There are many studies over the years that show bednets reduce
mortality from malaria, especially the mortality of young children and
pregnant women. However, the best cases are a reduction in mortality
of something in the range of 40% to 60% ... which means that there is
still a lot of death arising from malaria ... not to mention a lot of
death from other preventable childhood diseases.
A best practice strategy is going to be one where available resources
are used in the most cost effective way. The heavy focus on bednets is
almost certainly not the most cost effective ... and now that a very
large amount of money has been used in this manner, it is becoming
clear that a strategy based on bednets is not working particularly
well and is not going to be sustained by the donors for ever, and
without donors, the malaria bednet program will die.
A malaria management program should have a community focus and do what
works in the community and is based on surveillance for entomological
knowledge about the community, screening for medical information, and
a full range of control interventions: medical treatment, source
control, vector control and personal protection. The key is to get the
malaria transmission rate to be very low and to keep it low. Malaria
can be reduced rapidly ... but it comes back just as fast. This is a
dynamic problem that needs day to day action to keep it under control.
I like to contrast what is recommended for malaria in Africa where
thousands of children die every day from malaria with the control of
West Nile Virus in the USA where the potential for death is big, but
the actual death is perhaps 40 (???) a year.
From what I am learning IRS and source control (larvaciding) should be
a big part of malaria management best practice. They seem to be much
more cost effective than bednets ... where effectiveness is the
reduction in the malaria burden in society.
Sadly ... data are not flowing ... and data based analysis is
difficult. Opinion is not a good basis for decision making.
The Transparency and Accountability Network: Tr-Ac-Net in New York
Integrated Malaria Management Consortium (IMMC)
917 432 1191 or 212 772 6918 peterbnyc@...
On Thu, Dec 11, 2008 at 9:08 AM, Kennedy Owino
> Dear all,
> I am happy about the discussion gaining momentum here and hope that our thoughts will provide certain solutions.
> Thanks Tom, Dennis and Dan for your views.
> Ricardo, you asked what type of pepper my Grand Ma used.
> It was a Red pepper (not round but finger shaped)- i cant find appropriate word to describe it.
> Peter Burgess says,
> "There are many questions ... essentially a lot of little questions that give data ... and the data will give answers. My hope is that one of these days we will start to be collecting the dots in a coherent way so that it becomes easy to connect the dots and get the right best answer"
> Peter further asks what Malaria used to be like before the advent of bed nets in Kenya and how it is now.
> Another question may be, Why is there still wide spread cases of malaria in Kenya, particularly around the Lake Victoria region yet there has been massive campaigns and mosquito nets distribution?
> My attention was drawn to a particular publication in one of today's dailies touching on the topic of Malaria.
> It said that , a study conducted by Maseno University, Nagasaki University of Japan, and I.C.P.E also published in Malaria Journal (http://www.malariajournal.com/) revealed sad findings in Nyanza Province of
Kenya (around lake Victoria) that hampers the fight against malaria.
> There is wide spread misuse of bed nets, Bed nets intended for bedrooms end up on the fishing beaches.
Poor fisher men who can not afford fishing nets use new distributed
bed nets to fish and also they have opted to dry small fish (omena) on
> The emerging trend is mostly happening in Luanda Beaches of Sondo District. This is raising concerns among the public Health experts and the Fisheries Department.
> The habit reverses the gains already made in fighting against malaria, the misuse also poses a risk to the fish stocks.
> The District has received a substantial number of nets from the Goverment and N.G.O's. This year alone over 20,000 pieces were distributed. More stastistics can be found at http://www.malariajournal.com/
> The big question here is, Do you think Poverty and Ignorance also hampers efforts to contain Malaria?
> How can we reverse the trends where Bed nets end up being misused?
> All the best in our positive quests,
> Ken Owino
> Nafsi Africa Acrobats