Malaria: Walking the Talk

Published on 15th July 2008

More than 2 billion people worldwide are at risk of getting malaria. Up to 500,000,000 contract it every year, mostly in sub-Saharan Africa. The disease kills nearly a million African children annually, making it the continent's greatest executioner of children under age five.

In Uganda, a nation of 30 million people, malaria is highly endemic in 95 percent of the country. According to the U.S. Centers for Disease Control, malaria affects nearly 30 percent of Ugandan adults, 20 to 50 percent of older children, and 50 to 80 percent of young children. Because malaria often strikes victims multiple times in a single year, 60 million cases of malaria caused 110,000 deaths in 2005 in Uganda.

In Uganda's Apac District, a person is likely to be bitten 1,560 times a year by mosquitoes infected with malaria parasites. The disease perpetuates poverty--sick people can't work--and it increases deaths from HIV/AIDS, tuberculosis, diarrhea, and malnutrition.

Activist Roadblocks

Controlling and eradicating malaria should be a global priority, but many governments and non-governmental organizations fail to take sufficient measures. Others, such as the Pesticide Action Network (PAN), actively oppose vital interventions.

PAN, an environmental group active in more than 60 countries, opposes all pesticide use and actively seeks to ban necessary pesticide applications in favor of less effective "natural" alternatives.

The United Nations organization UNICEF partners with Malaria No More (MNM), a nonprofit organization founded in 2006 to combat malaria in Africa, to raise money from donors, distribute educational materials and long-lasting insecticide-treated bednets (LLINs), and provide anti-malarial drugs.

According to the MNM Web site, "sometimes" the two groups organize teams to spray insecticides on the inside walls of houses, to "kill the female mosquito after she feeds on a person" (which can of course lead to infection before the insect is killed). Under "some special circumstances," the two groups support treating mosquito breeding sites, if the larvacides are deemed "environmentally friendly."

Those limited measures help reduce disease and death tolls, but they will not result in No More Malaria. Until the procedures regularly include larvacides and insecticides to control mosquitoes, and DDT where appropriate to keep mosquitoes out of houses, UNICEF and MNM will not reduce malaria cases and deaths to what moral people would deem tolerable levels--close to zero.


Bed Nets Inferior

Kenya claims widespread distribution of LLINs cut malaria deaths in half, at least while regular compliance was monitored. But that means 15,000 people still die annually. For Uganda, a 50 percent reduction using bednets would mean 30,000,000 cases and 55,000 deaths.

Uganda's Ministry of Health recently studied 410 children who had been given LLINs and instructed in their proper use. Within three weeks, 52 percent of the children were again infected with malaria.

"The use of nets relies greatly on behavioral change and compliance, while indoor spraying eliminates that factor and protects everyone in the sprayed house," noted John Rwakimari, director of the Uganda Malaria Program, an official branch of the Uganda health ministry.


All Weapons Needed

To achieve morally defensible levels of malaria, countries require comprehensive, integrated programs that include every weapon in the arsenal. None is appropriate in all places, at all times, but all must be available so they can be employed when and where appropriate.

That is why the U.S. Agency for International Development (USAID), the President's Malaria Initiative, and the World Health Organization (WHO) say larvacides and insecticides are essential in the war on malaria and are safe for people and the environment.

Larvacides, insecticides, and DDT--in conjunction with nets and other interventions--can dramatically reduce the number of malaria victims.

In addition, it is important to ensure people who become infected are treated with ACT drugs. Using this approach, Botswana, South Africa, Swaziland, and Zanzibar have largely eradicated malaria.


Ugandan Success

Uganda, where I just spent a week on an anti-malaria mission, is using all these weapons. It has sprayed 95 percent of households in Kabale District with Icon, a highly effective insecticide, and slashed the incidence of malaria parasites in residents from 30 percent before spraying to 3 percent afterward.

Three other districts also have been sprayed, and Uganda's Health Ministry plans to spray another 15 highly endemic areas, including the Apac District, in 2008. In January it added DDT to its program for indoor residual spraying that will keep at least 70 percent of mosquitoes from entering homes for up to six months, with a single application.

Radical environmentalists still oppose DDT and other spraying programs, and some USAID and WHO staff continue to undermine efforts to utilize chemical interventions. However, Uganda is adamant about ending the needless slaughter of its children and parents. President Yoweri Museveni, Director General of Health Services Sam Zaramba, and other leaders know DDT will save lives.

 


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