Simply, these are insecticide treated nets, prophylactic and curative malarial drugs and indoor residual sprays. Despite increased funding for these initiatives to over 1.94 billion dollars, the decline in the number of deaths due to malaria has decreased only by 20%. One in 5 child deaths is still related to malaria in Africa. Pregnant women, children and adults are still dying - the burden on families, economies and medical systems is horrendous.
I have been travelling to sub-Sahara Africa since 2007. My sojourns have been limited to Ethiopia, Southern Sudan and Nigeria. I have discussed the malaria problem with federal and regional politicians and administrators, with medical personnel and with villagers. I have been to areas off the beaten tourist path and would like to give you some of my thoughts and observations on the matter.
Apparently 289 million bed nets were delivered to the African sub-Sahara region by the end of 2010 - a lot of nets! When asked if they use them, the response is, "On cool nights, not when it's hot." In malaria season it is always hot. I can tell you from personal experience it is stifling and uncomfortable. I suspect it is difficult for anyone to sleep under a bed net. Think about it, how many 5 year olds and pregnant women are in bed to sleep between the hours from 6:00 to 9:00 p.m. when malaria mosquitoes are believed to do their peak biting, not many. A tidbit of additional information, scientists have observed for some time that the malaria mosquito does not limit its vampire habits to the confines of a home.
In a recent presentation at the American Mosquito Control Association annual meeting, it was revealed that mosquitoes in some parts of the world have been observed to be resting on permethrin treated bed nets without adverse affects. In other words they are not dying, they are not repelled ... they are developing resistance.
It was also reported that the nets were expected to last 5 years before replacement. Reality, they are usable for only two to three years. Is there anybody in the market for 289 million slightly worn and torn bed nets - have we got a deal for you?
The nets are primarily available for pregnant women and children under the age of 5. Older people, men, women and children either have malaria or get it. Some get sick, some die, most survive but I suspect that many are more likely to succumb to other maladies because of it. They are reservoirs for the transmission of the disease by the Anopheles mosquito to other people.
Regarding the prophylactic medical treatment of pregnant women and children under 5 years, it really is not universally available. On my recent trip to Juba, Southern Sudan, a village elder in Kator payam told me a pregnant woman had died recently from malaria.
I was at a clinic outside of Gambella, Ethiopia in 2007 and met the nun who ran the small hospital. She was swamped with 2000 malaria cases. The drugs were received and applied but with no response. An investigation revealed that the shipment was not kept in a refrigerated truck during transit and was rendered useless.
Despite the efforts to develop new malaria medications, resistance is a constantly evolving problem. Black market drugs and under dosing complicate matters further.
Indoor residual sprays with DDT has come into favour once again over the past few years and justifiably so. Unfortunately, resistance has been reported. One scientist commented that adult mosquitoes were observed with DDT crystals on their legs with no ill effect.
The malaria pathogens and their mosquito vectors will forever change and evolve, challenging our efforts to reduce significantly the incidence and impact of the disease. It is my humble opinion that the phrase "global eradication" is not applicable to malaria, at least not in my life time. With the current initiatives, malaria certainly will not be eradicated in Africa by 2015. A more realistic goal is malaria managed communities.
We must change our tactics. Malaria and other mosquito vectored diseases are being managed well in the U.S, Canada and Europe. It is done primarily with vector management technology involving mosquito larvicides and adulticides.
In the 21st century, control of diseases like malaria and West Nile virus in developed countries is all about vector control. Modern mosquito larvicides, adulticides and modern application technologies are doing the job. I thought that it was worth repeating.
Put another way, developed countries do not use bed nets, indoor residual sprays and rely very little on medicine to control mosquito vectored disease. Yet these countries are funding and promoting this current three-pronged approach in third world countries. Is this hypocrisy or ignorance? Angelina Jolie, George Clooney, Bill Gates ... any comments?
Africans are well informed and those that I have met are asking, "Why not vector control?" meaning larviciding and perhaps adulticiding. However, I am stepping the question up a notch, "Why not Integrated Vector Management?
We really do need to "rethink." I am not suggesting that we eliminate the current approaches, they have their place. But if we really want to address malaria and the human condition in third world countries, we need to incorporate integrated vector management in the program.
We should financially support the transfer of integrated vector management technology, the training of people at the grass roots level and the implementation of programs at the community level. Further, we should support the development of their self reliance and the incorporation of our technology into African cultures as they see fit to do.
Suggested Authors With Articles Supporting the Argument for Vector Management:
Utzinger et al. 2001
Killeen et al. 2002
Wilson 1943
Shousha 1948
De Castro et al. 2004
Fillinger et al. 2009
Just Google the name and date. Also Google Stephen Ghana Conspiracies 2011; I give him credit for some of the points in this article.
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