignored its own results, which failed to provide any evidence supporting their supposedly environmentally sound ideas. Although there are no insecticides with DDT's unique properties (DDT primarily acts as a repellent and not as a toxic agent), UNEP is pushing ahead with efforts to eliminate DDT by 2020. This arbitrary deadline, dreamt up by UNEP officials, violates the Stockholm Convention itself, which expressly excluded any DDT elimination timeline.
Aside from violating both the letter and spirit of the Stockholm Convention, UNEP has pressured the WHO to discourage DDT use and has pressured India to stop producing the chemical. This has probably lowered demand for DDT from Indian-government owned Hindustan Insecticide Limited (HIL), which is the last producer of DDT on the planet.
UNEP has not acted alone—it has been spurred on by environmental groups. There does not appear to be much difference between militant greens inside or outside of UNEP. But producers of competitor products to DDT, such as the chemical company Bayer, the agrochemical industry lobby group CropLife, and bed net manufacturers, have quietly also egged on UNEP. With a timid malaria and donor community shying away from conflict, wanting everyone to "sing from the same hymn sheet," UNEP has had a free run at ending DDT use.
For at least the last decade, Southern African nations have been the most active users of DDT. Health ministers from nations like South Africa and Namibia have consistently pointed out the benefits of DDT to their malaria control programs, and African heads of state that are members of the African Leaders Malaria Alliance recently reiterated their support for DDT. But UNEP ignores such strong support for DDT. Africa's malarial nations have been struggling to source DDT from HIL in India and there have been shortages of the life-saving chemical.
And African leaders have had enough. On April 5, SADC wrote to UNEP Executive Director Achim Steiner. SADC said "it would be infeasible and highly irresponsible to abandon the use of DDT at any foreseeable date ... The SADC Member States therefore reject as premature the efforts of the [Stockholm Convention] Secretariat to eliminate DDT production by 2020, or any other arbitrary deadline, and strenuously protest that the Secretariat undertook this initiative without an express consensus of Stockholm Convention Parties ... It is therefore SADC Member States' firm insistence that the Secretariat suspend all efforts to eliminate DDT production and use."
With a strident tone unusual for diplomatic correspondence, the letter explains the desire of all SADC member states to have DDT produced within the region, and cleverly asks for assistance of the Stockholm Convention Secretariat, which, under its rules, it is duty-bound to provide: "SADC requests the Secretariat to arrange technical assistance to establish state-of-the-art, bio-secure and eco-secure DDT synthesis and formulating factories in the Region."
Environmental activists inside and outside UNEP love to hate DDT and will seemingly stop at nothing to ensure it is never produced or used. But there is a macabre irony in their anti-DDT campaigns. With all the technological advancement of the 21st century that now ensures the average person born today will live longer than at any time in human history, SADC will be producing a chemical first synthesized in the 1800s. It is due to decades of anti-insecticides campaigning that there has not been any real investment, public or private, in the search for true replacements of DDT.
SADC is doing the right thing for the health and welfare of its citizens. Let's hope this move helps change the way the public and the UN thinks about public health insecticides and the life-saving role they play.
http://www.american.com/archive/2011/april/africans-tell-the-un-to-buzz-off

MALARIA: The truth about DDT

Dichlorodiphenyltrichloroethane (DDT) was used worldwide until the 1970s, when concerns about its toxic effects, its environmental persistence, and its concentration in the food supply led to use restrictions and prohibitions. In 2001, more than 100 countries signed the Stockholm Convention on Persistent Organic Pollutants (POPs), committing to eliminate the use of 12 POPs of greatest concern. However, DDT use was allowed for disease vector control. In 2006, the World Health Organization and the U.S. Agency for International Development endorsed indoor DDT spraying to control malaria. To better inform current policy, we reviewed epidemiologic studies published from 2003 to 2008 that investigated the human health consequences of DDT and/or DDE (dichlorodiphenyldichloroethylene) exposure.

Data sources and extraction
We conducted a PubMed search in October 2008 and retrieved 494 studies.

Data synthesis
Use restrictions have been successful in lowering human exposure to DDT, but blood concentrations of DDT and DDE are high in countries where DDT is currently being used or was more recently restricted. The recent literature shows a growing body of evidence that exposure to DDT and its breakdown product DDE may be associated with adverse health outcomes such as breast cancer, diabetes, decreased semen quality, spontaneous abortion, and impaired neurodevelopment in children.

Conclusions
Although we provide evidence to suggest that DDT and DDE may pose a risk to human health, we also highlight the lack of knowledge about human exposure and health effects in communities where DDT is currently being sprayed for malaria control. We recommend research to address this gap and to develop safe and effective alternatives to DDT.

http://ehp03.niehs.nih.gov/article/info:doi/10.1289/ehp.11748

MALARIA: Wellcome Film of the Month

26 Apr, 2011  Yesterday was World Malaria Day and we thought we’d mark the occasion by highlighting some videos about the disease from our archive.
Mosquitoes and malaria, 1988 is one of the Moving Image & Sound department’s definitive films on the subject. The audience for many of the films in Moving Image and Sound has tended historically towards professionals in the field and this film made by a team of Wellcome Foundation Film Unit stalwarts (Dr Len Goodwin with cinematography by the late Douglas Fisher) is unashamedly technical in nature; explaining how to detect the presence of malaria parasites in mosquitoes.
In fact. two films are cunningly fused together in this one title: extracts from an earlier title from 1953, Dissection of a mosquito for malaria parasite have been sourced in order to illustrate the ‘traditional’ and somewhat laborious method (minute mosquito legs and wings are amputated, the evidence studied by sight alone under microscopes). The modern enzyme-linked immunosorbent assay (or ELISA) method for detecting malaria sporozoites and oocysts in female Anopheles mosquitoes are then shown in detail. The impact of this technique relates to epidemiologists’ ability to understand the degree of infection in an area where the mosquitoes are collected (and presumably plan accordingly). ELISA is a biochemical technique and has been used to test for HIV and in the detection of illegal drugs usage. However, some controversy does surround the interpretation of the division between what constitutes a positive and a negative result.

Other films about malaria in the Wellcome Film collection:
Private Snafu vs. Malaria Mike, 1944 is a Warner Brothers film made for the US army. Using the might of Hollywood in its propaganda efforts (Mel Blanc who voiced Bugs Bunny and Dr Seuss, aka Theodore Geisel, as supervising producer), it was one of a series aimed at military personnel; providing information about how easily malaria can be contracted. The eponymous hero, Snafu makes a catalogue of errors such as not using repellent. At the end, the mosquito tells his son what he did in the war – with Snafu’s scalp hanging on the wall.
DDT versus malaria: a successful experiment in malaria control by the Kenya Medical Department, 1946 is a film with a complex provenance. It shows film footage of the campaign to check a malaria epidemic in the Kipsigis tribal reserve in Kenya by spraying village huts with DDT. It shows very sick villagers suffering from malaria with everyday life almost at a standstill. It was decided that the film could also be used for propaganda purposes and so several narrative elements have been fictionalised in the film (which is rather stilted and jarringly patronising in places).
Wellcome’s involvement in tropical medicine is well-documented in our collection. The Story of the Wellcome Foundation, 1955, is an ‘industrial’ film, shot in colour with an upbeat tone, communicating the optimism of the era. Research into malaria is revealed as beginning as early as 1901 and the film shows an image of Wellcome’s floating laboratory on the Nile. The Wellcome Building in the mid-1950s is shown to be a hive of activity at the cutting edge of research into the quest for cures for many debilitating and life threatening tropical diseases – many of which are still being pursued by Wellcome Trust-funded scientists today.

Find out more about malaria research on the Wellcome Trust Malaria website.
You can learn about the Wellcome Film project here. If you would like to make use of this archive footage in your own projects, please visit the Wellcome Library catalogue to download the original files, which are distributed under a Creative Commons Attribution-Non-Commercial 2.0 UK: England & Wales licence.
http://wellcometrust.wordpress.com/2011/04/26/wellcome-film-of-the-month-malaria/

MALARIA: Ghana: Malaria Day in Ghana, a reflection of the odds

25 April 2011
Hayford Siaw, Executive Director : Volunteer Partnerships for West Africa


According to the World Health Organization report on malaria in Ghana, US$27million and US$38million was spent on Malaria in 2008 and 2009 respectively. In spite of the huge amount of money invested, Ghana still recorded very worrying figures with 3,694,671 cases in 2009 compared to 3,200,147 in 2008. Admission to hospitals due to malaria also went up from 272,802 in 2008 to 277,047 in 2009. Death due to Malaria from the records of clinics and hospitals stood at 3,378 in 2009.
It must be noted that, the National Malaria Control Program (NMCP) is on record in it strategic plan that 70% of the Ghanaian population rely on traditional medicines. The absence of data from traditional medicine providers therefore should raise concern on the number of malaria deaths and sickness that goes unreported.
The increase in the scourge of malaria should be accepted as a failure on leadership responsible for controlling and or eliminating Malaria in Ghana. Indeed, the National Malaria Control strategic plan is a failed policy program and should therefore be re-examined. There is too much wastage on personnel instead of actual resources going into interventions that will help reduce both cases of admission and deaths. Over 30% of money allocated for Malaria Control went into Human Resources alone.
Historically malaria has been the cause of deaths all over the world. Of course it is no longer a threat to the developed world and has been modified in the developing countries with the exception of Sub-Saharan Africa where it is endemic. The United States was one of the first Western Counties to eliminate malaria, due to an extended campaign using surplus military aircraft left over from World War 2 which was equipped with insecticide dispersal systems necessary to dispense DDT as a Dust or liquid. This operation was a success and by 1950 only 5 years after the end of the war the Center for Disease Control in Atlanta Georgia, declared the United States malaria free.
Mr. Robert Desowitz in his book THE MALARIA CAPERS writes; from colonial times until the 1940s, malaria was the American disease. One of the first military expenditures of the Continental Congress was for $300 dollars to buy quinine to protect General Washingtons troops. During the Civil War one half of the white troops and four fifths of the black soldiers of the Union Army were stricken with malaria annually.
The malaria mosquito has the reputation of being 9 feet tall in Sub-Saharan Africa, more feared than the mighty crocodile. The truth be told, it is just an insignificant noisy insect, a biological creature, just like us. If the humble mosquito has the ability to infect humans with a parasite, humans should reciprocate in kind and infect the mosquito with an organism, to give as well as we get from this bane of mankind.
To be more specific, I would like to propose at this time we use a biological agent known as a fungus spore. There is a product in commercial production in the United States, used on organic farms that also have applications for the control of adult mosquitoes. Research done on malaria mosquitoes has indicated only one spore has the ability to kill a mosquito. Although it may take up to 10 days to kill the mosquito, after 2 days the mosquito no longer feeds. This product is a soil fungus, most soil insects are immune to its effects. However an airborne insect like the mosquito has no natural immunity to this spore and according to research done at UC Davis in California, the mosquito will never develop immunity to this fungus. When exposed the mosquitoes were 80 times less likely to transmit malaria.
According to Dr. Kenneth D. Vernick, a microbiologist at the University of Minnesota stated a soil fungus that devoured insects, whose mosquito-killing powers were described by British scientists last year, could be used to hunt down the most malaria-susceptible bugs in any swarm and knock them out of the gene pool. He also said for unknown reasons, it weakens plasmodium-carrying mosquitoes more than it does others. Even after exposure to a 12 day old spray, 89% of the mosquitoes died.
This is good news as plasmodium falciparum is the most dangerous parasite of the four malaria parasites that infect man and the most prevalent by far in Ghana where it comprises up to 98% of infections.
This is all fine and dandy you might say, however, how is this fungus spore to be delivered to the recipient, the malaria mosquito? The same way the Americans did it 60 years ago, using aircraft equipped with insecticide, aerosol generators. This is the only effective method.
WHO writes in it 2010 report on Ghana, ‘’there is no evidence of a reduction in suspected malaria cases between 2000 and 2009, while inpatient cases in all ages increased’’.
http://www.ghanaweb.com/GhanaHomePage/NewsArchive/artikel.php?ID=207445

MALARIA: The argument for DDT

Donald Roberts : 17 Mar 2011

Cloaked in presumptions of an enlightened understanding of malaria, its history and evolution, Sonia Shah's "The Fever" presents a subtle array of denunciations and smear tactics against the tools, the methods, and even the motivations of key individuals who endeavored to control malaria, both past and present. Shah comes across as a journalist who is looking for fame. She describes herself as hating mosquitoes, but perhaps she hates people more.
"The Fever" is a book written to charm and soothe other people like herself, the armchair environmentalists who think people are the problem—and who want to eradicate DDT and other essential public health insecticides, not eradicate malaria.
In contrast to Shah, I am an entomologist who has worked for 45 years to combat malaria, and I state unequivocally, from my experience in the developing sector, that DDT is an essential part of the armamentarium against malaria, and that indoor residual spraying with DDT is most effective in stopping the spread of malaria. The key here is the unique spatial repellency of DDT: Mosquitoes, even those that are DDT-resistant, are repelled by DDT and, more often than not, do not enter a house that has been sprayed.
I say this at the outset of this review, because it is crucial to keep in mind that Shah's denunciations of past and present programs to control or eradicate malaria are consistent with those who are responsible for allowing malaria to continue to kill millions of people—instead of eradicating the disease. My intention here is, for the record, to counter some of the misstatements Shah makes to build her case that malaria isn't all that bad.
Full review available at http://www.21stcenturysciencetech.com/Articles_2011/Winter-2010/Books_The_Fever.pdf
http://www.fightingmalaria.org/news.aspx?id=1592

MALAROA: Malaria threatens Tanzania's highlands as temperatures rise

01 Mar 2011 12:55 alertnet // Felix Mwakyembe

 Rungwe District malaria coordinator, Gideon Ndawala, oversees a nurse attending malaria patient Asha Nsasu. ALERTNET/Felix Mwakyembe

MBEYA, Tanzania (AlertNet) – Tanzania’s southern highlanders have long worried about pneumonia and other respiratory illnesses brought on by the cool, wet weather. But as climate change contributes to warmer temperatures in the region, residents are facing a new health threat: malaria.
In Rungwe, a highland district in the south-western Mbeya region bordering Malawi and Zambia, malaria is fast replacing coughs, fever and pneumonia as the most serious local health problem.
The change has taken by surprise the region’s residents, who live over 1,000 metres (3,200 feet) above sea level and outside Tanzania’s traditional malarial zones.
Asha Nsasu, 32, of Isebe village, had no idea she had contracted malaria when she was sent to Makandana District Hospital in late December.
“I felt weak. I thought it was pneumonia,” Nsasu said. “Then they told me it was malaria.”
In 2009, health centres in Rungwe district reported 100,966 malaria cases, a jump of 25 percent from 2006, hospital records show.
Malaria is now the biggest public health threat facing Rungwe district, which lies about 940 kilometres (590 miles) southwest of Dar es Salaam, according to the Tukuyu Medical Research Centre, part of the National Institute for Medical Research.
One third of outpatients visiting the hospital were diagnosed with the mosquito-borne illness in 2007, according to records from that year, making it the most common disease for outpatients.
Most highland areas in the east African country are experiencing a growing burden of malaria cases, officials at the Tukuya Centre said.

TREES DOWN, TEMPERATURES UP
Climatic changes brought on in part by local environmental degradation are contributing to the growing prevalence of malaria in the district, said Gideon Ndawala, Rungwe district’s malaria coordinator.
“People have cleared the forests, rain has decreased, temperatures have risen,” Ndawala said in an interview.
“(When) I first reported on the district in 1983, it was very cold and it rained throughout the year except from mid-September to early November. The weather was not favourable for mosquito breeding,” he said.
Now, however, temperatures are higher and rain more erratic, he said, and mosquito populations – which thrive on warmer temperatures and breed in pools of stagnant water – are on the rise.
Worst hit by the surge in malaria are Tukuyu district town, Ikuti, Rungwe Mission and Ilolo, according to district health officials.
Half a century ago, these traditionally cool areas saw no mosquitoes and did not register any malaria cases, but now the weather is warmer, said Ambakisye Joram Mwakatobe, a 76-year-old man from Bulyaga village in Rungwe.
“In the past, we never saw mosquito nets here. I saw a net for the first time at the age of 20, when I joined Butimba Teachers College in 1957,” he said, in an interview at his village home.
Mwakatobe said cases of malaria began to appear several decades ago but residents did not relate them to warming temperatures, believing the mosquitoes instead were arriving on buses from lower regions.
“It was in the 1970s when we started getting malaria here. I thought it was the buses from Kyela and Usangu that brought mosquitoes,” he admitted. But “the weather also started to change in those years,” he said.
A half-century ago, “it was very cold here and it rained throughout the year. Three things were compulsory: a sweater, pullover or heavy jacket; an umbrella or raincoat; and gumboots,” he added. “There was frost all day long and cars had to put their lights on.
“But today things have changed,” he said. “Look, now we even put on light shirts. There is no need for sweaters, gumboots or umbrellas.”
Scientists agree that the changing weather is feeding into Rungwe’s worsening malaria problem.
“Up until 1960, districts like Rungwe, Mbeya, Mufindi, Njombe, Makete and Iringa in the southern highland regions were malaria free. Today is quite different - malaria prevalence is high,” said Akili Kalinga, a research scientist at Tukuyu Medical Research Centre.

GOVERNMENT ACTION
Malaria accounts for 30 percent of the burden of disease in Tanzania and is a huge drain on productivity, according to a report produced by research scientists for the Sixth Africa Malaria Day in 2006.
In response to the rising malaria caseload, the government is taking steps to stem the disease’s expansion.
Measures include public health education in newly vulnerable districts on home cleanliness and water storage, how to eliminate the places of still water where mosquitoes live and breed, and the use of mosquito nets and fumigation, said Dr. Sungwa Ndagabwene, Rungwe’s medical officer.
“The government is taking serious measures to fight malaria. We started with a ‘mosquito nets for all’ campaign – saying every person should sleep under bed nets,” Ndagabwene said.
The government also has begun spraying the inside of homes with insecticide, first in the Kagera region and now throughout the Lake zone, near Lake Victoria, he said. It plans to expand the spraying program, which has helped cut malaria transmission in Zanzibar, to the rest of the Tanzania’s malaria-affected regions.
Such spraying programs aim to kill mosquitoes that land on the inside walls of homes. Spraying can protect homes for between four to ten months depending on the insecticide, according to the World Health Organisation (WHO).
WHO has approved 12 insecticides it considers safe for such spraying programs, including DDT - a controversial endocrine disruptor that has proved one of the most effective ways to control mosquito populations but that has also been linked to environmental damage and health problems including cancer.
Ndagabwene said spraying the chemical only indoors limited its environmental impact. WHO officials have said they believe the benefits of using the pesticide outweigh its risks.
The Stockholm Convention bans the use of DDT but exempts countries that choose to use the chemical to control malaria.
Tanzania is one of the world’s worst malaria-affected countries, recording 14 to 18 million clinical cases annually and 60,000 deaths, 80 percent of them in children under five years old, according to a 2010 malaria reduction plan put together by U.S. AID.
Children under five and pregnant women are most affected by the disease, Tanzanian health figures show.

Felix Mwakyembe is a freelance writer based in Dar es Salaam. This story is part of a series supported by the Climate and Development Knowledge Network.
http://www.trust.org/alertnet/news/malaria-threatens-tanzanias-highlands-as-temperatures-rise

MALARIA: A Disease Close to Eradication Grows, Aided by Political Tumult in Sri Lanka

Lynsey Addario for The New York Times

By DONALD G. McNEIL Jr.: Published: December 27, 2010
 Malaria cases jumped 25 percent in Sri Lanka from 2009 to 2010, the country’s ministry of health is reporting. And while this year’s total is still small, at 580, the trend is unsettling to experts.
Sri Lanka is a bellwether for the dream of malaria eradication — and Exhibit A for the argument that politics affects the disease more than climate or public health measures do.
The country — the former British colony of Ceylon, famous for tea and cinnamon — is an island, so eradication is possible.
That almost happened once. After independence arrived in 1948, Sri Lanka had an estimated one million annual cases. With DDT and chloroquine, it drove that down to 18 cases by 1963. But spraying was cut back as DDT fell into disfavor, and by 1969, there were more than 500,000 cases.
Simultaneously, the country’s ethnic fabric fell apart. The majority Buddhist Sinhalese passed laws discriminating against the Hindu Tamils, who were favored under the British, leading to 30 years of civil war. The majority was also split for decades between pro-Soviet and pro-Western factions.
Malaria persisted, with cases highest in the north and east, where the Tamil Tiger insurgency was strongest. Nonetheless, by 2005, the country was below 2,000 cases, though experts said they were undercounted in rebel areas.
Last year, the rebellion was crushed, and malariologists hoped the new national reconciliation policy would lead to eradication. As cases ticked up, a ministry official blamed global warming — a weak argument in a wet tropical country. But he also said more clinics would be opened in former rebel areas.
http://www.nytimes.com/2010/12/28/health/28global.html?ref=health

MALARIA: Sex drive comes first in malaria fight

December 10 2010 Reuters
Sapa-AFP
  The controversial insecticide DDT should not be used to fight malaria in Malawi because it reduces men's sexual performance, a newspaper report quoted a government official as saying. Photo: Reuters

Blantyre - The controversial insecticide DDT should not be used to fight malaria in Malawi because it reduces men's sexual performance, a newspaper report on Friday quoted a government official as saying.
“The side effects of DDT in men are that men easily get tired, there is reduction in libido and sperm production,” Andrew Daudi, principal secretary in the ministry of agriculture, was quoted as saying by the Weekend Times.
The insecticide is banned in Malawi as in most other countries but members of parliament's Committee on Health and Population have called for its return despite its dangers to the environment.
They say it is more effective than other chemicals used to kill malaria-carrying mosquitoes responsible for the deaths of thousands of people here every year.
Rabson Chirwa, an MP also quoted in the report, disagreed with Daudi.
“Should we be dying of malaria because men want to produce more sperm and because men want to have libido? These reasons do not hold water,” Chirwa said.
Neither referred to the chemical's detrimental effect on wildlife, the environment and human health, which led to it being banned by the United States in the 1970s and most other nations subsequently.
Malawi's campaign to fight malaria by providing free or cheap mosquito nets has failed to curb the number of deaths caused by the disease, the government said in March, prompting some MPs to argue that the use of DDT is merited.
Up to 7,000 Malawians died of malaria in 2009, with 4.5 million cases recorded. Health experts say the government spends about seven million dollars (5.3 million euros) annually to treat malaria cases.
DDT (Dichloro Diphenyl Trichloroethane) is a contact poison that can ward off disease-carrying insects such as mosquitoes. It was used to great effect to fight malaria during World War Two, leading to its widespread subsequent use in agriculture. -
http://www.pretorianews.co.za/sex-drive-comes-first-in-malaria-fight-1.1000059

MALARIA: Can We Simplify Malaria History?

Scientific American is known for making the latest scientific advances - from dark matter to disease management - accessible to a wide audience. An article in the November 2010 issue on malaria vaccine progress is generally a good example. The following passage though, may simplify the history of eradication a bit too much.
In the 1960s an enormous campaign wiped out the disease in many parts of the world and drove down its number in others. But that success ultimately bred its own end. As malaria became perceived as less of a threat, global health agencies became complacent; their chief tool, DDT, was found to be toxic to birds, and they largely abandoned their efforts. Malaria numbers roared back more fiercely than before.
Two specific issues from the foregoing do not paint the full picture. First, bird deaths did not stop malaria eradication, though the toxicity issue is true in its own context. The real end of DDT was bred by mosquitoes developing resistance to the pesticide, which was discerned even before the campaign reached its height. The Lancet in reviewing Randal Packard’s book, The Making of a Tropical Disease, a Short History of Malaria, explained that …It (the eradication campaign)was far too monodimensional, relied too much on DDT spraying, and neglected the palpable problem that the delivery infrastructure was not in place in too many parts of the malarious world. The emergence of widespread mosquito resistance to DDT, and parasite resistance to the cheap mainstay of therapy, chloroquine, compounded the difficulties.

Secondly, at least for colleagues in the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), malaria research overall did not halt. Surely the funding levels were not as high as we see today, but persistent research provided us with new tools including insecticide treated bednets, artemisinin-based combination therapy, and nearly a dozen insecticides for indoor residual spraying, for which we are thankful.
True, these additional tools do not confer permanent immunity as a vaccine eventually should, but their implementation has driven down the number of malaria deaths in many countries, and when a vaccine comes along to strengthen the toolkit, we will be farther down the long road to elimination. The malaria lifecycle is complex, and health systems designed to deliver malaria interventions is equally complex (and challenging), which means we cannot and should not expect a magic bullet in the near future.
As Randal Packard pointed out a key lesson from the first eradication campaign needs repetition, lest we again blame it all on the birds. Aside from developing insecticide resistance, there was clear indication that the health systems in the most highly endemic areas were not able to maintain continuous IRS application.
Health systems are stronger today, due in part to recognition by partners (international and internal) that malaria cannot be controlled, much less eliminated, without health system strengthening. It is these same health systems that will also be required to deliver the new malaria vaccines, so they better be strengthened before vaccines are rolled out.
Another short note of concern about the Scientific American article - in a box entitled “Plan B: Vaccine Alternatives” we are correctly shown that the effort to eliminate malaria has other tools that must be sustained. Unfortunately the text refers to malaria as a ‘virus’, though elsewhere in the article the stress on ‘parasite’ prevails.
http://www.malariafreefuture.org/blog/?p=1111

MALARIA: The Making of a Tropical Disease: A Short History of Malaria

The Making of a Tropical Disease: A Short History of Malaria by Randall Packard
Johns Hopkins University Press, 2008

Of all diseases, malaria is perhaps the one with the most subtle interplay with human history. It has long affected human beings, and has left its genetic mark on modern populations. Thalassaemia, glucose-6-phosphate dehydrogenase deficiency, sickle-cell trait, the Duffin antigen, and several other genetic variations owe their prevalence to the disease. The disease acted as a barrier to European imperialism and rendered many areas of the world, even in Europe, largely unproductive. Malaria thus influenced, and its incidence has been in turn influenced by, agricultural practices from time immemorial. It is perhaps the most ecologically sensitive of all human diseases.
This ecological imperative drives Randall Packard's powerful narrative in The Making of a Tropical Disease: A Short History of Malaria. He recounts the repeated impact of human activity on the incidence of malaria worldwide. In the American south, the Roman Campagna, the Indian Punjab, or the Brazilian northeast, the story was much the same. Agricultural practices created niches where the relevant Anopheles species could breed. Packard's most common trope is that of sharecroppers or subsistence farmers eking out a marginal living, with no resources and no incentive to improve the land. Malaria was especially cruel in that sometimes activities that ought to have been economically sound, such as crop irrigation or railroad building, could increase its incidence.
While discussing the common themes in the early history and incidence of malaria, Packard also emphasises that malaria is the most local of widespread diseases. This fact was dimly perceived in the traditional experience of “mal aria”, the quintessential disease of place. The reasons for this became clear only after the mosquito mode of its transmission was discovered at the end of the 19th century, by Ronald Ross (1857—1932), working in India, and Giovanni Battista Grassi (1854—1925), working in Italy, two malarious countries. In the decades that followed, the variable breeding habits and life-cycles of the many species of Anopheles that can spread malaria worldwide were gradually elucidated, as well as the reasons why strategies for malaria control had to be tailored to meet the variable social, economic, and ecological realities that were encountered.
The discovery of the role of Anopheles in the transmission of malaria created a period of optimism. The discovery that yellow fever, too, was transmitted by mosquitoes, and the successes in containing these two insect-borne diseases in Cuba, Panama, and elsewhere seemed to bear out the simple equation: control relevant insects and you control the disease.
These early successes were not easy to duplicate, however, and malariologists during the interwar period became polarised: those who believed that the control of malaria in an area would lead seamlessly to economic development, since a healthy population could transform a society; and those who held that the key to the malaria problem was economic prosperity in the first place. The latter group took the history of malaria in England as paradigmatic: “agues” and intermittent fevers had long been prevalent in marshy, badly drained areas of England, but had gradually disappeared from the 18th century, as England modernised. These two positions translate roughly to modern debates about vertical and horizontal malaria programmes, and although Packard clearly has more sympathy for the horizontal approach, he also reports modern studies that suggest that the dichotomy is not so simple. Indeed, Ross, generally a passionate advocate of vertical, insect-directed initiatives, also firmly believed that malaria eradication needed all effective approaches; both/and, not either/or, was his message.
Much of the subtle, ecologically and clinically sensitive knowledge so painfully gained during the interwar years was lost in the dichloro-diphenyl-trichloroethane (DDT) era. Packard allows himself one of the two iconic jokes of modern malariology, that DDT did not eliminate malaria, only malariologists. (The other story, not recounted here, is that Leonard Bruce-Chwatt, during one of the 1950s debates on DDT, suddenly folded his hands together, closed his eyes, and loudly intoned, “Let us spray.”) Almost half of Packard's book is devoted to this modern period, and he has much to say about the reasons why WHO's Global Malaria Eradication Programme, instituted in 1955, was abandoned in 1969. It was far too monodimensional, relied too much on DDT spraying, and neglected the palpable problem that the delivery infrastructure was not in place in too many parts of the malarious world. The emergence of widespread mosquito resistance to DDT, and parasite resistance to the cheap mainstay of therapy, chloroquine, compounded the difficulties. Excessive DDT use in agriculture was unfortunate, and its long-term environmental consequences concerned many. The programme also cost more than donor countries were prepared to countenance, or recipient countries could afford.
Packard is always dispassionate, never needlessly accusatory, but he also provides the evidence for the real mistake in the 1969 decision to pull the plug on the eradication programme. Although it had not achieved its goal in many parts of the world, it had achieved much. In the panic of abandonment, the international funding agencies forgot Ross's message: both/and. Instead of cutting off almost all malaria aid, the international community should have returned to the more diversified strategies of an earlier era. Despite all the difficulties in the late 1960s, and the problems since, the world was less malarious when WHO's eradication programme ended than when it began.
One must not put too optimistic a spin on contemporary malaria, and Packard offers some useful comparisons of the similarities and differences between the current Roll Back Malaria initiative and the eradication ambitions that preceded it a generation ago. Tellingly, Packard returns to the kind of analysis with which he began his book, in the traditional period of malaria. Focusing especially on Zambia, he shows how the same environmental and economic factors have coalesced to produce malaria in a country that was once the most prosperous in Africa. Packard argues that countries whose economies are based too intimately on one or two major industries (copper mining in Zambia) are especially vulnerable to fluctuations in international demand. Cotton production, for example, features in Packard's analysis of the contemporary malaria scene, an activity compounded by the US government's reversing fairtrade practice and subsidising its own cotton producers. Packard clearly believes that traditional socioeconomic understanding of malaria still has purchase. His is a sober message.
The Making of a Tropical Disease: A Short History of Malaria is a fine book. Its major weakness lies in the disappointing graphics. Clinical aspects of the disease are given short shrift, and few of the many larger-than-life personalities in malaria's history get their due. But this short book carries through its thoughtful approach with admirable power and consistency. Now that Bill and Melinda Gates have boldly put eradication back onto the malaria agenda, the lessons of the past acquire even more currency. Packard's book highlights how challenging the task will be.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2808%2960612-1/fulltext

MALARIA: COMOROS: The battle against malaria lies in the balance

  Photo: Guy Oliver/IRIN: A man waits for medical attention at the Wanani clinic in Moheli, Comoros

Comoros billboard protesting France's decision to incorporate Mayotte as a French overseas department. "Mayotte is Comorian and will be forever"


FOMBONI, 3 December 2010 (IRIN) - On arrival in Moheli, an island in the Comoros archipelago, you have to prove that you are taking, or have taken, anti-malarial drugs, otherwise you will have to swallow a pill provided by the authorities.
The precaution is part of a three-year campaign sponsored by the governments of Comoros and China to control or even eradicate the mosquito-borne disease by eliminating the parasites that cause malaria from the population, thereby preventing transmission of the disease.
Mosquitoes feed off an infected host, ingesting the gametocyte forms of the parasite, which then transform into infectious sporozoites and are transferred to the next human hosts when the infected mosquito bites them.
In Africa the most dangerous and prevalent malarial parasite is Plasmodium falciparum. Symptoms of the disease include fevers, vomiting, diarrhoea, anaemia, convulsions and muscle spasms, and appear about 10 days, but often longer, after a human host has been infected.
Rachadj Attoumani, who is responsible for Moheli's malaria surveillance, told IRIN that there has not been "one recorded death from malaria [on the island] ... whereas before about two or three people died each month," since the campaign began in October 2007.
The main components of the project are the mass distribution of anti-malarial drugs produced by the Chinese pharmaceutical company, Artepharm, a DDT spraying campaign, and insecticide-treated nets - which now cover 90 percent of the island's beds - provided by the World Health Organization.
Moheli has about 42,000 people, of whom about 82 percent have taken anti-malarial drugs; those who have not were either not on the island, or had refused, Attoumani said.
The drug campaign required "sensitization" of the recipients, but many, including Attoumani, had experienced debilitating and recurring malaria, and the opportunity to rid their systems of it had provided the incentive.
The medication is a formulation based on artemisinin and piperaquine that the producers say on their website "has a synergistic effect which reduces the infectivity of the [malarial] gametocytes and clears the gametocytes in their early stage, therefore blocking malaria transmission."
There has been concern about the anti-malarial drug from some quarters, as it has not been subjected to any rigorous scientific peer review.
The roll-out of the course of medication island-wide - assisted by a team of 11 researchers from China's Guangzhou University of Traditional Medicine - began with two tablets administered in the first 48 hours, a single dose on the tenth day, and then at intervals of ten days for the next six months.
Children between the ages of one and seven years were given the drug in a soluble granular form, but babies and pregnant women were excluded from the campaign.
Surveillance ahead of the project found that rates of infection varied across the island, but all leant towards endemic levels. Ndremeani had the highest rate of malarial parasites - 94 percent of the villagers were infected - in Hagnamoida 48 percent were infected, but in Fomboni, the island's capital, only about 10 percent of the people were infected. 
In the immediate aftermath of the mass drug programme, malarial parasites were reduced to 0.5 percent among the population, and were currently hovering around 1.5 percent, Attoumani said.

Islands as anti-malarial experiments
Islands have often been seen as ideal for malarial elimination because population movements are limited and the land mass is isolated, and a range of approaches have been tried.
The Mediterranean island of Sardinia, where malaria is thought to have arrived in 502 BC during the Carthaginian conquest, has been known since classical times as the "unhealthy island". Between 1946 and 1950 the Rockefeller Foundation spent millions of dollars on trying to eradicate mosquitoes - the vector for the disease - by spraying 267 tons of DDT. The experiment did eliminate malaria, but the stated objective of ridding the island of mosquitoes was not achieved.
On the neighbouring French island of Corsica a multi-pronged approach was adopted. Marshland was drained and now delivers 60 percent of the island's agricultural production. Systematic DDT spraying campaigns were carried out, coupled with the large-scale distribution of the anti-malarial medication, quinine, and the introduction of Gambusia fish, which feed on mosquito larvae, led to the eventual eradication of malaria.
If someone tests positive [for malaria], which is very rare, I immediately give them [anti-malarial] medicine, as well as their family
Mauritius was exposed to the mosquito-borne disease in 1865 and two years later experienced an epidemic that killed between an eighth and a quarter of the population in a calendar year. After a long campaign of indoor spraying, the island was declared malaria-free by the World Health Organization in 1973.
Aneityum, one of the 80 inhabited islands of Vanuatu in the southwest Pacific, successfully eliminated malaria using a similar approach to what is being tried in Moheli.
During a period of about two months in 1991 the entire population of 718 people were administered weekly doses of chloroquine, pyrimethamine/sulfadoxine (Fansidar) and primaquine, and all slept under insecticide-treated nets. A monitoring programme over the next nine years recorded only two instances of malaria, both a consequence of infections from outside of the island.

Risks of re-infection
However, the scale of the Moheli experiment sets it apart from the experience of Aneityum Island, but reducing the malarial parasite on the Comorian island is not without risk.
Attoumani said when people had malarial parasites there was also a level of immunity, but after treatment this immunity tailed off, and should "someone be infected with malaria, the symptoms will develop quickly".
In the 1940s and ‘50s the French colonial government in Madagascar began a DDT spraying and disease monitoring programme to control malaria in the highland regions of the country, but in the 1970s, more than a decade after independence, this came to a halt. A malaria epidemic subsequently broke out in the area and is estimated to have killed 40,000 people in five years.
In 11 of Moheli's 26 villages, monitoring laboratories staffed by single operators with a few months’ training, who are paid US$20 a week, take blood samples and rapidly diagnose any malarial parasites with the aid of a microscope.
Benechieq Chema, 28, studying for his baccalaureate, is on call every day in the laboratory in the village of Wanani, with a population of about 2,500 people in a banana, cassava and potato farming area about 20 km from Fomboni. He told IRIN that "maybe a couple of people will come", complaining about a fever and want to be tested for malaria.
"If someone tests positive [for malaria], which is very rare, I immediately give them [anti-malarial] medicine, as well as their family, and then inform [Fomboni] about the case," he said.
However, it is the friends or family returning to Moheli from visits or work on the neighbouring Comorian islands of Anjouan and Grand Comore, where malaria remains at high levels, that pose the greatest risk of an outbreak.

Nationwide roll-out?
Although the two main points of entry, the airport and seaport, have strict malaria controls in place, an aid worker who declined to be named, told IRIN that in reality "you cannot hermetically seal the island".
Comoros is a nation of seafarers and it is not unusual for people to arrive on Moheli on small fishing boats without going through a formal point of entry. A Moheli resident who preferred to remain anonymous told IRIN that occasionally the officials were not at their posts when a plane or ferry arrived.
Attoumani said the key to sustaining very low rates of malarial infection on Moheli, or even eliminating the disease, was the other two islands in the archipelago.
The government of Comoros is encouraging better transport links between the islands as a way of fostering greater national unity because the three-island nation has endured more than 20 coups and secession attempts since independence from France in 1975, but this also increased the risk of malaria transmission between the islands.
Attoumani said China had dispatched medicines and microscopes to the Comoros for the roll-out of the initiative on Anjouan and Grand Comore - which have much larger populations - but the Comoros government did not have the financial resources to pay staff for the monitoring component of the programme.
http://www.irinnews.org/report.aspx?ReportID=91276

MALARIA: DDT and Greenpeace

The Channel 4 film claims environmentalists were responsible for a ban on DDT, which led to the death of millions from malaria. But DDT was never banned for use as a malaria preventative.
We support the continued use of DDT in malaria control programmes where there are no effective alternatives.
We thought that an investigation by Prospect Magazine a couple years ago finally laid this myth to rest.
According to the investigators, the postwar attempt to eradicate malaria by the spraying of DDT was a failure, largely because the overuse of insecticides led to the development of resistance in mosquito populations....
http://www.greenpeace.org.uk/about/greenpeace-ddt-and-malaria

MALARIA: India: Persistent transmission of malaria in Garo hills of Meghalaya bordering Bangladesh, north-east India

Malaria Journal 2010, 9:263doi:10.1186/1475-2875-9-263
Published: 22 September 2010

Abstract (provisional)
Background
Malaria is endemic in Garo hills of Meghalaya, and death cases are reported annually. Plasmodium falciparum is the major parasite, and is solely responsible for each malaria-attributable death case. Garo hills are categorized high-risk for drug-resistant malaria; however, there exists no data on malaria transmitting mosquitoes prevalent in the region. Included in this report are entomological observations with particular reference to vector biology characteristics for devising situation specific intervention strategies for disease transmission reduction.

Methods
The epidemiological data of the West Garo hills have been reviewed retrospectively for 2001-2009 to ascertain the disease transmission profile given the existing interventions. Point prevalence study was conducted in Dalu Community Health Centre that lies in close proximity to international border with Bangladesh to ascertain the true prevalence of malaria, and parasite species. Mosquito collections were made in human dwellings of malaria endemic villages aiming at vector incrimination, and to study relative abundance, resting and feeding preferences, and their present susceptibility status to DDT.

Results
Investigations revealed that the West Garo hill district is co-endemic for Plasmodium falciparum and Plasmodium vivax, but P. falciparum was the predominant infection (>82%). Malaria transmission was perennial and persistent with seasonal peak during May-July corresponding to months of high rainfall. Entomological collections revealed that Anopheles minimus was the predominant species that was incriminated by detection of sporozoites in salivary glands (infection rate 2.27%), and was ascertained to be fully susceptible to DDT.

Conclusion
For the control of malaria, improved diagnosis and sustained supply of drugs for artemisinin-based combination therapy are strongly advocated, which should be enforced for treatment of every single case of P. falciparum. Greater political commitment is called for organized vector control operations along border/ high-risk areas to contain the spread of drug-resistant malaria, and averting impending disease outbreaks.


http://www.malariajournal.com/content/9/1/263

MALARIA: Studies of Susceptibility of Mosquitoes to Insecticides Guide Malaria Interventions in Ethiopia

In Ethiopia, indoor residual spraying (IRS) of houses with insecticide has been one of the primary tools to prevent malaria transmission for more than 40 years. Entomological monitoring activities to study mosquito behavior and their susceptibility to insecticides were originally performed decades ago to inform IRS operations, but were discontinued due to insufficient funding and lack of trained manpower. PMI recently reintroduced these entomological monitoring activities as part of its support for IRS operations in Ethiopia.
Throughout 2009, PMI supported entomological monitoring activities at 11 sites in Oromia Regional State in order to determine and characterize the dominant mosquito species in the area, as well as test mosquitoes’ susceptibility to three classes of insecticides.

The findings from the entomological monitoring activities indicate that Anopheles arabiensis is the predominant malaria vector in Ethiopia and that this mosquito displays varying levels of susceptibility to the tested insecticides. Susceptibility to organochlorine insecticides such as DDT was shown to be low in all sites assessed, with only 0 to 35 percent of mosquitoes killed 24 hours after insecticide exposure. Susceptibility to pyrethroid and organophosphate insecticides was more variable (46 to 76 percent and 68 to 100 percent, respectively), however, and susceptibility to carbamate insecticides was shown to be high (96 to100 percent). The susceptibility to tested insecticides largely depended on prior insecticide use, with organochlorines and pyrethroids having been extensively used in previous IRS operations and in the agricultural sector, respectively.
Ethiopia is currently scaling up IRS activities as one of the interventions to eliminate malaria in the country. “The findings are crucial to ensure that future IRS operations will remain effective and will have the desired impact on malaria transmission,” says Alemayehu Getachew, focal person for PMI’s IRS implementing partner.
Along with its support for IRS operations in Oromia Regional State, PMI will continue to support entomological monitoring activities, as well as assist other in-country malaria stakeholders to expand monitoring activity into other regions of Ethiopia.
http://www.pmi.gov/news/voices/ethiopia_intervention.html

MALARIA: Cleaner environment lowers incidence

For over half a century, the battle against malaria has been waged with powerful anti-malarial drugs and potent mosquito-killing insecticides, weapons born from the wonders of synthetic chemistry. In recent years, however, fed up with the financial and ecological drawbacks of chemical warfare, malarious communities from China to Tanzania to Mexico have been forging a new way to fight the scourge, one that draws inspiration from the lessons of ecology more than chemistry. Rather than attempt to destroy mosquitoes and parasites outright, these new methods call for subtle manipulations of human habitats and the draining of local water bodies — from puddles to irrigation canals — where malarial mosquitoes hatch.The most striking example comes from Mexico, which has completely abandoned its previously lavish use of DDT in malaria control for insecticide-free methods and has seen malaria cases plummet.Like many countries, Mexico for decades relied upon insecticides to fight the disease, by spraying mosquito-killing chemicals on the interior walls of homes where blood-feeding mosquitoes rest, among other methods. Between 1957 and 1999, taming Mexico’s malaria required 70,000 tons of DDT.New, environmentally-sensitive methods, such as clearing vegetation along waterways and around homes, were introduced in Oaxaca, the country’s most malarious region, in 1998. By 2002, malaria cases had fallen from more than 17,500 to just 254, and Mexico incorporated the new methods
In Oaxaca, officials recruited volunteers to remove algae and trash from rivers and streams.into its national anti-malaria program. By 2000, Mexico had completely phased out use of DDT in malaria control; by 2002, it had phased out all other insecticides in malaria control as well, while simultaneously keeping malaria in check. No deaths from malaria were reported in Mexico in 2008, the most recent year of data available from the World Health Organization.Similarly, in Sichuan, China, new, non-chemical methods involving the manipulation of water flow in irrigation canals have led to the near cessation of malaria, with malaria rates plummeting from 4 per 10,000 in 1993, to less than 1 per 10,000 by 2004. In several counties of the province, no malaria cases were reported at all between 2001 and 2004. Similar non-chemical gains against the disease have been achieved in Dar es Salaam, Tanzania, as well.
http://www.e360.yale.edu/content/feature.msp?id=2270

MALARIA: Haiti

On top of the almost unimaginable devastation caused by January's earthquake in Haiti, the nation is bracing for the ravages of the rainy season. Torrential downpours have already flooded homes and turned tent cities into muddy misery. Ominously, the number of cases of malaria, which is spread by the bite of mosquitoes and which was endemic in Haiti even before the earthquake, is increasing.
To reduce the incidence of malaria, various aid groups are planning to distribute more than 3 million bed nets, an ultra-low-tech, only modestly effective intervention. What is really needed is the chemical DDT, an old, cheap and safe tool to control the vector -- the Anopheles mosquito -- that spreads the disease.
Malaria is a scourge of humanity, particularly for the inhabitants of poor tropical countries. Forty-one percent of the world's population live in areas where malaria is transmitted, and each year 350 to 500 million cases of malaria occur worldwide. The disease imposes huge costs on individuals, families and governments, which are a crushing economic burden on malaria-endemic countries and impede their economic growth. It has been estimated that economic growth per year of countries with a high incidence of malaria was 1.3 percentage points lower than that of similar countries without malaria.
A drug called chloroquine is a useful preventive but many strains of the malaria parasite in Haiti have developed resistance to it. Other drugs called artemisinins are safe and exhibit potent, rapid antimalarial activity, and in combination with other anti-malarials they have been used effectively for several years to treat multiple-drug-resistant malaria. But resistance has arisen and is increasing, so that in the absence of a vaccine elimination of the mosquitoes that spread the disease is the key to preventing epidemics.
Unfortunately, flawed public policy limits the available options.
In 1972, on the basis of data on toxicity to fish and migrating birds (but not to humans), the U.S. Environmental Protection Agency banned virtually all uses of the pesticide DDT, an inexpensive and effective pesticide once widely deployed to kill disease-carrying insects. DDT was subsequently banned for agricultural use worldwide under the 2001 Stockholm Convention on Persistent Organic Pollutants, which stigmatized the chemical and effectively constituted a prohibition.
Although DDT is a (modestly) toxic substance, there is a vast difference between applying large amounts of it in the environment -- as farmers did before it was banned -- and using it carefully and sparingly to fight mosquitoes and other disease-carrying insects. DDT remains largely near where it is sprayed, and no study has ever linked environmental exposure to DDT to harm to human health.
When DDT is used at all now, it is sprayed indoors in small amounts to prevent mosquitoes from nesting, so exposures would be low. A basic principle of toxicology is that the dose makes the poison, and with modern regimens, both environmental and human exposures would be very low.
The regulators who banned DDT failed to take into consideration the inadequacy of alternatives. Because it persists after spraying, DDT works far better than many pesticides now in use, some of which are toxic to fish and other aquatic organisms. With DDT unavailable, many mosquito-control authorities are depleting their budgets by repeated spraying with short-acting, marginally effective insecticides. Read more: http://www.miamiherald.com/2010/05/03/1610610/ddt-can-stymie-malaria-carrying.html#ixzz0oqSp6Fr8