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Sunday, May 13, 2007

Malaria, DDT and the case of Poverty in Malawi

Malaria, DDT and the case of poverty


Kondwani Munthali

The recent reaction from Tobacco Association of Malawi on the use of DDT in houses as a malaria control measure cans least be described as shocking. Malaria remains the number one killer and cause of morbidity (illnesses) among Malawians. Contrary to popular opinion, it is Malaria and not Aids which is the number one killer both in Malawi and Africa. Up to one million Africans die each year from malaria.

In Malawi, malaria is endemic meaning that everyone is at risk of suffering from malaria. Closer to seventy –percent of our hospital beds are occupied by malaria patients. It has dire socio-economic consequences than any other disease.

Malaria has become regarded as both a disease of poverty and a cause of poverty, as it accounts for a large loss of labor productivity.

Local and international political commitments have been made to address the challenges that African nations must overcome to control epidemic and endemic malaria. The Roll Back Malaria (RBM) global partnership established in 1998 by the WHO has found strong support.

Malaria infection in pregnancy is recognized as a major public health concern (WHO). Pregnant women are at increased risk of developing severe malaria than non-pregnant women. Complications of malaria in pregnant women include maternal anemia and death, transplacental infection of fetus, spontaneous abortion, preterm delivery, neonatal anemia, and neonatal low-birth weight (LBW). In endemic areas of Africa, malaria in pregnancy is estimated as the cause of over 10,000 maternal deaths, 8-14% of all LBW babes, and 3-8% of all infant deaths .
The factors of poverty, lack of formal education, and a growing population have identified Malawi as a country in dire need of assistance to strengthen government activities. Malawi was ranked 165th of 177 in the UNDP Human Development Index and is the 5th poorest country in the world in GNP per capita (US $170) . It still suffers from serious inequities in the distribution of income, with over 65% of the population living below the absolute poverty line.
Malawi’s health indicators are among the worst in the world despite the substantial inputs that have been invested in the health sector over the past years. Malawi’s progress on the Millennium Development Goals indicates lagging progress in many areas. Communicable diseases, food insecurities, and inadequate health care services pose severe challenges to the weak government. Life-expectancy has dropped from 41 years in 2004 to 37.5 years in 2005 .

Statistics indicate that 70% of mortality among in-patients is due to communicable and other preventable diseases (malaria, nutritional deficiencies, pneumonia, anemia, enteritis, measles and TB). Malawi is challenged by a HIV rate of 14%, increasing tuberculosis prevalence, and chronic malnutrition rates. Malnutrition is endemic in Malawi, with 50% of children under-five chronically malnourished. Malaria is the most common reported cause of morbidity in both adults and children, and both the incidence and case fatality rates appear to be rising.
Malaria is caused by a parasite that is spread to humans its vector, the anopheles mosquito. The anopheles mosquito passes the malaria parasite between humans during feedings. There are four species of malaria parasite. Plasmodium falciparum, which causes the most severe malaria, is the most common malaria species found in Malawi. Symptoms vary in severity. Infected humans may be asymptomatic, display classic symptoms (including fever, chills, sweating, headaches, and muscle pains), or present with severe illness (cerebral malaria, anemia, kidney failure) that may lead to death (CDC). The severity of illness is largely dependant on the humans acquired immune system, genetics, and general state of health. In endemic areas such as Malawi, treatment for malaria is recommended within 24 hours of first symptoms. In the absence of any known etiology, antimalarial treatment is recommended for any individual presenting with fever. Medications that treat malaria include chloroquine, sulfadoxine-pyrimethamine, mefloquine, atovaquone-proguanil, quinine, doxycycline, and artemisin derivatives.
To compound the endemic prevalence of malaria and the severity of disease, drug resistance has proven another challenge in Malawi. Chloroquine was the main antimalarial, inexpensive and effective, until drug resistance to the medication was found to be high. Fansidar or SP has just been regarded the same as of late last year. A combination of drugs is being explored to effectively deal with Malaria.

Preventive efforts have focused on providing Insecticide treated bed nets for pregnant mothers and wider public campaigns for the public to take precautions to deal with Malaria.

However, agreeable among many DDT has far greater success rate in dealing and completely stopping malaria than any other intervention. That is why compelling scientific evidence has seen the WHO recognizing this banned substance as more appropriate for dealing with malaria.

For institutions such as TAMA whose scientific capacity is challenging to ascertain, its fear are unfounded and definitely out of economic interests. A healthy and productive farmer without malaria will produce a healthier tobacco.

Reduction in public spending over malaria due to reduced cases in our hospitals shall mean more support to appropriate technologies that will see farmers producing better and quality tobacco.



Further to this, the United States and other Western countries eradicated malaria from their countries by using the same DDT. When the ban was announced towards the end of the 90’s, Thailand and India refused to stop producing the chemical for its health use. Today, malaria cases in the countries are on their way out.

Experiments in South Africa in using DDT, resulted in seventy percent reduction of hospital admissions, while countries such as Ethiopia, Benin and Gambia are reporting great success in use of DDT against malaria.

The tobacco and environmental concerns might be legitimate, but human health and its costs has far greater consequences than anything added together. TAMA should have done its appropriate research to ascertain the dangers of DDT before making a potentiall qualified empty statement.

Further to this, remarks from the Chairman of Parliamentary Health Committee indicate how slow information trickles down on important discoveries, including qualified medical personnel as the Chairman is.

The case for DDT has been proven that it works and reduces malaria. Malawi will save millions of dollars for its development programme if malaria cases dropped today. Employers will be happy with malaria-free excuses for a year as productive employees will no longer suffer from malaria.

Hospital overcrowding and pressures on the health workers will be much less, if malaria is controlled. Infants and under five children and pregnant mothers will no longer die unnecessarily if DDT is used.

A Malawi free of Malaria would be a productive nation. DDT provides that chance, which is much greater. After all, we used DDT on tobacco and they still smoked it. I believe they wont stop.

You cannot play on human lives. Economically, DDT provides a better alternative as the huge costs of hospital admissions, drug procurements, inactive ill labour and treatment is higher.

Malaria is a cause of poverty and caused by poverty. Remove it we have economic prosperity.

Kondwani Munthali
Global Health fellow
Harvard University

2 comments:

TaMara Kampondeni said...

I am just dumbfounded to read the article, "Malaria, DDT and the case of Poverty in Malawi" by Kondwani Munthali. I don't think the argument about the pesticide DDT is whether it works to eradicate mosquitoes that transmit malaria or not, but its effects to human health. The US banned the use of DDT in 1973 and so have EU countries, yet the US still manufactures this pesticide for exports to mostly 3rd world countries - why do you think that is? I suggest Mr Munthali reads, "Silent Spring" by the late Rachel Carson. You might not see its impact right away, but DDT is toxic and hazardous people's health.

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