Beating malaria without DDT

I told you so.

Recent research and assessments of anti-malaria campaigns in Africa show dramatic results from the use of bed nets and other non-DDT spraying methods.

Rachel Carson was right.

I was compelled to jump into this issue when Utah’s U.S. Rep. Rob Bishop made a silly and incorrect statement against Rachel Carson, after his failed attempt to derail a bill to rename a post office in her honor on the 100th anniversary of her birth.  The slam-Rachel-Carson effort turned out to include Oklahama U.S. Sen. Tom Coburn (who has since recanted), and an array of anti-science types who rail against “environmentalists” and made astoundingly false claims against Carson’s work and Carson herself.

In those cases, Carson’s critics called for a return of massive spraying of DDT.  Eventually most of them backed off of calling for outdoor spraying.  Eventually Sen. Coburn lifted his hold on the post office renaming legislation (and it passed).

The calumny continued on the internet, however, with an active hoax campaign for DDT and against environmental protection and Rachel Carson.  Steven Milloy joined Lyndon Larouche in promoting the anti-Carson screeds of the late Dr. Gordon Edwards, a UC Davis entomologist who argued against science that DDT was harmless to humans and animals.

Enough about history.  Look at the real results on the ground, today:

First, note the study published in Lancet that documents a dramatic decrease in malaria in Gambia, using “low-cost” strategies that include bed nets.  Agence France Presse carried a summary of the study. [Another link to the same AFP article.]

Incidence of malaria in Gambia has plunged thanks to an array of low-cost strategies, offering the tempting vision of eliminating this disease in parts of Africa, a study published Friday by The Lancet said.

At four key monitoring sites in the small West African state, the number of malarial cases fell by between 50 percent and 82 percent between 2003 and 2007, its authors found.

The tally of deaths from malaria, recorded at two hospitals where there had been a total of 29 fatalities out of 232 admissions in 2003, fell by nine-tenths and 100 percent in 2007. A fall of 100 percent means that no deaths attributed to malaria occurred that year.

“A large proportion of the malaria burden has been alleviated in Africa,” the study concludes.

Also see:

• Reuters article on the study, which cautions that reductions mean people still die of malaria, so more needs to be done.
• Story from IntheNews.UK
• Canadian Broadcasting Company story, “Bed nets pay off with plunge in malaria rates in Gambia“
• Abstract of the study, in The Lancet

Second, note that malaria rates also fell in Kenya, with a shift in infections away from young children, a very good sign. TropIKA.net carried a summary of that study.

Toronto’s Globe and Mail carried a longer story on Kenya’s experience, “Malaria a rare public-health success story in Africa.”

“We had to stay home and tend the sick – you can never leave them to go and work in the fields – and then there was no income and we were hungry. So truly, that 100 shillings was a great investment.”

The family heard about the importance of using a bed net to fend off malaria in a sermon at church, and then on the radio. Now, a year later, they would be able to get them for free, as Kenya ramps up its efforts to get every single citizen sleeping under a net.

Already, two-thirds of Kenyan children are sleeping beneath them and, as a result, child malaria deaths have fallen by 40 per cent in the past two years.

This remarkable success story has been repeated across much of Africa: Deaths of children under 5 declined 66 per cent in Rwanda from 2005 to 2007 and by 51 per cent in Ethiopia.

“This really is the one global public-health story that is simply and straightforwardly positive,” said Jon Lidén, spokesman for the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has been behind much of the push.

“It’s not a gradual change. It’s a fundamental change in the fight against malaria.”

Yet the decidedly unglamorous innovations responsible for the change – spraying houses, treating standing water to kill larvae, mass distribution of cheap polyester nets and better drugs, and simple public education on the need to treat suspected malaria quickly – receive almost no attention.

“We never make the headlines with this stuff,” said Shanaaz Sharif, head of disease control for Kenya’s Ministry of Health, which has thus far given out 11 million nets at a cost to the government of $6 each.

From the Toronto Globe and Mail: “Sulay Momoh Jongo, 7, is seen inside a mosquito net in a mud hut is seen inside a mosquito net in a mud hut in Mallay village, southern Sierra Leone, on April 8, 2008. Although free treatment is sometimes available in Sierra Leone to fight the mosquito-borne disease — whose deadliest strain is common in the country’s mangrove swamps and tropical forests — many cannot get to health clinics in time. Worldwide, more than 500 million people become severely ill with malaria every year. One child dies of the disease every 30 seconds. Picture taken April 8, 2008. (Katrina Manson/Reuters)”

Despite pledges from the U.S. to signficantly increase funding to fight malaria, money has not flowed from the U.S., especially for bed nets.  Ironically, Canada is the chief donor of the nets.

Canada has had a key role in this success: The Canadian International Development Agency is the single largest donor of bed nets to Africa – nearly 6.4 million by the end of last year. In addition to government support, Canadian individuals and charities – notably the Red Cross – have embraced the issue by making donations and fundraising.

“Canadians … haven’t got the credit they deserve,” said Prudence Smith, head of advocacy for Roll Back Malaria, a partnership between key global-health agencies and donors such as the Bill and Melinda Gates Foundation.

Not all news is good. In Zimbabwe, dictator Robert Mugabe misused $7.3 million in malaria-fighting money from the Global Fund to Fight AIDS, Tuberculosis and Malaria. So far, he has not repaid the Global Fund. Politics continues to kill Africans, not an absence of DDT.

In India, where DDT use is untallied, manufacture massive, and use virtually uncontrolled, malaria is resurgent. According to The Telegraph in Calcutta, malaria is epidemic among people living in poorer sections of the city, often with fatal results.  ExpressIndia.com’s headline tells the story:  “Malaria puts city on the edge:  toll rises to 8.”

Public health officials in India will step up information and education campaigns, and urge residents “not to panic.”

See also:

• Times of India reports “Panic breeds in fever pockets”
• The Statesman reports a death of a 23-year-old breeds local panic

In the Philippines, the government’s press agency promotes malaria prevention steps.

Science Daily reports progress in the long march for a malaria vaccine.

Public health officials warn the U.S. is completely unprepared for a malaria outbreak, according to The Orlando Sentinel, via the Houston Chronicle.

More:

• Revere covered this story at Effects Measure at Science Blogs