On April 25 this year, World Health Organization (WHO) member countries especially those burdened by the malaria disease celebrated World Malaria Day. The annual celebration which began in 2007 is an opportunity for malaria affected countries and regions to share experiences, seek donor funding, and allow researchers and scientists to showcase advances in malaria control. In Liberia, the slogan for this year’s World Malaria Day was “Get Tested for Malaria before Treatment.” Implicit in the slogan is the focus on treatment not prevention.
The centerpiece of Liberia’s malaria control program at the Ministry of Health and Social Welfare is the distribution of insecticide-treated mosquito bednets. While the use of insecticide-treated mosquito bed nets has proven to show positive outcome in malaria prevention, adopting it as the main malaria intervention strategy is insufficient and at best timid in the face of damning statistics on the toll of the disease on the Liberian population. A study by the United Nations International Children Emergency Fund (UNICEF) estimates that 3000 children under the age of 5 years die each day as a result of malaria in Sub-Saharan Africa. Liberia’s share of those deaths is eight children a day. In addition, there are countless prenatal and postnatal developmental problems suffered children when a mother infected with malaria passes the disease on to her unborn child. On an annual basis, GDP losses in Liberia as a result of the disease can be counted in the millions, according to another UNICEF study.
When we put all of our eggs in one basket, so to speak, with the use of bednets as the key malaria prevention strategy, we are, in a sense, waving a flag of surrender to an insect. We are essentially accepting the cohabitation of people and the malaria vector in the same living space. That should not be the case when there now exists other effective and evidence-based malaria control strategies. Mosquito larvae elimination is an evidence-based approach that Liberia can adopt as part of a comprehensive malaria intervention strategy. First we identify the mosquito habitat (swamps, gutters, garbage dumps, wet grounds, sitting pools of water, etc) including communities with high incidence of malaria. Second, we conduct periodic indoor and outdoor spraying using the chemical or pesticide known as DDT (Dichlorodiphenyltrichloroethane).
DDT will destroy the eggs, larvae, and pupae of mosquitoes and any insect for that matter, thus short-circuiting the development of adult mosquitoes that can serve as vectors of the malaria parasite.
DDT is an effective malaria control agent. According to the Centers for Disease Control and Prevention (CDC) in the United States, DDT was used to eradicate malaria in the United States in 1951. It was also used to eliminate malaria as a public health concern in Ecuador and several other countries around the world. Liberia can adopt similar strategy.
On reading this suggestion, there may be people who will cite the dangers of DDT to human health. That should be an interesting debate when the current effects of malaria on our people are compared to the potential harm DDT can cause. The controversy over DDT is as a result of environmental zealots in the early 70’s who used the impact of the pesticide on the eco-system to amplify a corresponding effect on human health. In all the flack DDT has received to the extent of being banned in the United States, there has been no scientific evidence linking the use of the pesticide for malaria control to an adverse human health outcome. We must not in clear conscience allow eight children to die everyday in Liberia (3000 mortalities a day in Sub-Saharan Africa) from a disease that can be prevented with the application of DDT because we want to save the ecosystem. The status of malaria today in Liberia calls for a pragmatic approach, one that is devoid of timidity.