Man made Malaria
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Source: malaria@wehi.edu.au
It is often reported that malaria, particularly in Africa, is on the
increase. One of the factors that is important in the transmission
of malaria is the mosquito population density. Mosquito density is
largely determined by larval breeding conditions. The main vectors
in Africa belong to the Anopheles gambiae complex, species which
breed in rainwater puddles and other smallish collections of water.
On a recent visit to Sudan it was apparent that virtually all of the
breeding sites of the local vector Anopheles arabiensis were man
made, in particular 4 wheel drive horseless carriages. Large areas
were criss-crossed with wheel ruts full of water (it was the rainy
season) most of which had thriving populations of Anopheles ara-
biensis. Indeed when I think about it in Tanzania and Papua New
Guinea water filled car tracks often provided a reliable source of
larvae (just as a bed net might be a source of blood fed females).Is there a relationship between the rise in malaria and the in
creasing number of four wheel drive vehicles in Africa??I believe it was recently found in the Gambia that villages without
a primary health care system had lower mortality rates than those
with primary health care. Perhaps nobody drove to the former vil-
lages often enough to create suitable vector breeding sites???
I have been on this list a number of months and have watched with in-
terest on the various topics, but recent comments on Four Wheel
Drives, environmental control, controlling malaria with spades have
tempted me to join the affray.
I am involved in two projects in the Zambezi Valley in Zimbabwe along
Lake Kariba which involve community participation in all aspects of
malaria control, firstly health education to promote self protection,
secondly community participation in vector control, in particular en-
vironmental control and larviciding (winter dry season control of
permanent water bodies and rainy season control) and lastly in treat-
ment by "volunteers" in remote areas away from health centres. The
only inputs are larvicides which are cheap and health education mate-
rial and of course chloroquine for volunteers - everything else like
mosquito nets and repellents have to be purchased by the community,
but if the control of breeding sites is carried out properly, pur-
chase of nets etc. becomes unnecessary - these are mainly for the
rich who perceive filling in holes etc. below their dignity.
This approach to malaria control has been prompted by the following
observations.
1) Malaria thrives on ignorance and apathy. Car tracks, puddles etc.
help, but most people in Zimbabwe simply don't recognise the prob-
lem on their doorstep e.g. I have seen on a number of occasions
teachers teaching malaria to their children with nice pictures of
larvae etc. and not being able to recognise the larvae breeding
right outside the classroom door. You cannot persuade a person to
fill a puddle if he cannot see the problem.
2) Despite all the difficult technical stuff on this conference, ma-
laria is an incredibly easy disease to understand from a control
point of view - it involves a mosquito and a human host and that
mosquitoes breed in water - this is something a five year old can
understand but don't get taught. To stop malaria you just have to
stop the little buggars biting you and the way you do that is
varied hence often the more technical stuff for the technically
minded.
Over the last three years I have seen school children control malaria
in their immediate areas - it is not difficult, it just requires a
lot of helping hands and being very methodical in your approach. But
in one area I was able to sleep out in the middle of the malaria sea-
son without a single mosquito bite in a place with plenty of man made
puddles including a few car tracks thrown in!
In 1996, the area of Lake Kariba suffered from a huge increase in ma-
laria. In one health centre catchment area where there was not enough
insecticide to spray the houses, the local health staff were given a
couple of spray pumps and larvicide and told to get the community mo-
bilised. Six weeks later, at this health centre, the health staff
were able to sit around reading newspapers while other adjacent cen-
tres were having huge queues of people waiting to be attended.
This is not to say that community control is easy - it does not pro-
duce instant results all over, but is a developmental process over
years where people learn to take care for their own health. For my-
self, I have worked in the worst malaria areas of Zimbabwe for six
years and I have yet to catch malaria, but I am careful, but if I do
catch it I will only have myself to blame - this is the spirit that
we are trying to engender in the local population.
Basically I believe that malaria can be controlled simply and cheaply
by using the one resource that have to live with the disease on a day
to day basis. Selling malaria control might be difficult in some ar-
eas, but I have never found mosquito control a difficult concept to
sell - there are few people in this world who enjoy mosquito bites -
it is just a matter of persuading them to do something about it. One
man can do nothing, but a million people dealing with a million pud-
dles can do wonders!
Regards,
Tim Freeman
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Tim Freeman
Malaria Specialist
Save the Children Fund (UK)
P.O.Box 4689, Harare, Zimbabwe
Tel: (Bus) +263-4-793198/9
(Res) +263-4-301525
Fax: (Save the Children Fund) +263-4-727508
mailto:freeman@healthnet.zw
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