Tuesday, 11 March 2008

DDT and Malaria: Back to the Basics II

by Ndubuisi Edeoga

Every Nigerian doctor remembers the phrase from medical school “common things occur commonly”…always think of malaria!

The burden of disease of malaria on the Nigerian population is self-evident. At a recent event, our Minister of State for Health was quoted as saying that 110 million Nigerians are active malaria patients …don’t ask where he got his data...he does not say :).

The Roll Back Malaria Partnership was launched with pomp by African heads of state in Abuja in 2000 where they came up with the ABUJA DECLARATION. Despite the initial razzmatazz, many have described this as a failing health initiative. Many reasons have been suggested; one recent one is most poignant. by Mark Grabowsky in an article in Nature, one of the preeminent journals in the scientific community. Grabowsky says disease surveillance is the secret weapon behind the successes in polio and measles control, powering funding and informing decisions. But no such systematic surveillance data exists for malaria. He might just have a point! Without high quality data to show progress, it is most difficult to focus energy....
you cannot manage what you cannot measure!

Jeffery Sachs in his book The End of Poverty raised the profile of malaria…saying “one issue that has been tragically neglected for decades now is malaria. A disease that kills up to 3 million people every year. It's a disease that could be controlled quite dramatically and easily if we just put in the effort". He attributes extreme poverty in malaria endemic regions of the world mostly to malaria. Though we believe that it will rank behind a whole series of other self-inflicted causes in Nigeria, it definitely is one that can be solved.

Over the years DDT has gone through the waves of love and derision in public opinion. In the 1950s and 60s, DDT spraying eradicated malaria was used across Southern Europe, and it was used commonly in Africa until the late 1970s. At the same time, DDT was being used across the world as a farming pesticide. But widespread spraying was eventually shown to kill fish and threaten birds. DDT became a "pariah" chemical. But NO studies ever proved that it also damaged human health, yet it was widely believed to do so and was banned.

Now, however, some African governments are beginning to judge that the ecological risks posed by DDT do not compare with the danger of malaria getting a deadlier grip. The bottom-line is in the last 50 years of intense study no causal relationship between DDT and harm to human health has been documented. Now the pendulum has swung again…DDT is back in fashion! Some have called it a renaissance.
Maybe sometime in the future we will come to understand the forces that led to its ban in the first place and share with them the burden of death inflicted.
WHO has recently changed its policy governing malaria control and now endorses use of indoor residual spraying of insecticides (IRS) as a primary means of malaria control, to include use of DDT. Additionally the US Agency for International Development has changed its policy on use of IRS and DDT funding countries to use DDT. Presently DDT use in the South African Malaria control program is showing amazing results. Dramatic reductions in their malaria cases are being recorded and maintained. Many countries in Africa have reinstated the use of indoor spraying with DDT as the mainstay of their anti-malaria programs. These enormous changes in policy should not be ignored by the Nigerian Health Ministry. We expect our country to show leadership in the use of DDT in responding to malaria.

As we reposition to achieve the Millennium development Goals, I take us back to Mr. Sachs book were he says that “there are certain places on the planet that, because of various circumstances—geographical isolation, burden of disease, climate, or soil—these countries just can't quite get started. So it's a matter of helping them get started, whether to grow more food or to fight malaria or to handle recurring droughts. Then, once they're on the first rung of the ladder of development, they'll start climbing just like the rest of the world”. I suggest Nigeria is NOT one of those places. We have what it takes…but we need the will. In 2006 the WHO gave the country $180 Million in interest free loans to fund malaria programmes.

Non of this was for DDT....hopefully this will change

4 comments:

mcneri said...

The roundabout to DDT. As they say in Nigeria, we are back to square one. This was after governments in South Africa took their fate into their own hands. The issue of malaria makes me wonder, do we have one world, really? While Google is talking about digitizing healthcare (see post in my blog), we are still grappling with problems of the 60s and 50s. Irrespective of what the priorities are for WHO, UNICEF and other international health bodies, I think Nigeria should sit up and address its problems as a nation for once. The citizens are interested, they are skilled and maintain prestigious positions all over the world. What remains is a seriousness of effort on the part of the leadership.
M.Osita Nwaneri

Anonymous said...

My dear doctors:

The problems with Nigeria, as with all human societies, are primarily philosophical. The solution lies in the cultural acceptance of the proper philosophical ideas. The articles below shed light on how the wrong philosophical ideas helped kill millions people in Africa who could have been saved by the use of DDT.

I recommend reading Ayn Rand's "Atlas Shrugged" as a gateway into how to go about solving Nigeria's problems.

I wish you the best of luck in your crusade.

Sincerely,
A fellow Nigerian.

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Reject Environmentalism, Not DDT

http://www.capmag.com/article.asp?ID=4787


Silent Spring Revisited: Rachel Carson's Environmentalist Diatribe vs. Science

http://www.capmag.com/article.asp?ID=4105

Global Warming vs. Science

http://www.aynrand.org/site/News2?page=NewsArticle&id=5408

chikwe ihekweazu said...

There will be a continued role for DDT in malaria control until equally cost-effective al-ternatives are developed. This position statement summarizes the issues surrounding the use of DDT for vector-control purposes.

The use of DDT in malaria vector control
WHO position statement
World Health Organization, Global Malaria Programme, 2007
16 pp. 284 kB:
http://www.who.int/ipcs/capacity_building/who_statement.pdf

Bola Falash said...

though effective DDT's disadvantages overshadow its prospects. A potential poison reported in breast milk as a result of its widespread outdoor use. I think the solution lies in looking inwards at our ivory towers and commissioning a research for suitable alternatives to DDT. who knows? someone somewhere may have the answer in theory.