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African Malaria Dialogue focusses on classical methods for malaria control

May 25, 2013 - 15:27 -- William Jobin

SUMMARY OF RECENT AFRICAN MALARIA DIALOGUE at BENTLEY UNIVERSITY on 21 MAY 2013

Fifteen of us attended from Bentley, BU, Yale, Harvard and MIT, and from Ghana, Sudan, Nigeria, Canada and US. Derek Willis from Columbia U also joined us via Skype.

MALARIA IN ETHIOPIA
Jim McCann reviewed the complexity of malaria and agricultural development in Ethiopia, and noted the slow pace that knowledge about malaria has followed in Ethiopia, especially regarding the ID of the An. gambiae complex (1962) and the first recognition by WHO that there were two species in Ethiopia (1976).

RESISTANCE TO PYRETHROIDS AND BENDIOCARB
Mike Reddy reported on evidence of resistance of Anophelines to pyrethroids, DDT and bendiocarb in Equatorial Guinea. The rapid development of resistance to bendiocarb was surprising, perhaps because of previous experience the mosquitoes had through agriculture. He cited the recent experience in Guinea and in Tanzania as an impelling reason to seek alternative methods for mosquito control.

HUMIDITY AND ANOPHELINES
Teresa Yamana explained the recent development of their HYDREMATS computer simulation of anopheline population dynamics as affected by relative humidity, using data from Niger in a habitat which had no surface water, and in one which was at the bottom of a streambed. Addition of humidity to temperature effects gave much better correlation with observations, but there are still gaps, perhaps due to nutrients in runoff.

GHD ONLINE DISCUSSION OF CLASSICAL AND DURABLE CONTROL METHODS
Bill Jobin reviewed the recent experience with the Global Health Delivery online discussion about durable and classical malaria control methods, noting the passionate support for bednets by the Peace Corps volunteer who was distributing bednets, and also the widespread enthusiasm for bednets among charitable groups who continue to donate large numbers of bednets for use in Africa. The passion for bednets is a new component in the fight against malaria, and should not be dismissed lightly, despite their drawbacks.

FOCUS ON CLASSICAL CONTROL METHODS
Bill also raised the larger question about where we should focus the energy of our African Malaria Dialogues, in light of the entrenched commitment to the use of insecticides, bednets and drugs by PMI, who also actively ignore the classical methods of drainage, screens and environmental management. The WHO and PMI strategies are linked with highly developed Public Relations approaches to fund-raising, which so far have been successful with the US Congress and general public, despite serious technical inconsistencies, and defiance of history.

Although it is very unsatisfying, there seems little alternative to letting the current WHO and PMI strategies run their course. Because of the difficulties and frustrations we have experienced in trying to get PMI and WHO to adopt broader strategies, our energies would probably be better focused on refining and promoting the classical methods, especially in support of the work at MIT by the eltahir group, who are exploring the adaptation of TVA strategies to reservoirs in Ethiopia. Noriko Endo is doing her doctoral thesis on this subject, in Koka Reservoir.

Of course we should continue to speak out with constructive criticism of PMI, encouraging them to broaden their approach.

Comments

Submitted by Melinda Smith (not verified) on

Our church have missionaries in Africa. One of our missionaries, Pieter Loots, has an urgent need for solving the problem of malaria in the district where he does missionary work. Local people in his region suffer from Malaria. I was asked to do some research on ways to prevent
malaria. We are going on an outreach in July 2013 and our aim is to assist Pieter in finding ways to help the local people. Can anyone recommend a solution which will not be expensive and will reach a maximum number of people in the local village in Malawi?

William Jobin's picture
Submitted by William Jobin on

Hi Melinda,

Thank you for your request about Malawi. I can give you a number of things to do, of varying costs and effectiveness. Our general recommendation is to follow the Kitchen Sink Strategy - you throw everything at it except the Proverbial Sink.

I am going to do some quick research on malaria in Malawi, but in the meantime there are a few things to keep in mind. One is that people going to Malawi from outside of Africa, with no previous exposure to malaria, are at high risk from the infection. So if you are going there for just a month or two, you have to take extra precautions. For medical advice I suggest you go to the website for CDC - Centers for Disease Control, in Atlanta.

I am a public health engineer and will instead advise you on things the village people can do for themselves around their homes and village.

But it would also help if you gave me a little more information first. Exactly where in Malawi is the village? Can you or Pieter describe the local ecology - topography - especially related to water. Malaria mosquitoes breed in standing water. Are there lakes, swamps, streams nearby?

Also can you describe the typical housing, and the range of housing? The mosquitoes bite at night, usually inside the house while people are sleeping. Are there some houses in good enough condition that they can put on screens? What are the walls, ceilings and roofs made of?

Also how many people in the village, how close are they to other villages? Having some info on these things will help me in giving your recommendations. Do you have a website for your mission? That would help me too.

But please also be aware that malaria is embedded in Africa, it will not easily go away, so you have your work cut out for you. I have worked in Zimbabwe, Angola and Sudan, but not in Malawi, which Is why I want to check for recent and local info before I give you advice.

Bill

William Jobin Director of Blue Nile Associates

Submitted by cris van Beek (not verified) on

Hi,
We are working in small villages in Malawi about 60km north west from Lilongwe.
Website www.kleine-schritte.be
We want to buy about 2500 LLIN nets for 19 villages the same time.
What is the best place to buy. Is there a factory for LLIN nets in Malawi?

William Jobin's picture
Submitted by William Jobin on

I would try the US Embassy Health Officer, who could put you in contact with the US Presidential Malaria Initiative, who could probably help you buy the nets, or contact the World Health Organization office in Lilongwe. Remember the nets are temporary, and only last about 3 years so you should be ready to replace them, or to graduate the households to screens and improved wall coverings.
Bill

William Jobin Director of Blue Nile Associates

William Jobin's picture
Submitted by William Jobin on

Hi Melinda and Pieter,
I had hoped by now to hear where in Malawi is your mission. Please let me know as soon as you can.
In the meantime, your visit in July comes at a good time for malaria, which is highly seasonal there. July is the cool, dry season, thus there are few mosquitoes and a low risk of malaria.
Also note that there are other diseases to worry about. Lake Malawi is home to aquatic snails which transmit schistosomes, a parasite which you should avoid.
Although July is a good time, there are other times of the year when mosquitoes and malaria are very common, depending where your mission is, what is its altitude, etc.

Bill, waiting for more news

William Jobin Director of Blue Nile Associates

Submitted by Graham Matthews (not verified) on

Moira and I lived in Malawi from 1968 to 72 on an agricultural research station and although I did not get malaria, Moira did get it on one occasion despite taking a prophylactic and being in a well screened house. However as you will be there in the dry season, the risk of malaria is far less especially on the higher ground near Lilongwe. While I agree bed nets are important to protect young children, adults tend to stay up later and can easily be bitten both inside and outside houses. It will good if you can get the villagers to understand that mosquito larvae breed in water so it is important to minimise locations suitable for mosquito larvae by draining areas, or if there is permanent water [ponds], can fish be used [develop aquaculture] or the seasonal ponds be treated with a larvicide. Improving houses with screens on doorways and eaves plus using mud to fill small holes in walls can also limit mosquito access into houses. The village may also be in an area where indoor residual spraying is being done, but in the long term, the other measures suggested need to be considered.
You must also visit the Lake Where there are sandy beaches near Salima , the wave action means that snails transmitting schistosomiasis are not a problem unlike areas with reeds etc, From my first visit there in 1958 until we left, I enjoyed many visits to the Lake.