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Re: [learningfromeachother] Misuse of Bednets

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  • Edward Cherlin
    On Thu, Dec 11, 2008 at 6:08 AM, Kennedy Owino ... The same problem exists in Tanzania. I was at an Engineers Without Borders meeting yesterday where the
    Message 1 of 3 , Dec 12, 2008
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      On Thu, Dec 11, 2008 at 6:08 AM, Kennedy Owino
      <nafsiafricaacro@...> wrote:
      > 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?

      The same problem exists in Tanzania. I was at an Engineers Without
      Borders meeting yesterday where the question came up. Our information
      is that bed nets are often not properly hung, but we have no
      explanation of what that means. Are they hung at all? Are there gaps
      around the edges? Is there some other problem?

      We know that bed nets cannot eliminate malaria. There will always be
      exposure to mosquitoes at dawn and dusk, or even at night. Who has
      figures for the best practices?

      Here are my only data points, from twelve years ago.

      http://archive.idrc.ca/books/reports/1996/01-06e.html

      # The results from the first mortality study of
      insecticide-impregnated mosquito nets in The Gambia showed a reduction
      in deaths from all causes in children under the age of five of 63%.
      (Lancet 1994; 344: 1175-82)

      # The results of the second study in The Gambia confirmed the earlier
      study results showing a reduction in mortality of 25 to 38% in
      children under 9 years of age. (Lancet 1995, 345: 479-83)

      # More than 20 studies of insecticide-treated nets (ITNs) have been
      conducted in different areas of the world where malaria is endemic.
      Most studies have documented a reduction in malaria disease rates
      between 20 and 63% following the introduction of ITNs.

      So we must immediately ask what causes the variance among these studies.

      > 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 nets.

      I can see a straightforward remedy for this particular issue.

      > 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 habbit reverses the gains already made in fighting against malaria, the
      > misuse also poses a risk to the fish stocks.
      > The District has received a sabstantial 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?

      I'm sorry, what else?

      Anybody who is interested in helping with these questions should look
      at the HIFA2015 mailing list (Health Information For All by 2015) and
      the Health list at http://lists.laptop.org/. Earth Treasury is
      starting a textbook project, and would of course include health as one
      of the most important subjects.

      > How can we reverse the trends where Bed nets end up being misused?

      Distribute fishing nets along with bed nets? Teach people to make
      fishing nets or bed nets?

      > All the best in our positive quests,
      >
      > Ken Owino
      > Nafsi Africa Acrobats
      > www.nafsiafrica.org
      > +254723568251
      >
      >
      >
      > --- On Thu, 12/11/08, graham <DIYSolar@...> wrote:
      >
      > From: graham <DIYSolar@...>
      > Subject: [mendenyo] Re: Ending malaria as a volume of thinking and research!
      > To: mendenyo@yahoogroups.com, holistichelping@yahoogroups.com
      > Date: Thursday, December 11, 2008, 2:57 AM
      >
      > Dear Andrius and others,
      >
      > I have already started making arrangements to test solar-powered fans with
      > Peter.
      > I imagine it would be best to have someone on the spot to do any
      > co-ordination, etc
      > with other experiments.
      >
      > It might be useful to test pepper but from what I have read it is
      > extremely difficult to research malaria as there are so many many factors to
      > be
      > considered!
      >
      > Graham
      >
      >
      >
      > Peter Burgess, Graham Knight,
      >
      > Would one or both of you be willing to partner with Peter Ongele on a
      > malaria related $100 project which I might sponsor (perhaps reviewing the
      > data they have collected, or trying out peppers as an insecticide, or
      > trying out solar powered fans?)
      >
      > Perhaps one of our Africans might be Peter's partner? That's possible as
      > well. We simply need somebody interested and willing to exchange letters
      > in our groups so that we can all see the progress of Peter's explorations.
      >
      > Thank you all for your letters!
      >
      > Andrius Kulikauskas
      > Minciu Sodas
      > http://www.ms lt
      > ms@...
      >
      >> Dear All,
      >>
      >> I know next to nothing about malaria but I did a short investigation some
      >> years
      >> ago as I had read that bed nets are often ineffective.
      >> Not because mosquitoes get through the netting but because the 'climate'
      >> under
      >> a net can be so appalling that many, especially children, rather remove
      >> the net and
      >> risk the consequences.
      >> A recent googling shows this is still widely reported.
      >>
      >> In consequence I tried to find people interested in using pv solar-powered
      >> fans
      >> but only now have I found someone, Peter Ongele, who is interested in
      >> testing
      >> this possibility!
      >>
      >> Graham
      >>
      >>
      >>
      >>
      >> Dear Colleagues
      >>
      >> I am delighted that this malaria conversation is moving ahead.
      >>
      >> There is a huge body of knowledge about malaria ... and most people
      >> are only accessing a very small bit of it. One of the challenges is to
      >> *manage* this vast knowledge resource and do things that work.
      >>
      >> I see the goal as being to reduce the burden of malaria in the area as
      >> fast as possible and at as low cost as possible. In order to manage
      >> this there is a need to figure out what works and what does not.
      >>
      >> As I understand it, insecticide treated bednets have been distributed
      >> in the area ... but malaria persists. Why is this? Is this a fact, or
      >> part of a fact? There are some questions that need to get answered:
      >> .... how many bednets were distributed and when?
      >> .... how many in the area population? How many bednets per person ...
      >> per household?
      >> .... what was the malaria like before bednets? What is it like after
      >> bednets?
      >> .... are bednets being used?
      >>
      >> If there is a health clinic (or clinics) in the area ... what are the
      >> month by month cases of malaria? Is the number going up or down? What
      >> about seasonality? What about rainfall and temperature and humidity?
      >>
      >> Under 5 child mortality and pregnant women (PW) are vulnerable to
      >> malaria mortality. Any changes over time for under 5 and PW mortality.
      >>
      >> Is there any change in the prevalence of malaria parasites in the
      >> human population? Is this being measured at the clinic or clinics?
      >> What methods are being used.
      >>
      >> Is there any source control of the mosquitoes? What is being done?
      >>
      >> Is there any change in mosquito population? Are there any mosquito
      >> traps? How many? Where are they? What results? Is there daily data ...
      >> or weekly? How does this look month by month?
      >>
      >> Is there any change in the prevalence of malaria in the mosquito
      >> population? Who is measuring this?
      >>
      >> Is interior residual spraying (IRS) being used? What chemical is being
      >> used? What spray rates? When is it being done?
      >>
      >> 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.
      >>
      >> But before that will happen, there is one last set of data. How much
      >> do things cost? How can everything that needs to be done be done in
      >> the least cost manner (this is cost efficiency). At the same time,
      >> least cost is not the ultimate goal ... most cost effective is the
      >> goal ... what activities give the biggest reduction in the burden of
      >> malaria?
      >>
      >> This is a multi-variate problem ... not easy to get a perfect answer
      >> ... but quite easy to get something a lot better than what has
      >> prevailed in the past.
      >>
      >> Hope this is helpful ... I realize that I should have been more
      >> helpful over the past weeks and months ... but I am trying to pull
      >> together a response to the WHO Global Malaria Action Plan (WHO-GMAP)
      >> using what we refer to as Integrated Malaria Management Best Practice
      >> (IMM-BP). My hope is this will help to move the focus of malaria
      >> control activities from Washington and Geneva to the African Community
      >> and the local professionals who are most engaged and concerned about
      >> progress ... and at the same time be a good basis for ongoing
      >> financial support for malaria control even though the capital markets
      >> have imploded.
      >>
      >> Sincerely
      >>
      >> Peter Burgess
      >>
      >> On Wed, Dec 10, 2008 at 12:26 AM, Kennedy Owino
      >> <nafsiafricaacro@ yahoo.com> wrote:
      >> > Hello Sam and all,
      >> >
      >> > I admire Great thoughts circulating here on how we can help in
      >> combating the
      >> > greatest world killer which is affecting Kenya big time.
      >> > Sam, a thought just crossed my mind, pepper was being used
      >> traditionally to
      >> > kill insects like coackroaches and also mosquitos.
      >> > Grandmothers used to drop some berries or fruits of pepper into the
      >> open
      >> > fire in the traditional three stone cooking stove and in a shortwhile
      >> all
      >> > disturbing "dudus" (mosquitoes and coakroaches would be dead).
      >> > A cultural focuss or an approach can be taken on researching on if
      >> some form
      >> > of insecticide can be developed out of this.
      >> > Better still people in the villages would use this cultural/outdated
      >> method
      >> > besides the use of Bed nets to control mosquitoes.
      >> > I doubt if using pepper should have any negative impact on the
      >> environment.
      >> >
      >> > Sam, i respect that you put your time and experience into finding ways
      >> of
      >> > dealing with the spread of malaria.
      >> > Malaria should be a big concern, last week i had to donate blood to an
      >> > American (a friend of a friend) who was dying in Nairobi Hospital
      >> because of
      >> > Celebral Malarial infection he got while on vaccation in Tanzania.
      >> > He was quickly evacuated to Nairobi, he was on support unit and
      >> urgently
      >> > required blood platellets (if that is the right spelling).
      >> > At first he was wrongly diagnosed to be suuffering from typhoid, it
      >> was
      >> > serious , his parents flew in from the States and evenually he had to
      >> be
      >> > flown out to seek proper treatment in America.
      >> > Anyway, this shows how serious this may be not only to people living
      >> in
      >> > Africa but also to visitors and tourists as well.
      >> >
      >> > I laud and support your point- Ending malaria as a volume of thinking
      >> and
      >> > research- but most of the solutions lies with us, just a little bit of
      >> > thinking.
      >> >
      >> > Have a thoughtful day!
      >> >
      >> > Ken Owino
      >> > NAfsi Africa Acrobats
      >> > www.nafsiafrica. org
      >> > +254723568251
      >> >
      >> >
      >> > --- On Mon, 12/8/08, Samwel Kongere <jambita1@yahoo. com> wrote:
      >> >
      >> > From: Samwel Kongere <jambita1@yahoo. com>
      >> > Subject: [mendenyo] Ending malaria as a volume of thinking and
      >> research!
      >> > To: Mendenyo@yahoogroup s.com
      >> > Date: Monday, December 8, 2008, 6:41 PM
      >> >
      >> > Hello Chris, Peter, Graham and all,
      >> >
      >> > I am crossinly happy with your all thoughtful messages
      >> > and links. I trust our valuable time and commitment
      >> > will give us wonderful answers/results.
      >> >
      >> > I carried out personal talks with the public health
      >> > department in our district, on how combined efforts
      >> > can help end malaria. With the Rusinga island malaria
      >> > project, data, mosquito nets will help reduce malaria
      >> > but most of it are studies which only help scientists
      >> > and educationist not the low class villagers.
      >> > With my own a wareness on malaria cases. There are two
      >> > districts which benefited to a substancial change in
      >> > fighting and ending malaria. The chemical used in
      >> > Rachuonyo and Kisii districts will be introduced in
      >> > other areas. This is a government effort.
      >> > We are organizing a consortium in Kisumu on July 1-3rd
      >> > 2009 to bring a real local combined a wareness on
      >> > matters of sustainabillity. Once the budget is
      >> > finalised we will send invitations to attendees.
      >> > We need your contributions which can be sent to me or
      >> > Tom Ochuka, as we are planning.
      >> > Cheers to all!
      >> > Samwel.
      >> >
      >> > http://www.surveymo nkey.com/ s.aspx?sm= 5VvLrzLaXHc0i_ 2bh5XdOTxA_
      >> 3d_3d
      >> >
      >>
      >>
      >>
      >>
      >>
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      >>
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      >> 12/10/2008 6:53 PM
      >>
      >
      > --
      > Minciu Sodas
      > http://www.ms lt
      > ms@...
      > +1 312 618 3345
      >
      > ________________________________
      >
      > No virus found in this incoming message.
      > Checked by AVG - http://www.avg com
      > Version: 8.0.176 / Virus Database: 270.9.16/1842 - Release Date: 12/10/2008
      > 6:53 PM
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      >



      --
      Silent Thunder (默雷/धर्ममेघशब्दगर्ज/دھرممیگھشبدگر ج) is my name
      And Children are my nation.
      The Cosmos is my dwelling place, The Truth my destination.
      http://wiki.sugarlabs.org/go/User:Mokurai
    • Peter Burgess
      Dear Colleagues There are many studies over the years that show bednets reduce mortality from malaria, especially the mortality of young children and pregnant
      Message 2 of 3 , Dec 12, 2008
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        Dear Colleagues

        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.

        Sincerely

        Peter
        ____________
        Peter Burgess
        The Transparency and Accountability Network: Tr-Ac-Net in New York
        www.tr-ac-net.org
        Community Accountancy
        Integrated Malaria Management Consortium (IMMC)
        917 432 1191 or 212 772 6918 peterbnyc@...

        On Thu, Dec 11, 2008 at 9:08 AM, Kennedy Owino
        <nafsiafricaacro@...> wrote:
        > 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 nets.

        > 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
        > www.nafsiafrica.org
        > +254723568251
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