Steps Must Be Taken To Avoid Resistance To Malaria Drug (3)
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Dear Colleagues,
The ORDA concern about resistance is interesting. Yes, it seems
that after a while heavy use of a drug, or inappropriate use of
a drug, creates resistance. So less use of a drug would appear
to be a good way to go.
The next decision is to address the fact that if there is less
drug use, we can expect an increase in death from malaria. So we
would now have more death but less resistance to the drug. I do
not think that it a desirable outcome, though when I listen to
the dialog about resistance I get the impression that this is in
fact an acceptable outcome.
So in order to have less resistance and less death from malaria
we have to come up with some other strategy. A strategy to re-
duce the amount of malaria being transmitted would seem to be a
good way to go. And then for the relatively few people that
catch malaria then use the drug in whatever dosage is going to
work.
What strategy then to stop people catching malaria:
* insecticide impregnated bednets
PLUS
* interior residual spraying of insecticides PLUS
* cleaning up stagnant water that are breeding places for mosquitoes
PLUS
* wearing sensible clothes PLUS
* using various forms of mosquito traps PLUS
* outdoor insecticide spraying
* ground fogging from a vehicle for whole neighborhood
* aerial spraying for areas where mosquitos thrive (such as
marshes and swamps
PLUS
* larvicides in water bodies that cannot be drained PLUS
* prophylactic medication PLUS
* curative medication when needed.
The mix of techniques incorporated into any community strategy
should be based on local conditions, including the local behav-
iour of the mosquitoes. The insecticide and the methods should
be carefully planned so that adverse side effects are minimized.
Bill Nessler has been asking for examples of places that have
eliminated malaria and controlled mosquitoes without the use of
insecticides and large scale spraying, including aerial spray-
ing. Did anyone give any examples yet? Are there any? Certainly
insecticides were used in the USA, in Australia and in Central
America and the Caribbean. WHO and UNICEF used insecticides
widely in the 1950s and 1960s and then stopped mainly because
the donors got donor fatigue and other disease interventions
were given funding priority over continuing a long term malaria
program (see Children of the Nations by Maggie Black published
by UNICEF in 1987 pages Chapter 4 pages 62 to 81).
The good news is that scientific knowledge is now much advanced
from the 1950s and the 1960s... and if we use evidence based de-
cision making we can now make development performance a whole
lot better than in the past.
As many of you know I come at problems from an accounting and
corporate performance perspective. What is the best way to spend
a modest amount of money to get the most real durable benefit?
In my view, making progress against malaria in Africa is a good
use of scarce resources. Someone else (the entymologists, the
epidemiologists, the doctors, the community leaders) needs to
tell me what is the BEST strategy to reduce the adverse impact
of malaria in Africa.
Sincerely,
Peter Burgess
Tr-Ac-Net in New York
Tel.: +1-212-772-6918
mailto:peterbnyc@gmail.com
The Transparency and Accountability Network
With Kris Dev in Chennai India
and others in South Asia, Africa and Latin America
http://tr-ac-net.blogspot.com
http://www.tr-ac-net.org