What does the future hold for the fight against malaria in Africa?
William Jobin's blog
WINTER DIALOGUES OF AFRICAN MALARIA COALITION
MIT 26-27 JANUARY 2013
Despite the cold weather, malaria was definitely in the air in Cambridge during the last week in January. Shortly after the African Malaria Coalition held our Winter Dialogues at MIT, Harvard held a Malaria Forum just up the river. There were important differences in the two meetings, but the subject was clearly the same; how to strengthen the fight against malaria.
African Malaria Coalition and the Harvard Malaria Forum
Jim Webb's forthcoming book on the history of the fight against malaria in Africa is a plea for all of us..... (for me that includes WHO and USPMI folks)..... to learn from history, especially the history of these clever mosquitoes who quickly learn to overcome any synthetic biocide produced by the chemical industry. He cites the experience in Turkey, Pakistan and Sudan where the malaria programs went through 8 major classes of biocides after DDT lost its effect..........
Resistance to drugs and biocides happens when we try to control malaria. It is a historical pattern we have seen repeatedly. And we know that ACT is about the only way to treat malaria now in Africa, especially since resistance to chloroquine has been widespread for years.
And we are also seeing that the use of permethrin for spraying houses - the same biocide used to treat bednets - is beginning to cause resistance in mosquitoes in Africa too.
Well, for one thing, we know how to build durable electric power supplies.
When 17 hydroelectric dams were built on the Tennessee River in the southern USA after the Second World War, malaria disappeared from the region within a few years, and never returned. This was before DDT and chloroquine. Why? Because the availability of adequate water and affordable electricity resulted in increased income for the people, better housing with screens, and electric fans that made sleeping indoors comfortable in the hot, humid malaria season.
Epidemiological nugget three;
Malaria World has become a broad and wonderful forum for exchanging information on malaria, with about 7,000 members, coming into 2013. And lately there have been many items relevant to the big fight against malaria in Africa. These items have come from all over the world; the latest exciting one being the contribution by the people from Southern Africa who are showing us the way.
But there are important groups who are noticeable for their absence.
Epidemiological Nugget Number Two........Many malaria programs are slowly converting to better diagnostic methods for reporting the prevalence of malaria. However the numbers have to be carefully analyzed, because of the artifacts caused by changes in False Positivity of the better diagnostic tests. The most common diagnostic method used in Africa - and reported through WHO - is called Clinical Diagnosis. This method, relying on the clinical judgement of the health care worker, has a False Positivity Rate of about 80%.
Epidemiological Nugget Number One: Bednets are avoided by adults, especially during the hot and humid malaria season.......However infants cannot escape their mothers protective care, thus infants usually sleep under bednets, even though no one else in the family does.........Now - what happens when groups like PMI report their success in terms of reduced Infant Mortality, or prevalence of malaria among infants?..........It is no surprise that Infant Mortality drops because the infants are sleeping under bednets.
Water, Engineers and Malaria..............