I invite you to help me imagine a solid and realistic approach to malaria control in Africa, rather than continuing our criticism of the current poorly focussed and unsustainable attempts by WHO, RBM and the US PMI. I think we need a permanent Institute where African malaria people can develop, implement and expand anti-malarial measures. Because the current emphasis on drugs, biocides and bednets is inherently unsustainable, let us take a more sensible and rational approach which utilizes ecological changes.
William Jobin's blog
Lessons from the failed WHO Blue Nile Health Project in central Sudan, 1980-1990
How could a fascist dictator realize how to control malaria in Italy 80 years ago, when we can’t figure out what to do in Africa today ?
NOTE; He did it in 3 steps: larval source management with larviciding, improved housing and education, and finally medical treatment
In the latest Annual Report of PMI (April 2014), they cite the reduction in mortality rates of children under five as proof of the beneficial impact of the anti-malarial work of PMI. Figure 1 of the report cites the following figures for the 15 PMI focus countries which have the best data. However, as in the past, they have not done a comparison with other countries in Africa. The same is true in general of the reports from the Roll Back Malaria program. For some strange reason they don't want to measure changes in malaria prevalence.
Do any of you have experience with the Garki Project, to add to my comments below? I would especially appreciate comments from those of you who knew what the thinking inside WHO Geneva was, at the time.
What lessons can we learn from the failure of the WHO Garki Malaria Project in Kano, Nigeria, 1970-1980?
SUGGESTIONS ON HOW TO AVOID THE IMMUNITY TRAP
Inherent in a strategy which requires repeated application of temporary control methods, is the specter of the Immunity Trap. After several years of suppressing malaria transmission by temporary methods, if the methods are suspended for any reason, the previously protected population will be extremely vulnerable to acute disease and death because they will have lost their immunity. The longer the temporary methods are used, the greater will be the risk for the population to fall into the Immunity Trap.
SUGGESTIONS ON HOW TO SLOW THE RESISTANCE TREADMILL
My field experience in fighting malaria in Africa started with five years in central Sudan where I helped organize the Blue Nile Health Project in 1979, aimed at protecting 2 million people in the million acre Gezira Irrigation System. I benefited a great deal from the malaria experience of my Sudanese colleagues, as well as from the Iranians and others in the WHO Regional Office for the Eastern Mediterranean. I also benefited from the support of WHO Geneva, and from Letitia Obeng in UNEP.
DROUGHT AND MALARIA IN ANGOLA
Drought in southern Angola 2000 to 2006
When I was asked by the US Agency for International Development to go to Angola in 2005 to start the Presidential Malaria Initiative (PMI), I was told to begin spraying interiors of homes in the southern provinces of Huila and Kunene as soon as possible. I think they picked me because Portuguese is one of my favorite languages, and I had worked on malaria control in Sudan for 5 years, besides being with CDC in Puerto Rico when the island was finally declared malaria-free.
Although these problems do not have much significance in the Environmental Pathway to Malaria Suppression described in my previous blog, they are two major problems for folks following the WHO Chemical Dependency Pathway. They are: