April 25th is World Malaria Day, a time to look back at progress made over the past year in the quest to control this dangerous disease. We also take a look at progress made in the shift toward sustainable, least toxic and effective malaria control tools.
Last year, we marked the day by highlighting on-the-ground successes in Senegal, Kenya and Ethiopia in reducing malaria with community based approaches. This year I join my colleague Dr. Paul Saoke from Physicians for Social Responsibility, Kenya to give our on-the-ground perspective on the path we think malaria control needs to take going forward.
The problem is still an urgent one. According to the WHO's World Malaria Report 2013 and the Global Malaria Action Plan, 3.4 billion people (half the world’s population) live in areas at risk of malaria transmission in 106 countries and territories. In 2012, malaria caused an estimated 207 million clinical episodes, and 627,000 deaths. An estimated 91% of deaths in 2010 were in Africa.
While the rates of malaria deaths are slowly going down, the large numbers of malaria cases remain a serious cause for concern — especially for young children. Good malaria control projects need to get funded and signficantly scaled-up to help reduce the burden of malaria in Africa.
Funders shape malaria projects
The priorities of funders and funding agencies often shape what malaria control projects look like in African countries. Recognizing this, we at PAN International have focused over the past 18 months on partnering with those who fund malaria control work in African countries.
We realized that many funders focused on short-term solutions that rely heavily on chemical-intensive strategies, such as spraying people’s houses with insecticides — including the highly hazardous pesticide, DDT. This not only has negative health impacts for communities and their environment but also fuels the rise of insecticide resistance among mosquitoes who are malaria vectors, making insecticides ineffective in controlling malaria in the long-term.
According to the World Health Organization (WHO);
Resistance to insecticides is an increasing problem in vector control because of the reliance on chemical control and expanding operations, particularly for malaria and dengue control. Furthermore, the chemical insecticides used can have adverse effects on health and the environment.
Dr. Soake reports from his experiences with DDT spraying in East Africa that resistance to DDT is widespread. This has further implications on alternative chemicals like organophosphates, carbamates and pyrethroids which may not work where DDT resistance has been noted. We have seen these effects in West Africa as well.
Sustainable long-term malaria control cannot be achieved in an environment informed by "silver bullet" methods and tools such as spraying inside people's homes with hazardous pesticides. Known health effects from indoor spraying of DDT, include cancer, male infertility, miscarriages, low birth weight, developmental delays in children and nervous system and liver damage.
The "Funders' Framework"
Dr. Paul Saoke of PSR-Kenya highlights human health harms of chemical-intensive malaria control.
We here at PAN Africa worked with our colleagues at PAN Germany and PAN North America, as well as malaria control experts from the International Center for Insect Physiology and Ecology in Kenya, to create a clear and concise decision-making tool to help malaria funders steer their projects towards more sustainable paths.
The "Funder's Framework" is designed to assist malaria control funders in achieving the most significant reduction in malaria possible while using cost-effective, ecologically sound and sustainable Integrated Vector Management (IVM) interventions. Dr. Saoke's experience in East Africa highlights the importance of these approaches:
"The methods that are working well in Africa rely on people’s participation, and focus on solutions such as cleaning mosquito breeding sites, improving sanitation, improving health treatment facilities and ensuring widespread awareness about malaria’s causes and prevention. Such community- and ecosystem-based IVM provides effective vector control and minimize risks to human health and the environment."
The Framework incorporates lessons from successful activities across the continent that have implemented sustainable IVM-based controls, and draws on work done by the WHO. It also provides indicators for malaria control program officials to assess how well IVM is adopted in their projects and programs.
The Framework focuses on three key elements of a holistic IVM strategy:
- evidence-based decision making at community level by community members
- social mobilization to support communities becoming primary stakeholders in IVM
- use of non-chemical approaches to vector control within community-guided IVM
These IVM strategies are compatible with the mainstays of many African malaria control programs: use of bednets and medications to prevent and treat malaria.
Several U.S. and European malaria control funders have told us the Framework is a valuable resource. It provides a short, easy-to-use tool for malaria control program officers to assess malaria control project options, and fully consider non-chemical alternatives. It can help them implement the kind of IVM which works well in many African countries in controlling malaria, without harming either people’s long-term health or the environment.
Here’s hoping we can report back on the widespread uptake of this Framework — and adoption of safe, effective programs that reduce the malaria burden in African communities — by the time World Malaria Day rolls around next year.
Dr. Abou Thiam is Regional Coordinator of Pesticide Action Network Africa (PAN Afrique) based in Dakar, Senegal.
Dr. Paul Saoke, M.D, also contributed to this post. Dr. Saoke is the Executive Director of Physicians for Social Responsibility Kenya and is based in Nairobi, Kenya.
Photo credit: cimmyt/Flickr