Mozambique uses 4 million mosquito nets in turn from pesticide, in war on malaria

June 20, 2017

Mozambique’s National Malaria Control Programme distributed 4 million LLIN, insecticide-impregnated nets, to protect children and others from malaria as they sleep, the time most malaria-infecting mosquito bites occur. Malaria Consortium photo

Mozambique’s National Malaria Control Programme distributed 4 million LLIN, insecticide-impregnated nets, to protect children and others from malaria as they sleep, the time most malaria-infecting mosquito bites occur. Malaria Consortium photo

Mozambique is one of only ten nations still using DDT for Indoor Residual Spraying (IRS) to fight malaria.

But DDT’s effectiveness diminishes rapidly, as does the effectiveness of the other eleven insecticides generally used for IRS against malaria or other vector-borne diseases. Insecticides are sprayed indoors, and not outdoors, to provide protection where humans are most often bitten, and to prevent non-target mosquitoes and other creatures from being exposed to the insecticides. This prevents harmful pests from developing resistance to the insecticides, and diminishes damage to beneficial species, like food fish.

Instead of spraying, malaria fighters turn increasingly to bednets impregnated with insecticide, known as Long-Lasting Insecticide-impregnated Nets (LLIN). A net provides closer to 100% protection from bites than IRS. A net immediately protects anyone sleeping under it, while IRS must treat at least 80% of nearby homes to achieve more than 50 percent prevention.

While still using IRS, Mozambique stakes its future malaria fighting on nets.

The Malaria Consortium aided in the recent distribution of nets.

Malaria Consortium has successfully completed a mass distribution campaign of over four million long-lasting insecticidal nets (LLINs) across Nampula and Niassa provinces in Mozambique. The nets were distributed almost simultaneously across all districts of each province – 23 districts in Nampula in November 2016, and 16 districts in Niassa in May 2017 – using a new operational model aimed at optimising resources.

Throughout the campaigns, Mozambique’s National Malaria Control Programme was responsible for the LLIN acquisition and led overall planning and implementation through the decentralised structures of the health system. Malaria Consortium’s role consisted of operational support, which included financial management, transport, procurement, logistics, training, management of service providers, efficient use of resources and effective coordination at provincial, district and field levels.

Sonia Gwesela, Malaria Consortium Mozambique Country Director said, “In Nampula Province, a major achievement was that 99 percent of households collected their nets. We successfully delivered 98 percent of the nets in both provinces, coming well above the 90 percent target set by the National Malaria Control Programme.

“With the successful completion of the distribution, we can now focus on a post-distribution communications campaign about the correct use of LLINs,” she concluded.

The Malaria Prevention and Control Project is funded by the Global Fund to Fight AIDS, TB and Malaria and supports the efforts of the Mozambican government to reduce malaria throughout the country through scale up of prevention and control efforts with community involvement. Malaria Consortium is working in partnership with World Vision, Fundacao para o Desenvolvimento da Comunidadeo, International Relief and Development, and the Mozambique Ministry of Health.

Bednets can be twice as effective as IRS in preventing the spread of malaria. Beating malaria also requires upgrading health care for quick diagnoses and quick, complete treatment of malaria in humans, and prevention projects to drain mosquito-breeding places within 50 yards of homes; more prevention of bites means less medical treatment is required.

WHO estimated 5 million people died of malaria in the 1950s into the 1960s. WHO’s Malaria Report 2016 reported malaria deaths fell to less than 430,000 world wide, a more than 90 percent reduction since 1963, mostly accomplished without DDT.

Malaria Consortium on Twitter, @FightingMalaria.

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Bednets enough enough to beat malaria in most places

October 8, 2015

Reuters caption:  A displaced child plays on a mattress under a mosquito net laid in the open at Tomping camp near South Sudan's capital Juba January 7, 2014. Reuters/James Akena/Files

Reuters caption: A displaced child plays on a mattress under a mosquito net laid in the open at Tomping camp near South Sudan’s capital Juba January 7, 2014. Reuters/James Akena/Files

Another blow to the DDT partisans.

In a report published last January, which I just reread, researchers found that bednets alone offer enough prevention of malaria that Indoor Residual Spraying (IRS) using DDT or one of the other 11 WHO-approved insecticides, offers no additional protection, but at additional cost.

Lancet study said bednets alone are effective against malaria transmission, and spraying insecticides gives no additional benefit.

Reuters reported:

Spraying insecticides indoors offers children no additional protection from malaria when bed nets are used, a study said on Tuesday, as malaria cases and deaths worldwide continue to fall.

A study by medical journal The Lancet said donors should invest their limited resources on additional bed nets as the most cost-effective solution to tackling malaria, costing an average of $2.20 per person compared to $6.70 for insecticide.

“High bed net use is sufficient to protect people against malaria in areas that have low or moderate levels of malaria,” lead author Steve Lindsay said in a statement.

Malaria, a mosquito-borne parasitic disease, kills more than 600,000 people a year, and most victims are children under five living in the poorest parts of sub-Saharan Africa.

The study coincided with the launch of the World Health Organisation’s (WHO) annual World Malaria Report, which said the number of global malaria deaths fell by 47 percent between 2000 and 2013, with malaria cases also steadily declining, due to improved access to testing, treatment and bed nets. (http://in.reuters.com/article/2014/12/09/health-malaria-nets-idINKBN0JN0YT20141209)

 

Reuters’s report is longer, at Reuters’s site.

But another report by June indicates that gains against malaria can still be tough to maintain, especially with global warming creeping up on us.

The fight’s not over.


I get e-mail: Nothing But Nets needs your help with Congress, to fight malaria

May 26, 2015

Money, not DDT.

Among other goals of the hoaxsters who claim Rachel Carson was wrong and evil, and that the imaginary ban on DDT to fight malaria causes “millions of deaths,” is the erosion of trust in international  organizations that lead the fight against malaria, especially WHO, UNICEF and USAID.  Sadly, the hoaxsters have friends in Congress who threaten to withhold funding to fight malaria, often insisting that now-mostly-ineffective DDT be used instead of good, working preventive measures and medicines to cure humans of malaria.

And so, Nothing But Nets writes to ask for help:

Email your members of Congress and let them know that you support full funding for malaria prevention programs.                                       

Dear Ed,

Imagine this: working from 4:00 AM until well into the night, getting very little sleep, traveling along unpaved roads for hours at a time – all to deliver 2,000 bednets per day to the hardest-to-reach children and families.

Email your members of Congress and let them know that you support full funding for malaria prevention programs.

Take Action

In Mozambique, this is a typical day for health workers as they distribute nets to save lives as part of a campaign funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria. Thanks to the work of the Global Fund and other partners – including UN agencies and local communities on the ground – bednet coverage in Mozambique has gone from less than 5 percent of the population in 2000 to an impressive 60 percent today.

But without continued support from Congress, the life-saving impact of these nets could be lost.

Your member of Congress will vote soon on how much assistance the U.S. will provide to the Global Fund, along with partners like the President’s Malaria Initiative and the United Nations, the core agencies leading the fight against malaria. By showing your support to your representatives in Washington, you can help to make them champions in the fight against malaria and ensure that these bednets continue to make it to families who need them the most.

Thousands of people have already asked their members of Congress to support the crucial work of the Global Fund and other partners in the fight against malaria—will you join them today?

From all of us at Nothing But Nets, thanks for helping community health workers reach the last mile!

Dan Skallman
Senior Campaign Associate, Nothing But Nets

Original story and photo from The Global Fund to Fight AIDS, Tuberculosis and Malaria.

Take Action


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:


Fighting malaria: Bed nets crucial

June 12, 2010

Nota bene:  DDT not labeled “crucial”


Fighting malaria with reason

October 29, 2007

We can beat malaria without DDT; we can’t beat malaria without bednets.

Editorial from BMJ (née British Medical Journal?) points out that bednets really work, and they work better when distributed free of charge.  Nets cost about $5.00 each, but in nations where a good day’s pay is about $1.00, charging for them merely means they won’t be purchased and can’t be used.

Time for Sen. Tom Coburn, R-Oklahoma, and Steve Milloy, to listen to reason, stop bashing Rachel Carson, and start fighting malaria.

Update, February 2009; the original link seems irrecoverable; see also this research, BMJ 2007;335:1023 ( 17 November), doi:10.1136/bmj.39356.574641.55 (published 16 October 2007


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