This compilation of articles will be updated periodically and it is by no means comprehensive. The articles are arranged by category and inchronological order with the newest studies first. We hope it will prove to be a useful tool in the ongoing discussion among policymakers, advocacy groups and the media regarding the use of DDT and the need to improve efforts to effectively control malaria.
1. Cost-Effectiveness of Malaria Control Interventions When Malaria Mortality is Low: Insecticide-Treated Nets Versus In-House Residual Spraying in India.
2. Epidemic malaria in the Menoreh Hills of central Java.
3. Social and cultural aspects of malaria.
4. Malaria past and present: The case of North Sulawesi, Indonesia.
5. No Future in DDT: A case study of India.
6. Cost-effectiveness and sustainability of lambdacyhalothrin-treated mosquito nets in comparison to DDT spraying for malaria control in western Thailand.
7. Current scenario of malaria in India.
8. Ecology, economics, and political will: The vicissitudes of malaria strategies in Asia.
9. Environmental management in malaria control in India
10. Impact of pesticide use in India
1) Bhatia, M.R., J. Fox-Rushby, and A. Mills. Cost-Effectiveness of Malaria Control Interventions When Malaria Mortality is Low: Insecticide-Treated Nets Versus In-House Residual Spraying in India . Social Science and Medicine. 2004; 59(2004): 525-39.
Available Online at: http://www.sciencedirect.com/
PANNA Summary: In India , a low malaria mortality region, both insecticide-treated nets and in-house residual spraying are effective in preventing malaria. Nets are more effective and more efficient than residual spraying, although nets cost more. Additionally, the amount of insecticide used for treated nets was much less than that used for spraying. Although unlikely, residual spraying may become more cost-effective than treated nets under certain circumstances.
Abstract: Malaria is one of the leading causes of morbidity and mortality in the developing world and a major public health problem in India . Disillusioned by in-house residual spraying (IRS), and increasingly aware that insecticide-treated nets (ITNs) have proved to be effective in reducing malaria mortality and morbidity in various epidemiological settings, policy-makers in India are keen to identify which is the more cost-effective malaria control intervention. A community randomized controlled trial was set up in Surat to compare the effectiveness and efficiency of IRS and ITNs. Both control strategies were shown to be effective in preventing malaria over the base-case scenario of early diagnosis and prompt treatment. The mean costs per case averted for ITNs was statistically lower (Rs. 1848, 1567-2209; US$ 52) than IRS (Rs. 3121, 2386-4177, US$ 87). The conclusions were robust to changes in assumptions. This study expands the scope of recent comparative economic evaluations of ITNs and IRS, since it was carried out in a low mortality malaria endemic area. (Department of Social Policy, London School of Economics , Houghton Street , London WC2A 2AE , UK .)
2) Barcus, Mazie J., F. Laihad, M. Sururi, P. Sismadi, H. Marwoto, M. J. Bangs, and J. K. Baird. Epidemic malaria in the Menoreh Hills of central Java. American Journal of Tropical Medicine and Hygiene. 60(3). 2002 pp. 281-292.
PANNA summary: DDT spraying and the introduction of chloroquine medication for malaria starting in the 1950s virtually eradicated endemic malaria from the island of Java. DDT spraying was abandoned by the Republic of Indonesia in the late 1980s and stocks were depleted by the early 1990s. Spraying of less effective and more expensive pesticides continued through the early 1990s. This study shows that the sharp decline in government spending on malaria control since the economic downturn of the late 1990s, especially the curtailment of indoor spraying, has lead to a real epidemic of malaria in the hills of central Java. The authors call for a revival of residual indoor spraying programs as the only proven effective solution to the outbreak.
Abstract: After more than 50 years of effective management, resurgent malaria threatens residents in the Menoreh Hills and the foothills of the Dieng Plateau of Central Java, Indonesia. The Dieng Plateau dominates the highland center of Central Java. The steep Menoreh Hills, surrounded by rice paddy habitats, cover approximately 500 km2 with no peaks greater than 1,000 m. We studied epidemic malaria in Purworejo district, one of the three districts containing the Menoreh Hills. Between 1986 and 1995, the annual parasite incidence (API) in Purworejo ranged from 2 to 11 cases per 1,000 residents per year and was typically approximately 5 per 1,000. In 2000 the API was 44.5. This sharp increase was confined to subdistricts in and around the Menoreh Hills and Dieng Plateau foothills. The primary vectors of malaria, those favoring steep, forested hillsides on Java, were Anopheles maculatus and Anopheles balabacensis. Deterioration of vector control activity, followed by a severe economic downturn in 1997, may explain the epidemic. Malaria in the Menoreh Hills and lower Dieng Plateau threatens surrounding areas of rice paddy inhabited by Anopheles aconitus as well as a nearby coastal habitat where the even more efficient vector Anopheles sundaicus occurs in abundance. Most of the 130 million people living on Java never experienced the hyper- and holoendemic malaria that occurred throughout most of the island before the effective DDT spraying and chloroquine treatment campaigns of the 1950s. Reintroduced endemic malaria threatens the island of Java. (U.S. Naval Medical Research Unit # 2, Jakarta, Indonesia)
3) Panvisavas, S., S. Dendoung, and N. Dendoung. Social and cultural aspects of malaria. Southeast Asian Journal of Tropical Medicine and Public Health. Dec 2001, vol. 32, no. 4. 727-732.
PANNA summary: Malaria eradication programs in the 1950's failed to remove the disease from rural Thailand, and so the authors want to advise WHO's current "Roll Back Malaria" campaign that only an integrated socio-cultural approach to malaria control in this area will be effective. The real causes of malaria persistence in rural areas, they contend, are poverty and discrimination. The political situation in Southeast Asia has led to a concentration of poor people--indigenous people turned wage laborers, poor farmers, refugees from neighboring countries, and soldiers--on the borders in the forests where malaria has the most potential to spread and health care is the least developed. Traditional systems of knowledge about malaria and its prevention are discredited and ignored. Only an approach that respects traditional knowledge and aims to alleviate poverty and involve communities will be effective.
Abstract: This paper examines the impact of social and cultural factors on malaria control in rural Thailand. It contends that standard vertical malaria control programs tend to ignore local workplace and living conditions instead of recruiting traditional practices into the planning scenario for more effective control. Careful attention to these practices in the context of local economic capacity can serve to offset the common failure to take the major causative factor of poverty into account. (Faculty of Social Sciences and Humanities, Mahidol University at Salaya, Nakhon Pathom, Thailand)
4) Henley, David. Malaria past and present: The case of North Sulawesi, Indonesia. Southeast Asian Journal of Tropical Medicine and Public Health. Sept 2001, vol. 32, no. 3, p. 595-607.
PANNA summary: According to the author, the most likely source of the long-term decline of malaria in North Sulawesi is large-scale conversion of forest to permanent farmland. DDT was being sprayed until the last of the national stock was used up in 1993 after a ban that started in 1990, then other more expensive chemicals were used until about 1997. During that period, malaria rates went down steadily. But in 1997 with the economic downturn in Asia, the government of Indonesia cut back spending on malaria control significantly and since then, malaria has made a small though significant resurgence. The author concludes that it is unlikely for environmental management, bed nets, or anti-malaria medication to be as effective as insecticide spraying in controlling malaria in North Sulawesi.
Abstract: The incidence and impact of malaria in North Sulawesi have declined both in the short term during the 1990s, and over a much longer timespan (though perhaps less continuously) since the end of the colonial period. The improvement already seems to have been well underway before deliberate vector control activities became extensive in the second half of the 1970s, and environmental changes affecting the Anopheles mosquito fauna, in particular the replacement of primary and secondary forest by permanent farmland, are probably the principal reasons for the long-term trend; other possible factors include the increasing use of antimalarial drugs. The well-documented decline in malaria incidence over the years 1991-1997, nevertheless, probably reflects the unprecedented scale of residual insecticide spraying in the province during that period, while the slight resurgence of the disease in the last three years corresponds to the subsequent cessation of house spraying as a result of the current economic crisis. Despite the evident importance of environmental change as a factor ameliorating the malaria situation in the long term, experience from the colonial era suggests that the prospects for deliberate environmental management (species sanitation) as an alternative malaria control strategy are poor. (Royal Institute for Linguistics and Anthropology (KITLV), Leiden, The Netherlands. henley@kitlv.nl)
5) Agarwal, Ravi. No Future in DDT: A case study of India. Pesticide Safety News, May 2001.
PANNA summary: India is an important case study to understand that DDT is becoming obsolete, not only owing to concerns over its toxicity, but also because it is losing its effectiveness in treating malaria. India has been manufacturing and using DDT for more than 50 years. Use for agriculture was banned in 1989, and use for malaria has been declining in favor of more multi-sector approaches to the problem, since unsafe levels of DDT are turning up in food supplies and the egg shells of large predatory birds, and its effectiveness is waning anyway. India currently spends 35% of its health budget on malaria control each year. The current strategy is based on prioritizing control in high-risk areas, reducing the use of chemical insecticides, and the prevention and control of epidemics through community participation, the use of bed nets, and early diagnosis and treatment. The use of DDT in urban areas has halted completely.
(no abstract available)
6) Kamolratanakul, P., P. Butraporn, M. Prasitisuk, C. Prasittisuk, and K. Indaratna. Cost-effectiveness and sustainability of lambdacyhalothrin-treated mosquito nets in comparison to DDT spraying for malaria control in western Thailand. American Journal of Tropical Medicine and Hygiene 2001, 65(4), 279-84.
PANNA summary: In a highly endemic region along the forested border between Thailand and Myanmar, the researchers conducted a relatively small-scale (~2300 people) comparative study of the cost-effectiveness of insecticide-treated bed nets and residual indoor spraying of DDT. Calculated on a "per case of malaria prevented" basis, they found that the treated bed nets were more cost-effective than DDT spraying. As DDT spraying is not particularly popular or practical in this region anyway, they recommend that pyrethroid-treated bed nets be used in this region, and considered for other regions in the future.
Abstract: The cost-effectiveness of lambdacyhalothrin-treated nets in comparison with conventional DDT spraying for malaria control among migrant populations was evaluated in a malaria hyperendemic area along the Thai-Myanmar border. Ten hamlets of 243 houses with 948 inhabitants were given only treated nets. Twelve hamlets of 294 houses and 1,315 population were in the DDT area, and another 6 hamlets with 171 houses and 695 inhabitants were in the non-DDT-treated area. The impregnated net program was most cost-effective (US$1.54 per 1 case of prevented malaria). Spraying with DDT was more cost-effective than malaria surveillance alone ($1.87 versus $2.50 per 1 case of prevented malaria). These data suggest that personal protection measures with insecticide-impregnated mosquito net are justified in their use to control malaria in highly malaria-endemic areas in western Thailand. (Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand)
7) Sharma, V.P. Current scenario of malaria in India. Parassitologia 41: 349-53, 1999.
PANNA summary: The author reviews statistics of malaria incidence and control in India. DDT is the insecticide most widely used for malaria control, followed by HCH, malathion, and synthetic pyrethroids, and they are all used for residual indoor spraying in rural areas and anti-larva operations in urban areas. The major vector species has become resistant to DDT and HCH in most of the country. At the same time, malaria rates are increasing in many parts of the country because of man-made environmental changes like irrigation projects and piped-in water supplies—anywhere rapid development is happening, malaria is invading. Indian national and state governments continue to pour resources and energy into the problem, with help from the World Bank.
Abstract: The Indian National Malaria Eradication Programme (NMEP) is reporting 2.5 to 3 million malaria cases, and about 1,000 malaria deaths annually. Malaria in the northeastern states is stable and in the peninsular India unstable. There are six major and three minor malaria vectors, of which Anopheles culicifacies transmits malaria in rural areas and An. stephensi in the towns. Other vectors are of local importance. Plasmodium vivax is the dominant infection and accounts for 60-65% cases whereas P. falciparum contributes 30-35% cases. Field operations to control malaria are impeded by resistance and/or exophilic vector behavior, parasite resistance to antimalarial drugs, operational problems in spraying, failure to search breeding of mosquitoes at weekly intervals, staff shortages and financial constraints. Resurgent malaria invaded new ecotypes created by green revolution, industrial growth and urban development resulting in paradigm shift towards man-made malaria. NMEP has launched a world bank-assisted enhanced malaria control project with primary emphasis to protect 62.2 million high risk population in 7 states. (Malaria Research Centre, Delhi, India. vps@icmrmrc.ren.nic.in)
8) Kidson, C. and K. Indaratna. Ecology, economics, and political will: The vicissitudes of malaria strategies in Asia. Parassitologia 40: 39-46, 1998.
PANNA summary: Though malaria is currently more prevalent in Africa than Asia, Asia is the epicenter of the multi-drug resistant strain of malaria, P. falciparum, that is currently overtaking much of the tropical world. This is probably due to the huge changes in economics, social and natural environments, and the huge migrations of people that have taken place on the continent over the past few decades. Some nations have come close to complete malaria control, such as China, Thailand, and Malaysia, but fail near national borders, especially those that are forested, as this is where the movement of people in search of economic opportunities has lead to weakness in control. In light of the enormous economic influences on and impacts of malaria, the author asks nations not to keep malaria in the public health sector, but bring its control into the realm of economic planning as well.
Abstract: The documented history of malaria in parts of Asia goes back more than 2,000 years, during which the disease has been a major player on the socioeconomic stage in many nation states as they waxed and waned in power and prosperity. On a much shorter time scale, the last half century has seen in microcosm a history of large fluctuations in endemicity and impact of malaria across the spectrum of rice fields and rain forests, mountains and plains that reflect the vast ecological diversity inhabited by this majority aggregation of mankind. That period has seen some of the most dramatic changes in social and economic structure, in population size, density and mobility, and in political structure in history: all have played a part in the changing face of malaria in this extensive region of the world. While the majority of global malaria cases currently reside in Africa, greater numbers inhabited Asia earlier this century before malaria programs savored significant success, and now Asia harbors a global threat in the form of the epicenter of multidrug resistant Plasmodium falciparum which is gradually encompassing the tropical world. The latter reflects directly the vicissitudes of economic change over recent decades, particularly the mobility of populations in search of commerce, trade and personal fortunes, or caught in the misfortunes of physical conflicts. The period from the 1950s to the 1990s has witnessed near "eradication" followed by resurgence of malaria in Sri Lanka, control and resurgence in India, the influence of war and postwar instability on drug resistance in Cambodia, increase in severe and cerebral malaria in Myanmar during prolonged political turmoil, the essential disappearance of the disease from all but forested border areas of Thailand where it remains for the moment intractable, the basic elimination of vivax malaria from many provinces of central China. Both positive and negative experiences have lessons to teach in the debate between eradication and control as alternative strategies. China has for years held high the goal of "basic elimination", eradication by another name, in sensible semi-defiance of WHO dictates. The Chinese experience makes it clear that, given community organization, exhaustive attention to case detection, management and focus elimination, plus the political will at all levels of society, it is possible both to eliminate malaria from large areas of an expansive nation and to implement surveillance necessary to maintain something approaching eradication status in those areas. But China has not succeeded in the international border regions of the tropical south where unfettered population movement confounds the program. Thailand, Malaysia and to an extent Vietnam have also reached essential elimination in their rice field plains by vigorous vertical programs but fall short at their forested borders. Economics is central to the history of the rise and fall of nations, and to the history of disease in the people who constitute nations. The current love affair with free market economics as the main driving force for advance of national wealth puts severe limitations on the essential involvement of communities in malaria management. The task of malaria control or elimination needs to be clearly related to the basic macroeconomic process that preoccupies governments, not cloistered away in the health sector Historically malaria has had a severe, measurable, negative impact on the productivity of nations. Economic models need rehoning with political aplomb and integrating with technical and demographic strategies. Recent decades in Chinese malaria history carry some lessons that may be relevant in this context. (Centre for Health Economics, Faculty of Economics, Chulalongkorn University, Bangkok, Thailand)
9) Sharma, V.P. Environmental management in malaria control in India. In Malaria: waiting for the vaccine. Targett, GAT. Ed. England: John Wiley & Sons Ltd, 1991.
PANNA summary: Malaria fell sharply in India during the malaria eradiation campaign of the 1960s due to DDT spraying, the success of which overshadowed the small successes of other methods. However, malaria resurged following the close out of the eradication program, peaking in 1976. A new government control campaign initiated in 1977 brought the numbers back down, but there has been a plateau since the early 1980s. The effectiveness of residual pesticide spraying was waning. For this reason, environmental management as part of an integrated control strategy has become necessary, and India began to implement it in the 1980s. The scheme includes breeding control by environmental manipulation (filling in small stagnant water holes and creating channels for water to run off) and biological means (introducing larval predators to breeding sites), both of which have been quite effective. Environmental management as a control strategy requires a great deal of scientific understanding and attention, and is not cost effective in sparsely populated areas, but has few of the negative side effects of insecticides.
(no abstract available)
10) H.N. Saiyed, V.K. Bhatnagar, Rekha Kashyap. Impact of pesticide use in India. Asian Pacific Newsletter. http://www.occuphealth.fi/e/info/asian/ap399/india05.htm
PANNA summary: A brief article on the health effects of pesticide production and use in India, both on people working with those pesticides and on the general population.
(no abstract available)