No air conditioning in your classroom? Maasai school in Tanzania

August 20, 2014

Maasai school in Tanzania. Photo by Noel Feans,

Maasai school in Tanzania. Photo by Noel Feans, “We rule the school.” September 2009; Creative Commons copyright, Wikimedia image; also on Flickr

Another photo illustrating classroom technology in different cultures.


2001 press release from NIAID, mosquito genome sequencing project: “DDT was once a powerful tool”

March 24, 2014

Caption from Vanderbilt University: Figure 1. Anopheles freeborni mosquito taking a blood meal. Image reproduced from the Centers for Disease Control http://www.cdc.gov/malaria/about/biology/mosquitoes/, CDC, public domain.

Caption from Vanderbilt University: Figure 1. Anopheles freeborni mosquito taking a blood meal. Image reproduced from the Centers for Disease Control http://www.cdc.gov/malaria/about/biology/mosquitoes/, CDC, public domain.

Press release from the NIH National Institute of Allergy and Infectious Diseases (NIAID):

Anopheles gambiae Genome Sequencing Project

March 5, 2001

 


Statement of Anthony S. Fauci, M.D.
Director, National Institute of Allergy and Infectious Diseases


Today, a global network of researchers announced that they are collaborating in sequencing the genome of Anopheles gambiae, the mosquito responsible for most cases of malaria in Africa. The National Institute of Allergy and Infectious Diseases (NIAID) applauds the efforts of the network and their goal of obtaining sequence data by the end of the year.

This information, together with the knowledge gained from the sequences of malaria parasites and the human genome, will provide researchers with a wealth of genomic data necessary for understanding this complex disease. (See the communiqueExternal Web Site Policy.)

The need for a multifaceted commitment to fight malaria and develop new and improved treatments, diagnostics and vaccines has never been greater. According to the World Health Organization, an estimated 300 to 500 million cases of malaria occur annually; in 1999, an estimated 1.1 million deaths were attributed to malaria, most of which occurred in children under the age of 5. Malaria is a public health threat in more than 90 countries, where 40 percent of the world’s population lives. Because of the enormity of this problem, NIAID has made malaria research a central focus of our scientific portfolio and supports a comprehensive research program, which includes basic, field-based and clinical research.

Malaria is caused by a single-celled parasite that is spread to humans by mosquitoes. The control of malaria continues to be a challenge because of the dual problems of increased rates of insecticide resistance in mosquitoes and increased rates of drug resistance in the malaria parasites. Reducing disease transmission by mosquito control has been a mainstay of regional and global malaria control programs. The insecticide DDT was once a powerful tool in global efforts to eradicate malaria. With the development of DDT-resistant mosquitoes, new tools are needed to control this disease. An improved understanding of the basic biology of mosquitoes and their genomes will contribute to our ability to understand and monitor insecticide resistance, develop new insecticides, and ultimately help control the malaria pandemic.

NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at www.niaid.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH…Turning Discovery Into Health ®

Some points to ponder, 13 years later:

  1. Dr. Fauci notes that DDT was, at one time, a powerful tool to fight malaria — but no longer.  DDT resistant mosquitoes means new tools must be found to replace DDT.
  2. Fauci makes no mention of a shortage of DDT for any reason.  It appears from the press release that DDT’s widespread use is compromised only by its decreasing effectiveness, not by any ban from any governmental entity.
  3. In 1999, 15 years ago now, about 1.1 million people died from malaria annually; estimates cited here are that 300 million to 500 million people actually got a bout of malaria through the year.  This compares with 2012 figures of fewer than 700,000 dead, and fewer than 250 million infections.
  4. Fauci said that, if malaria is to be defeated, it must be attacked on multiple fronts.  Spraying insects alone is not enough, increasing medical care alone is not enough — no single action provides a panacea.

 


World malaria report 2013 shows major progress in fight against malaria, calls for sustained financing (but not DDT)

March 21, 2014

News release from the World Health Organization:

World malaria report 2013 shows major progress in fight against malaria, calls for sustained financing

News release

Cover of World Malaria Report 2013

Cover of World Malaria Report 2013

11 December 2013 | Geneva/Washington DC - Global efforts to control and eliminate malaria have saved an estimated 3.3 million lives since 2000, reducing malaria mortality rates by 45% globally and by 49% in Africa, according to the “World malaria report 2013″ published by WHO.

An expansion of prevention and control measures has been mirrored by a consistent decline in malaria deaths and illness, despite an increase in the global population at risk of malaria between 2000 and 2012. Increased political commitment and expanded funding have helped to reduce incidence of malaria by 29% globally, and by 31% in Africa.

The large majority of the 3.3 million lives saved between 2000 and 2012 were in the 10 countries with the highest malaria burden, and among children aged less than 5 years – the group most affected by the disease. Over the same period, malaria mortality rates in children in Africa were reduced by an estimated 54%.

But more needs to be done.

“This remarkable progress is no cause for complacency: absolute numbers of malaria cases and deaths are not going down as fast as they could,” says Dr Margaret Chan, WHO Director-General. “The fact that so many people are infected and dying from mosquito bites is one of the greatest tragedies of the 21st century.”

In 2012, there were an estimated 207 million cases of malaria (uncertainty interval: 135 – 287 million), which caused approximately 627 000 malaria deaths (uncertainty interval 473 000 – 789 000). An estimated 3.4 billion people continue to be at risk of malaria, mostly in Africa and south-east Asia. Around 80% of malaria cases occur in Africa.

Long way from universal access to prevention and treatment

Malaria prevention suffered a setback after its strong build-up between 2005 and 2010. The new WHO report notes a slowdown in the expansion of interventions to control mosquitoes for the second successive year, particularly in providing access to insecticide-treated bed nets. This has been primarily due to lack of funds to procure bed nets in countries that have ongoing malaria transmission.

In sub-Saharan Africa, the proportion of the population with access to an insecticide-treated bed net remained well under 50% in 2013. Only 70 million new bed nets were delivered to malaria-endemic countries in 2012, below the 150 million minimum needed every year to ensure everyone at risk is protected. However, in 2013, about 136 million nets were delivered, and the pipeline for 2014 looks even stronger (approximately 200 million), suggesting that there is real chance for a turnaround.

There was no such setback for malaria diagnostic testing, which has continued to expand in recent years. Between 2010 and 2012, the proportion of people with suspected malaria who received a diagnostic test in the public sector increased from 44% to 64% globally.

Access to WHO-recommended artemisinin-based combination therapies (ACTs) has also increased, with the number of treatment courses delivered to countries rising from 76 million in 2006 to 331 million in 2012.

Despite this progress, millions of people continue to lack access to diagnosis and quality-assured treatment, particularly in countries with weak health systems. The roll-out of preventive therapies – recommended for infants, children under 5 and pregnant women – has also been slow in recent years.

“To win the fight against malaria we must get the means to prevent and treat the disease to every family who needs it,” says Raymond G Chambers, the United Nations Secretary General’s Special Envoy for Financing the Health MDGs and for Malaria. “Our collective efforts are not only ending the needless suffering of millions, but are helping families thrive and adding billions of dollars to economies that nations can use in other ways.”

Global funding gap

International funding for malaria control increased from less than US$ 100 million in 2000 to almost US$ 2 billion in 2012. Domestic funding stood at around US$ 0.5 billion in the same year, bringing the total international and domestic funding committed to malaria control to US$ 2.5 billion in 2012 – less than half the US$ 5.1 billion needed each year to achieve universal access to interventions.

Without adequate and predictable funding, the progress against malaria is also threatened by emerging parasite resistance to artemisinin, the core component of ACTs, and mosquito resistance to insecticides. Artemisinin resistance has been detected in four countries in south-east Asia, and insecticide resistance has been found in at least 64 countries.

“The remarkable gains against malaria are still fragile,” says Dr Robert Newman, Director of the WHO Global Malaria Programme. “In the next 10-15 years, the world will need innovative tools and technologies, as well as new strategic approaches to sustain and accelerate progress.”

WHO is currently developing a global technical strategy for malaria control and elimination for the 2016-2025 period, as well as a global plan to control and eliminate Plasmodium vivax malaria. Prevalent primarily in Asia and South America, P. vivax malaria is less likely than P. falciparum to result in severe malaria or death, but it generally responds more slowly to control efforts. Globally, about 9% of the estimated malaria cases are due to P. vivax, although the proportion outside the African continent is 50%.

“The vote of confidence shown by donors last week at the replenishment conference for the Global Fund to Fight AIDS, Tuberculosis and Malaria is testimony to the success of global partnership. But we must fill the annual gap of US$ 2.6 billion to achieve universal coverage and prevent malaria deaths,” said Fatoumata Nafo-Traoré, Executive Director of the Roll Back Malaria Partnership. “This is our historic opportunity to defeat malaria.”

Notes for editors:

The “World malaria report 2013″ summarizes information received from 102 countries that had on-going malaria transmission during the 2000-2012 period, and other sources, and updates the analyses presented in 2012.

The report contains revised estimates of the number of malaria cases and deaths, which integrate new and updated under-5 mortality estimates produced by the United Nations Inter-agency Group for Child Mortality Estimation, as well as new data from the Child Health Epidemiology Reference Group.


Ugandan court turned back challenge to DDT use

March 19, 2014

One more news story that demonstrates, first, there is no worldwide ban on DDT (not even with the POPs Treaty); and second, environmentalists probably couldn’t stop DDT use if they tried, in nations where malaria still poses a problem.

Uganda's location in Africa; WorldAtlas.com map

Uganda’s location in Africa; WorldAtlas.com map

Not that the DDT-crazy anti-environmentalist critics of Rachel Carson and WHO will notice, but here’s the news, anyway.

From All Africa, from The Observer in Kampala:

Uganda: DDT Petition Dismissed

By Derrick Kiyonga, 18 March 2014

A petition against the use of DDT to control malaria has been dismissed by the Constitutional court.

Judges said the 2009 petition by the Uganda Network on Toxic-Free Malaria Control (UNETMAC) did not raise any matter for interpretation under article 137 of the Constitution. UNETMAC had argued that indoor residual spraying (IRS) and the continued use of the insecticide was hazardous to Uganda’s agricultural exports.

The ministry of Health had earlier approved IRS in Apac and Oyam districts. The judgment by the five-judge panel was delivered by Justice Kenneth Kakuru.

Uganda’s lack of anti-malaria campaigns due to political unrest through much of the last 40 years appears to have contributed to rather severe problems in some provinces today.  At various points over the past decade, Indoor Residual Spraying (IRS) won court fights from business groups, trade groups, farmers, affected citizens and odd environmental organizations.  In each case, courts ruled in favor of DDT use.

IRS involves spraying the walls of a home where mosquitoes rest after biting a victim.  Hypothetically, the mosquito then gets a fatal does of insecticide, and will not live long enough to develop the next cycle of malaria parasites to pass back to human victims (the life cycle of the malaria parasite takes about 14 days in a mosquito’s gut before the bug becomes infectious).  DDT is not approved for outdoor use, but only for fighting disease, and only inside dwellings.

DDT and about a dozen other insecticides are used for IRS, in rotation, to avoid pushing the mosquitoes to evolve resistance to any one poison.  Even so, DDT grows less effective, and health workers increasingly avoid using it at all, in favor of other insecticides.

Despite a few hotspots of malaria in Africa, across the continent malaria infections and deaths continue to decline, a decline steady since the early 1970s, accelerated since 2000.

More:

Uganda. AfricaDiscovery.com

Uganda. AfricaDiscovery.com


Best flying of a U.S. flag in a while

September 6, 2013

You’d forgotten there’s another war going on in South Sudan?

Location of South Sudan in Africa.

Location of South Sudan in Africa (darkened area). Wikipedia image

More:

Best flying of a U.S. flag: A woman carries a bag of food in Gumuruk where @WFP is assisting IDPs uprooted by violence.

Best flying of a U.S. flag: A woman carries a bag of food in Gumuruk where @WFP is assisting IDPs uprooted by violence.


Resources for World Malaria Day 2013

April 25, 2013

Not a word about condemning Rachel Carson.  No plea to use DDT to try to poison Africa or Asia to health.  That’s a great start.

More:

Mother and son under a protective bednet, the most efficient method to prevent malaria.  Columbia University MVSim image

Mother and son under a protective bednet, the most efficient method to prevent malaria. Columbia University MVSim image


World Malaria Report 2012: Malaria still declining, but more resources needed fast

January 4, 2013

Significant gains against malaria could be lost because funding for insecticide-treated bednets has dropped, and malaria parasites appear to be developing resistance to the pharmaceuticals used to clear the disease from humans, while insects that transmit the parasites develop resistance to insecticides used to hold their populations down.

Malaria room

African bedroom equipped with LLINs (insecticidal bednets) Photo: YoHandy/Flickr

UN’s World Health Organization (WHO) published its annual report on the fight against malaria last month, December 2012.  Accompanying the many page World Malaria Report 2012  were a press release and a FAQ; the fact-sheet appears unedited below.

Insecticidal bednets have proven to be a major, effective tool in reducing malaria infections.  Careful studies of several different projects produced a consensus that distributing the nets for free works best; people in malaria-infected areas simply cannot afford to pay even for life-saving devices, but they use the devices wisely when they get them.  Nets often get abbreviated in official documents to “LLINs,” an acronym for “long-lasting insecticidal nets.”

Generally, the report is good news.

Dramatic facts emerge from the report:  The “million-a-year” death toll from malaria has been whacked to fewer than 700,000, the lowest level in recorded human history.  More people may die, and soon, if aid does not come to replace worn bednets, distribute new ones, and if the drugs that cure the disease in humans, lose effectiveness.  Many nations where the disease is endemic cannot afford to wage the fight on their own.

Links in the Fact Sheet were added here, and do not come from the original report — except for the link to the WHO site itself.

Logo for World Health Organization

17 December 2012

World Malaria Report 2012

FACT SHEET

Malaria is a preventable and treatable mosquito-borne disease, whose main victims are children under five years of age in Africa.

The World Malaria Report 2012 summarizes data received from 104 malaria-endemic countries and territories for 2011. Ninety-nine of these countries had on-going malaria transmission.

According to the latest WHO estimates, there were about 219 million cases of malaria in 2010 and an estimated 660,000 deaths. Africa is the most affected continent: about 90% of all malaria deaths occur there.

Between 2000 and 2010, malaria mortality rates fell by 26% around the world. In the WHO African Region the decrease was 33%. During this period, an estimated 1.1 million malaria deaths were averted globally, primarily as a result of a scale-up of interventions.

Funding situation

International disbursements for malaria control rose steeply during the past eight years and were estimated to be US$ 1.66 billion in 2011 and US$ 1.84 billion in 2012. National government funding for malaria programmes has also been increasing in recent years, and stood at an estimated US$ 625 million in 2011.

However, the currently available funding for malaria prevention and control is far below the resources required to reach global malaria targets. An estimated US$ 5.1 billion is needed every year between 2011 and 2020 to achieve universal access to malaria interventions. In 2011, only US$ 2.3 billion was available, less than half of what is needed.

Disease burden

Malaria remains inextricably linked with poverty. The highest malaria mortality rates are being seen in countries that have the highest rates of extreme poverty (proportion of population living on less than US$1.25 per day).

International targets for reducing malaria cases and deaths will not be attained unless considerable progress can be made in the 17 most affected countries, which account for an estimated 80% of malaria cases.

  • The six highest burden countries in the WHO African region (in order of estimated number of cases) are: Nigeria, Democratic Republic of the Congo, United Republic of Tanzania, Uganda, Mozambique and Cote d’Ivoire. These six countries account for an estimated 103 million (or 47%) of malaria cases.
  • In South East Asia, the second most affected region in the world, India has the highest malaria burden (with an estimated 24 million cases per year), followed by Indonesia and Myanmar.  50 countries are on track to reduce their malaria case incidence rates by 75%, in line with World Health Assembly and Roll Back Malaria targets for 2015. These 50 countries only account for 3% (7 million) of the total estimated malaria cases.

At present, malaria surveillance systems detect only around 10% of the estimated global number of cases.  In 41 countries around the world, it is not possible to make a reliable assessment of malaria trends due to incompleteness or inconsistency of reporting over time.

This year, the World Malaria Report 2012 publishes country-based malaria case and mortality estimates (see Annex 6A). The next update on global and regional burden estimates will be issued in December 2013.

Malaria interventions

To achieve universal access to long-lasting insecticidal nets (LLINs), 780 million people at risk would need to have access to LLINs in sub-Saharan Africa, and approximately 150 million bed nets would need to be delivered each year.

The number of LLINs delivered to endemic countries in sub-Saharan Africa dropped from a peak of 145 million in 2010 to an estimated 66 million in 2012. This will not be enough to fully replace the LLINs delivered 3 years earlier, indicating that total bed net coverage will decrease unless there is a massive scale-up in 2013. A decrease in LLIN coverage is likely to lead to major resurgences in the disease.

In 2011, 153 million people were protected by indoor residual spraying (IRS) around the world, or 5% of the total global population at risk. In the WHO African Region, 77 million people, or 11% of the population at risk were protected through IRS in 2011.

The number of rapid diagnostic tests delivered to endemic countries increased dramatically from 88 million in 2010 to 155 million in 2011. This was complemented by a significant improvement in the quality of tests over time.

In 2011, 278 million courses of artemisinin-based combination therapies (ACTs) were procured by the public and private sectors in endemic countries – up from 182 million in 2010, and just 11 million in 2005. ACTs are recommended as the first-line treatment for malaria caused by Plasmodium falciparum, the most deadly Plasmodium species that infects humans. This increase was largely driven by the scale-up of subsidized ACTs in the private sector through the AMFm initiative, managed by the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Drug and insecticide resistance

Antimalarial drug resistance is a major concern for the global effort to control malaria. P. falciparum resistance to artemisinins has been detected in four countries in South East Asia: in Cambodia, Myanmar, Thailand and Viet Nam. There is an urgent need to expand containment efforts in affected countries. For now, ACTs remain highly effective in almost all settings, so long as the partner drug in the combination is locally effective.

Mosquito resistance to at least one insecticide used for malaria control has been identified in 64 countries around the world. In May 2012, WHO and the Roll Back Malaria Partnership released the Global Plan for Insecticide Resistance Management in malaria vectors, a five-pillar strategy for managing the threat of insecticide resistance.

www.who.int/malaria

You were perceptive.  You noted there is no call from malaria fighters for more DDT, nor for any change in DDT policy.  This is a report from medical personnel, from public health experts, the real malaria fighters.  It’s not a political screed.

More, and related articles:


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