AFRO-NETS is about malaria (37)
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While we can all say that more money is better than less in the
malaria control and prevention problem I am of the opinion that
we can not talk about adopting 'best practice' until we know
what it is. You can throw all the money at what you call best
practice and it will not be cost-effective until your practice
itself is the scientifically and culturally accepted best-
practice.
I am a health economics professor in Chicago where we no longer
have malaria problems -- thanks to DDT. And the last time I vis-
ited my malaria endemic home town in the Eastern region of Ghana
I carried along all the malaria prevention paraphernalia only to
find out that bedrooms at homes and hotels are not structured to
use the bed nets, for example. I am talking about a major town,
the provincial capital of a region, with a nursing college, 5
great high schools, regional administrative headquarters and re-
gional ministries, a modern public hospital and a very high-
quality Catholic hospital, cyber cafes, etc, etc. and not a
SINGLE sign anywhere advertising malaria prevention strategies.
NOT ONE!!. I traveled all over the south of the country and did
not find any signs of malaria control strategies. I saw AIDS and
Family Planning educational materials on billboards. BUT NOT ONE
SINGLE MALARIA PREVENTION STRATEGY.
Meanwhile, there are open gutters all over the place filled with
stagnant water. What do I take out of this? Our people do not
even have the basic information to do the best they can for
themselves. If malaria is a health problem, which it is (because
it contributes to about 2 percent reduction in economic growth
in Africa in addition to excess mortality) then why are bednets
not free? Why do we not see relevant information being dissemi-
nated all over the place to assist people in making the right
choices? This is not only a money issue. Since the risk of ma-
laria is mostly an involuntary risk (you are exposed to mosquito
bites because you live there and it flies to you and bites you)
we need vector control as well as behavior modification.
My take is we need to place more emphasis on outdoor vector con-
trol. I do not care whether it is DDT or any alternative. But do
we have a scientifically proven alternative to DDT? If yes,
where are these alternatives and why are they not being used?
What are the relative risks of these alternatives compared to
DDT? After addressing these issues scientifically we need a pol-
icy of malaria control based on risk equity and pragmatic envi-
ronmental policy. The philosophy of pragmatic environmental pol-
icy accepts no absolute truths for all times. Because as science
advances we gain more knowledge and have to modify our policies
based on new ideas. And risk equity tries not to place too much
emphasis on certain risks while accepting other risks. What
other risks are African societies (and the West for that matter)
accept while effectively banning the risk of exposure to DDT?
If we use both these principles, risk equity and pragmatic envi-
ronmental policy, DDT in some concentrations and applied over
some period of time may begin to look good. What I see now is a
non-pragmatic policy based on scientific absolutism that all
levels of DDT are inherently unsafe, even when 30 million Afri-
cans get sick each year and 1 million die from malaria. There is
too much name calling in this debate while Africans are suffer-
ing from a preventable disease.
Bednets and indoor spraying can be part of that pragmatic pol-
icy. But we also need to get rid of the mosquito before it flies
into the house. That just makes sense to me, especially when my
87-year old mother gets malaria at least 3 times a year, mostly
involuntarily.
Edward Mensah
mailto:dehasnem@uic.edu