World Malaria Day

This past week has seen World Malaria Day, aimed at focusing the world's resources on irradicating this ancient and terrible disease. On Sunday I caught and article in the Washington Post, 'Eradicating Malaria Worldwide Seen As a Distant Goal at Best'
The article, well written and compelling, stirred me to write down my thoughts on the subject.

I live in a place that has the highest number of infected mosquitoes in the world, a District in northern Uganda. That's what the Ministry of Health and WHO tell me. It also has the third highest fertility rate, 1.2m babies born each year. Average age of population 14.9yrs. Put the two together and you get a huge infection rate that without radical action will continue to grow with the population explosion. Most deaths from malaria are babies, kids under five and pregnant women. It is not just deaths either, my town has a huge number of disabled children, their brains damaged by being boiled by malaria fevers or by being directly infected by the parasite

There is no silver bullet solution. My current work, a baseline study on malaria/HIV/TB gives me a close up view of the reality of malaria. The people tell me they cannot live 24/7 under an ITN, they often get bitten in the evening, eating supper or doing homework. They tell me too I should try sleeping under a net in a 12' hut crammed full of people on a red hot airless night. I can imagine. I have a big net in a 12' bedroom and a fan on all night. When the electricity fails (often) I sweat buckets and find it hard to sleep. I understand why, despite the risks, the people don't use them every night.

Moreover, most people here view malaria the way people in the US or Europe view a bad cold, and sometimes thats how it affects fit, healthy adults with partial immunity. So data on the disease is hugely inaccurate. There are already reports of ACT resistance, though no confirmed data. . I am not surprised, ACT like other antimalarials, is frequently used without firm clinical diagnosis. If the symptoms disappear after ACT treatment, it must have been malaria. ACT is costly; the stuff, now given free by MOH, it is often stolen, repacked and ends up for sale in village shops and even in neighboring countries. Health centers in my District, which have no ACT, direct patients to buy from the 'chemist shops', often supplied by the same healthcare workers. Selling medicines is often justified as the only means of subsidizing very poor salaries.

The nation's healthcare system is overwhelmed by population pressure and the burden of disease and under-mined by shameless corruption. The brain drain of healthcare workers, migrating to the US, Europe and other developed countries, to escape the appalling conditions of work and pitiful salaries, is accelerating the dissolution of the national health service.
There is no history of any nation with a ruined healthcare system ever successfully conquering any infectious disease, least of all one as old and complex as malaria

IRS, using DDT, the cheapest, most effective agent, has just begun here. It remains to be seen whether the expansion of the malaria campaign into a coherent, focused effort to include IRS, ITNs, ACT and education will have lasting impact on the disease, but I am pessimistic, without a vaccine.

As expected the campaign to use IRS is being dogged by the pious ranting of the self-appointed guardians of Africa's ecosystem, as if Africans were too stupid to understand the arguments and reach their own decisions. I have little time for such organizations as Beyond Pesticides. One would do well to remember that its staff earn a comfortable living through this NGO, lobbying on behalf of poor Africans. They have very comfortable offices, alongside the the lobbyists of E Street in DC. Their office rent would buy a huge number of ITNs.

They know the scientific evidence they quote is based upon massive use of DDT as a pesticide in US agriculture in the 1960s, when planes were used to dump tons of DDT per acre on cotton fields and fruit orchards. Even with this massive industrial overuse, the evidence, after 50 years of scientific scrutiny, connecting DDT with diseases in humans is thin indeed. IRS will use less DDT in a year across the entire country, than was dumped on a few acres of US cotton in the 60s

My advice to anyone who wants a credible voice at the table, is to come and live here, out in the countryside, away from the Cities, for a couple of years. To live without expensive Malarone prophylactics and designer insect repellants and about 200 miles from the nearest capable hospital

They are welcome to come with me to the villages to convince people they need to use an ITN all the time. They could also try and explain their version of the facts regarding IRS and DDT; tell mothers that "DDT can be passed on in breast milk". For many it will be an irrelevance, they will not be feeding their dead babies.
4/27/2008 7:15:09 AM