Schapira on malaria eradication

Despite some good technical developments, such tools are still not available, and an analysis of the potential of new tools that could be developed also does not suggest that we are likely to get rid of malaria parasites.

I think they should push forward as fast as possible on this. I haven't seen the statistics lately, but I know they are staggering on the deaths per year. But long term tests need to be conducted on pesticides, etc., before they are unleashed on the environment!
Dave Briggs :~)

Dave Briggs:

I hope you mean control, not eradication - that's the whole point.

I'm afraid my contribution to the 'open thread' on this subject got rather buried in a debate on healthcare in developed countries - so I hope you won't mind a re-post:

"Thanks for your blogging over the year Tim.

I was particularly interested in the way you exposed the CEI Rachel Carson hate sites, and the general assault on Science represented by the 'denialists' who promote DDT as the only show in town when it comes to combating malaria.

I've noticed that their sites are loud and noisy - but despite the fact that they seem happy to use the images of dead African children to promote their politics - they don't actually ever seem to do anything practical to combat malaria.

The most effective method of combating malaria, both in terms of cost, and scientifically supported efficiency is the use of insecticide-treated bednets. There is a charity which has managed to get all the support, transport and distribution costs covered - so if you donate to them you are actually buying a bednet - and they'll tell you exactly where it is going.

Nets cost $5US or £2.50 each (not sure about Aussie dollars?) - and if they've got their stats right, 20 nets will save a life, not to mention a lot more misery in terms of a nasty debilitating disease.

I've taken the opportunity to buy a few for Christmas, and have the satisfaction that it was the antics of the hate-filled individuals who set up the Rachel Carson defamation website, that prompted me to do so.

You might consider joining me?? ;)

http://www.againstmalaria.com/en/findoutmore.aspx

.. and in case there is any scepticism:

Their efficacy has been established by the WHO - and while at their current levels of use they can't be expected to eradicate malaria - they have a direct protective effect on the individuals that use them. Hey if enough people in the developed world coughed up a few quid (or bucks) - maybe we could have a real impact on the transmission of the disease itself.

Even official US agencies think a million lives could be saved:

"Bednets Reduce Malaria

* More than one million lives could be saved annually if insecticide-treated bednets (ITNs) were routinely used by the populations at greatest risk of malaria.
* Several models for delivery of ITNs have been developed, and the choice among them depends on how capable the commercial sector is to provide bednets.
* A new technology for dipping nets may soon turn people's conventional bednets into long-lasting bednets.

Insecticide-treated bednets (ITNs) are a highly effective way for individuals, families, and communities to protect themselves from malaria. Consistently sleeping under an ITN can decrease severe malaria by 45%, reduce premature births by 42%, and cut all-cause child mortality by 17% to 63%. When ITN coverage ratesreach 80% or more in a community, those residents not sleeping under an ITN also obtain a protective benefit."

http://www.maqweb.org/techbriefs/tb17bednets.shtml

Dean, although the nets do not eliminate malaria, they do keep down the human pool from which malaria spread (I'm saying this badly) which makes local eradication much easier.

Dean: on first glance, it appears that permanent impregnation and bednet shape are orthogonal design issues.

So far, I've seen no data to help me know if permanently-impregnated nets also deal with the shape issues discussed in the SciAm article, and I can't tell if the nets you recommend address those issues, whether permanent or not.

http://www.sciam.com/article.cfm?id=a-better-mosquito-net

Do you *know* the answer, and if so, can you point us where it says so?

So presumably the fans of an eradication program have conducted a rigorous cost-benefit analysis ala the Copenhagen Consensus to see whether the expenditure is justified when compared with other possible health spending.

Dean:

> Nets cost $5US or £2.50 each (not sure about Aussie dollars?) - and if they've got their stats right, 20 nets will save a life, not to mention a lot more misery in terms of a nasty debilitating disease.

Ian:

> So presumably the fans of an eradication program have conducted a rigorous cost-benefit analysis

At $100US to save a life, $100M would eliminate all the malaria deaths in Africa for a whole year. This is worth about 5 hours in Iraq. With African lives going so cheap, who can resist this bargain?

How bout that Lancet Iraq smackdown? Clear fraud in the Sadr City numbers, heaping indicating fraud in the death certificate numbers, recording data from the wrong time period, total refusal to talk about survey methods or disclose survey data... ouch.

http://news.nationaljournal.com/articles/databomb/index.htm

John Mashey..

- the article in Sci Am is a little disappointing don't you think? It doesn't produce any evidence that current designs of mosquito nets don't work - other than this simple and unsupported assertion:

"The widespread distribution, however, has not resulted in a significant decrease in malaria".

Since the article doesn't even address the fact that there are a new generation of impregnated nets currently being distributed until the very end:

"Several companies have recently introduced nets that are impregnated with long-lasting insecticide, eliminating the need for people to continually apply fresh coatings of chemicals to the nets. Companies must continue to improve mosquito nets if progress is to be made in combating malaria. And once better nets are available, researchers will be able to objectively judge the effectiveness of the distribution programs."

She presumably admits that her musings are out-of-date.

Yes we should always strive to produce better bed-nets (and better stuff in general) - but since you or I can afford to by cheap bednets now that are proven to save lives - then there really isn't much excuse for inaction.

Bednets are effective - even against insecticide-resistant mozzies, here is the WHO's position statement on Bednets, which contains references to all the relevenet research on their efficacy, and cost-effectiveness:

http://www.who.int/malaria/docs/itn/ITNspospaperfinal.pdf

http://www.who.int/tdr/research/finalreps/no5.htm

The National Journal (from the link above) opines:

This stunning toll was more than 10 times the number of deaths estimated by the Iraqi or U.S. governments

AFAIK the US government has never estimated civilian deaths in Iraq.

Perhaps TallDave can point me to one, before I simply dismiss the article he quotes as being not credible?

Ahh, the piece quotes Bush saying 30,000. I assumed "US government" meant "US government".

Dean:
From the web, Eva Kaplan, the author of the SciAm piece, has been involved with TamTamAfrica for a few years, and they were giving away LLITN years ago. There's at least one serious article on detailed usage patterns, ways to make them more effective, pricing, etc that thanks her and her field team, for their help. She's devoted more than casual time to this field, certainly knows about LLITNs, has worked to get them distributed. She simply raises the issue that: from *field* experience, giving someone a net doesn't automatically solve the problem, and that we ought to be designing better nets, and doing the *right* studies. [If I could figure out an easy way to help fund those...

I just asked a simple question: what type of nets? You didn't tell me "I don't know" (perfectly OK), but instead tried to discredit Ms Kaplan, and pointed me at URLs that didn't answer either. Her opinions may or may not be correct, but with all due respect to your efforts, she has probably done rather more work to get bednets into hands of people who will actually use them.

By all means, if someone wants to give a few dollars to a cause that's likely to be helpful, likely not to be completely wasted, and certainly not harmful, buying the existing bednets seems reasonable, and far better than many other things. (Done)

Sorry John, I was going by the content of that SciAm article alone, which seemed to suggest that ITN's were no good because of the continuing incidence of malaria. I guess this may be because it was edited down from a more substantial contribution.

As far as I was concerned the bednets currently in use are a worthwhile investment, as they are proven to protect people from malaria - when someone comes up with an improved design - then great.

So thanks and well done for contributing - I'm sure someone somewhere will be grateful for it..

Dave Briggs:

I hope you mean control, not eradication - that's the whole point.

Posted by: Marion Delgado | January 2, 2008 1:22 PM

I am for control, but we need to be careful not to make the solution worse than the original problem. Pesticides can be unexpectedly dangerous and extremely deadly for other than the targeted species.
Dave Briggs :~)