Famine in Somalia: ‘This is a race against time to save lives’ | Need to Know (PBS)

July 24, 2011

About genocide and other political issues that lead to the deaths of tens of thousands, or hundreds of thousands of people:  We keep saying “never again!”  When is never?  There is famine today in Somalia.

Alison Stewart of PBS’s Need To Know:

This week, the U.N. declared a state of famine in parts of Somalia. Need to Know speaks with Adrian Edwards of the U.N.’s Refugee Agency about the unfolding humanitarian crisis in the region.

Vodpod videos no longer available.

Video: Famine in Somalia: ‘This is a race again…, posted with vodpod

[2014 Update: Video expired, no longer available for streaming. Story and some details, here.]

More, Resources:


DDT “costly for Uganda”

July 22, 2011

To aid researchers looking for news from Africa on malaria and DDT, I’ll reproduce the entire news story from Uganda’s New Vision here.  Stories from this outlet frequently trouble me, in the unquestioning way writers take quotes from people where a more probing reporter might be more skeptical.  I am not sure of the status of New Vision among Uganda’s media, but it’s one of the few available to us here on a regular basis.

So, here’s the story, on DDT usage to fight malaria.  A couple of points we need to remember:  First, it’s clear that DDT is not banned in Uganda, and that DDT usage goes on, despite the crocodile tears of Richard Tren, Roger Bate, and the Africa Fighting Malaria, Astroturf™ group; second, this story relates difficulties in using DDT, including cost.  It’s not that the stuff itself is expensive.  DDT doesn’t work on all mosquitoes anymore, and it’s dangerous to much other wildlife.  Malaria fighters must do serious work in advance to be sure the populations of mosquitoes targeted will be reduced by DDT — that is, that the bugs are not immune to DDT — and care must be taken to control the applications, to be sure it’s applied in great enough concentrations, and only indoors, where it won’t contaminate the wild.

Here’s the story from New Visions:

DDT spraying costly for Uganda

Tuesday, 5th July, 2011

By Raymond Baguma and Gerald Kawemba

INDOOR residual spraying as a strategy to control malaria in Uganda is too costly and has affected the programme countrywide.

According to Dr. Seraphine Adibaku, the head of the Malaria Control Programme, this is why other malaria control strategies such as use of insecticide-treated nets and Artemisinin-based combination therapy are considered to be ahead of indoor residual spraying.

The Government is implementing the indoor residual spraying using pyrethrum-based and carbon-based insecticides in 10 malaria-endemic districts in the northern and eastern regions.

They include Amolatar, Apac, Kitgum, Kumi and Bukedea.

“About three million people in the 10 districts have been covered. We have reached over 90% of the population,” Adibaku said.

She added that under the Presidential Malaria Initiative, the budget for indoor residual spraying is sh4.5b per district each year.

Adibaku said it would be much cheaper if the ministry distributed insecticide-treated mosquito nets.

She, however, said indoor spraying has an advantage of delivering immediate impact compared to treated nets.

Adibaku disclosed that the health ministry is re-evaluating the effectiveness of using DDT for malaria control.

Dr. Joaquim Saweka, the World Health Organisation (WHO) resident representative in Uganda, said indoor residual spraying is highly effective and has been successful in Zanzibar and Rwanda.

He, however, added that it is capital intensive and needs a lot of money for each application done twice a year.

Saweka cited his previous posting in Ghana during which a town of 300,000 inhabitants required $3m for spraying each year.

He said with the high cost of spraying and low financial resources available, Uganda needs to prioritise usage of insecticide-treated mosquito nets.

Saweka added that Uganda is on the right path to eradicating malaria with efforts in prevention, diagnosis and treatment as well as universal coverage of insecticide-treated nets.

Health minister Dr. Richard Nduhura yesterday kicked off a nationwide programme to distribute 11,000 bicycles to health volunteers who will diagnose and treat malaria in homes. The programme is supported by the Global Fund.

It is part of the Government’s home-based management of malaria, which is part of a larger national strategy to deliver treatment to children within 24 hours after diagnosis.

 


Heritage Foundation urges that Africa be poisoned

May 7, 2011

Oh, not outwardly anti-Africa, but stupidly so.

The extreme right-wing Heritage Foundation lashed out at health care workers and scientists fighting malaria in Africa and Asia for World Malaria Day, April 25 (HF’s post showed up on May 5).  If these malaria fighters really were smart, HF’s Jane Abel wrote, they’d just poison Africa with DDT instead of protecting children with bednets and working to improve medical care.  According to Abel, DDT is safe for everyone but mosquitoes, and more effective than anything else malaria fighters use — so they are stupid and venal, she asserts, for not using DDT.

Here’s her post:

Environmentalists celebrated World Malaria Day last week (and Earth Day the week prior). Meanwhile, thousands of African children died of malaria.

While these activists may make themselves feel like they’re saving the world, they are ignoring the best possible solution to Africa’s malaria problem: the use of DDT to wipe out the Anopheles mosquito.

Even though the World Health Organization resumed promotion of DDT in September 2006—realizing it had the best track record for saving the lives of 500 million African children—environmentalists are still emphasizing the use of bed nets instead. DDT treatments almost completely eradicated the disease in Europe and North America 50 years ago, but today an African child dies every 45 seconds of malaria.

Providing sub-Saharan Africans with bed nets has had far from acceptable success in delivering the amount of protection needed from mosquitoes. The World Bank touts the fact that 50 percent of children in Zambia are now sleeping under nets as a good thing, but what about the other half who are left defenseless against a killer disease? The Democratic Republic of the Congo had only 38 percent of children under nets in 2010.

One would question why, in the 21st century, people should have to live inside of a net in order to be safe from malaria. The world has a better solution, and it’s not the quarantine of African infants. Dr. John Rwakimari, as head of Uganda’s national malaria program, described DDT, which is nontoxic to humans, as “the answer to our problems.”

World Malaria Day 2011 had the theme of “Achieving Progress and Impact” and aims to have zero malaria deaths by 2015. If the world really wants to make progress and increase the number of lives saved from malaria, it needs to embrace for Africans the best possible technologies available today, and that means DDT.

Here’s my response, which I predict will not show up at HF’s blog in any form*:

DDT is toxic to humans — just not greatly and acutely so.  Ms. Abel should be aware of recent studies that indicate even limited, indoor use of DDT in the end produces a death toll similar to malaria.  But we digress on just one of the errors assumed by Ms. Abel.

If DDT could wipe out malaria-carrying mosquitoes, WHO would not have slowed or stopped its use in 1965, years before anyone thought about banning the stuff.  By 1965 it was clear that overuse of DDT in agriculture had bred mosquitoes that are resistant and even immune to DDTJonathan Weiner noted in his Pulitzer Prize-winning book, The Beak of the Finch, that today every mosquito on Earth carries at least a few copies of the alleles that allow mosquitoes to digest DDT as if it were a nutrient.

DDT cannot be a panacea for malaria.

Please do not forget that malaria is a parasite disease, and that mosquitoes are only the carriers of it.  To truly eradicate malaria, we need to cure the humans — and if we do that, the mosquitoes do not matter.  With no infected humans, mosquitoes have no well of disease to draw from.  Without infected humans, mosquitoes cannot spread malaria.

Only 38 percent of children in Congo sleep under bednets?  I’ll wager that’s twice the percentage of kids that were ever protected from malaria in Congo by DDT.  In actual tests in Africa over the past decade, bednets have proven to reduce malaria by 50 to 85 percent; DDT, on the other hand, reduces malaria only 25 to 50 percent under the best conditions.  If we have to go with one and not the other, bednets would be the better choice.  Nets are much, much cheaper than DDT, too.  DDT applications must be repeated every 6 months, at a cost of about $12 per application per house.  Nets cost about $10, and they last five years.  Nets protect kids for $2 a year, better than DDT; DDT protects kids for $24 a year (that’s 12 times the cost), but not as effectively as nets.

Also, it’s important to remember that DDT has never been banned in Africa.  DDT non-use is much more a result of the ineffectiveness of DDT in many applications — why should we expect Africans to throw away hard-earned money on a pesticide that doesn’t work?

Finally, it’s also good to understand that, largely without DDT, malaria deaths are, today, at the lowest point in human history.  Fewer than 900,000 people a year die from malaria today.  That’s 25% of the death toll in 1960, when DDT use was at its peak.

Ms. Abel assumes that all Africans are too stupid to use DDT, though it might save their children.  He states no reason for this assumption, but we should question it.  If Africans do not use DDT, it may well be because the local populations of mosquitoes are not susceptible; or it could be because other solutions, like bednets, are more effective, and cheaper.

Ms. Abel has not made a case that DDT is the best solution to use against malaria.  DDT cannot improve a nation’s medical care delivery systems, to quickly diagnose and appropriately treat malaria in humans.  DDT cannot make mosquitoes extinct, we know from 66 year of DDT use that mosquitoes always come roaring back.  DDT cannot prevent mosquitoes from spreading malaria as effectively as bednets.

Maybe, just maybe, as evidenced by the dramatic reductions in malaria deaths, we might assume that modern Africans and health care workers know what they’re doing fighting malaria — and they do not need, want, or call for, a lot more DDT than is currently in use.

It’s too bad Heritage Foundation fell victim to so much junk science, and that the otherwise august press release operation pushes the grand DDT hoaxes.  Just once, wouldn’t it be nice if these conservative echo chambers would, instead of recycling the old, wrong press releases of other conservatives, would do a little research on their own, and get the facts right?

_______________

*  It’ll be fun to watch.  I sent my response early, early in the morning while rushing to get a presentation ready, and I made a couple of egregious typos, including identifying Jonathan Weiner as “Stephen Weiner.”  If HF wished to embarrass me, they’d publish that one out of their moderation queue — but I’ll bet that even with my typos, they can’t allow the facts through.  Also, for reasons I can’t figure, some guy named Thurman showed as the author of HF’s piece on May 5.  So I had referred to Mr. Thurman instead of Ms. Abel.  Interesting technical glitch, or story, there.

_______________

Update, May 8:  As we should have expected, Steven Milloy’s Junk Science Side Bar also went on record as favoring the poisoning of Africa rather than the fighting of malaria.  Milloy makes claims that DDT will beat malaria (ostensibly before it kills all life in Africa), but his sources don’t support the claim.  Milloy is always very careful to never mention that, largely without DDT, the death toll from malaria is at the lowest point in human history.  Instead he notes that while malaria fighters promoted World Malaria Day, lots of African kids died of malaria.  That’s true, but misleading.  Because of the malaria-fighting efforts of those Milloy tries to impugn, far fewer African kids die.  Contrary to Milloy’s insane and offensive claims, it’s not alright that “only people” die.  Milloy asserts implicitly that, but for environmentalists, thousands or millions of children would survive that do not know.  That’s not true:  Because of the work that Milloy denigrates, millions fewer die.  It wasn’t environmentalists who overused DDT and rendered it ineffective in the fight against malaria, it was Milloy’s funders.  Follow the money.


Anecdotal evidence: Malaria spreads to Tanzania highlands, warming climate blamed

April 16, 2011

Here’s one story that critics of science and scientists who study global warming will try to avoid mentioning:  Malaria’s spread in Tanzania appears to be due to deforestation plus a warming climate that altered historic rainfall patterns.

It’s anecdotal evidence, partly.  The case reinforces the point Al Gore made in An Inconvenient Truth, that climate change can smooth the path for the spread of diseases like malaria.

Via AllAfrica.com, from The Citizen in Dar es Salaam (Sunday Citizen News):

Malaria Threatens Nation’s Highlands

Felix Mwakyembe, 6 March 2011

Opinion

Mbeya — Tanzania’s southern highlanders have long worried about pneumonia and other respiratory illnesses brought on by the cool, wet weather. But as climate change contributes to warmer temperatures in the region, residents are facing a new health threat: malaria.

In Rungwe, a highland district in the south-western Mbeya region bordering Malawi and Zambia, malaria is fast replacing coughs, fever and pneumonia as the most serious local health problem. The change has taken by surprise the region’s residents, who live over 1,000 metres (3,200 feet) above sea level and outside Tanzania’s traditional malarial zones.

Ms Asha Nsasu, 32, of Isebe village, had no idea she had contracted malaria when she was sent to Makandana District Hospital in late December. “I felt weak. I thought it was pneumonia,” Nsasu said. “Then they told me it was malaria.”

In 2009, health centres in Rungwe district reported 100,966 malaria cases, a jump of 25 per cent from 2006, hospital records show.

Malaria is now the biggest public health threat facing Rungwe district, which lies about 940 kilometres (590 miles) southwest of Dar es Salaam, according to the Tukuyu Medical Research Centre, part of the National Institute for Medical Research. One third of outpatients visiting the hospital were diagnosed with the mosquito-borne illness in 2007, according to records from that year, making it the most common disease for outpatients.

Most highland areas in Tanzania are experiencing a growing burden of malaria cases, officials at the Tukuyu Centre said. Climatic changes brought on in part by local environmental degradation are contributing to the growing prevalence of malaria in the district, said Mr Gideon Ndawala, Rungwe district’s malaria coordinator.

“People have cleared the forests, rain has decreased, temperatures have risen,” Mr Ndawala said in an interview. “(When) I first reported on the district in 1983, it was very cold and it rained throughout the year except from mid-September to early November. The weather was not favourable for mosquito breeding,” he said.

Now, however, temperatures are higher and rain more erratic, he said, and mosquito populations – which thrive on warmer temperatures and breed in pools of stagnant water – are on the rise. Worst hit by the surge in malaria are Tukuyu district town, Ikuti, Rungwe Mission and Ilolo, according to district health officials.

Half a century ago, these traditionally cool areas saw no mosquitoes and did not register any malaria cases, but now the weather is warmer, said Mr Ambakisye Mwakatobe, a 76-year-old man from Bulyaga village in Rungwe.

“In the past, we never saw mosquito nets here. I saw a net for the first time at the age of 20, when I joined Butimba Teachers College in 1957,” he said, in an interview at his village home.

Mzee Mwakatobe said cases of malaria began to appear several decades ago but residents did not relate them to warming temperatures, believing the mosquitoes instead were arriving on buses from lower regions.

“It was in the 1970s when we started getting malaria here. I thought it was the buses from Kyela and Usangu that brought mosquitoes,” he admitted. But “the weather also started to change in those years,” he said.

A half-century ago, “it was very cold here and it rained throughout the year. Three things were compulsory: a sweater, pullover or heavy jacket; an umbrella or raincoat; and gumboots,” he added. “There was frost all day long and cars had to put their lights on.

“But today things have changed,” he said. “Look, now we even put on light shirts. There is no need for sweaters, gumboots or umbrellas.”

Scientists agree that the changing weather is feeding into Rungwe’s worsening malaria problem.

“Up until 1960, districts like Rungwe, Mbeya, Mufindi, Njombe, Makete and Iringa in the southern highland regions were malaria free. Today is quite different – malaria prevalence is high,” said Mr Akili Kalinga, a research scientist at Tukuyu Medical Research Centre.

Malaria accounts for 30 per cent of the burden of disease in Tanzania and is a huge drain on productivity, according to a report produced by research scientists for the Sixth Africa Malaria Day in 2006. In response to the rising malaria caseload, the government is taking steps to stem the disease’s expansion.

Measures include public health education in newly vulnerable districts on home cleanliness and water storage, how to eliminate the places of still water where mosquitoes live and breed, and the use of mosquito nets and fumigation, said Dr Sungwa Ndagabwene, Rungwe’s medical officer.

“The government is taking serious measures to fight malaria. We started with a ‘mosquito nets for all’ campaign – saying every person should sleep under bed nets,” Mr Ndagabwene said.

The government also has begun spraying the inside of homes with insecticide, first in the Kagera Region and now throughout the Lake zone, near Lake Victoria, he said. It plans to expand the spraying programme, which has helped cut malaria transmission in Zanzibar, to the rest of the Tanzania’s malaria-affected regions.

Such spraying programmes aim to kill mosquitoes that land on the inside walls of homes. Spraying can protect homes for between four to ten months depending on the insecticide, according to the World Health Organisation (WHO).

WHO has approved 12 insecticides it considers safe for such spraying programmes, including DDT – a controversial endocrine disruptor that has proved one of the most effective ways to control mosquito populations but that has also been linked to environmental damage and health problems including cancer.

Mr Ndagabwene said spraying the chemical only indoors limited its environmental impact. WHO officials have said they believe the benefits of using the pesticide outweigh its risks. The Stockholm Convention bans the use of DDT but exempts countries that choose to use the chemical to control malaria.

Tanzania is one of the world’s worst malaria-affected countries, recording 14 to 18 million clinical cases annually and 60,000 deaths, 80 per cent of them in children under five years old, according to a 2010 malaria reduction plan put together by USAID.

Children under five and pregnant women are most affected by the disease, official health figures show. (AlertNet)

The author is a freelance writer based in Dar es Salaam

More:


A fungus to fight malaria?

February 24, 2011

From a report in The Scientist Daily today:

Researchers have engineered transgenic fungi that drill into mosquitoes and kill the malaria parasite inside — the first tool of its kind — a February 25, 2011 study in Science reported.

Used in conjunction with traditional insecticide methods against mosquitoes, experts say this bioinsecticide has the potential to greatly improve malaria eradication efforts.

Mosquito infected with pathogenic fungus Metarhizium
Image: Courtesy of Raymond St. Leger

“This is a great example of trying to be innovative and use novel ways to look at this problem,” said Matt Thomas, a disease ecologist at Penn State who was not involved in the research. “It’s a move outside the existing insecticide paradigm, which has dominated parasite and vector control for 40-50 years.”

Read more: Fungus fights malaria? – The Scientist – Magazine of the Life Sciences http://www.the-scientist.com/news/display/58028/#ixzz1EuapNz8Z
Difficulties in developing this solution for use in the field promise no quick results.  Testing remains to be done on the process — and then there is the issue of how to infect the proper species of mosquito in the field.  Additionally, since this process involves genetic modification, there will be a raft of government approvals to contend with before deploying it, if it ever is deployed.

Unfortunately, putting the new technique into action may not be an easy task. “There are already difficult challenges in taking forward biopesticide technology,” said Thomas. “Now we’re adding in the additional regulatory and ethical issues around genetically modified organisms. It’s not a hurdle we should just dismiss as unimportant.”

Researchers at several different places pursue very different routes to help ease malaria — not one of them involving an increase in DDT use.
More:
  • Original article in Science:
    W. Fang et al., “Development of Transgenic Fungi That Kill Human Malaria Parasites in Mosquitoes,” Science 311: 1074-77 


George Clooney’s malaria? DDT didn’t cure it

January 25, 2011

Not sure why, but pro-DDT sites have been harping about George Clooney’s having contracted malaria, a second time, while performing one of his humanitarian acts in southern Sudan.

George Clooney in Sudan, Time Magazine photo

George Clooney in Sudan, Time Magazine photo

True, Clooney got malaria.  His take?

“This illustrates how with proper medication, the most lethal condition in Africa can be reduced to bad ten days instead of a death sentence.”

Sometimes it may pay to remember that malaria is disease caused by a parasite who must live part of its life cycle in humans, and part of its life in mosquitoes.  Killing mosquitoes only works until the next susceptible mosquito comes along to bite an infected human.

The goal of malaria prevention and eradication campaigns generally is to cure the humans, so regardless how many mosquitoes may be in a given location and regardless how many people they may bite, there is no malaria pool for the mosquitoes to draw from, to spread to other humans.

To beat malaria, we need to prevent the spread of the disease.  At some point that requires providing quick and accurate diagnoses of which parasites cause the infection, and a complete and completed regimen of therapeutic pharmaceuticals to actuall cure the human victims.  DDT is mostly a bystander in that crucial part of the fight.

What was Clooney doing in Sudan?  According to the New York Daily News:

Clooney was in Sudan in December to work with Google and the UN on a human rights project that combines satellite imagery analysis and field reports to prevent a new war from occurring in the troubled country.

“We want to let potential perpetrators of genocide and other war crimes know that we’re watching, the world is watching,” he said in a statement at the time. “War criminals thrive in the dark. It’s a lot harder to commit mass atrocities in the glare of the media spotlight.”

Do you consider it odd that Clooney’s contracting malaria might gather more news in western outlets than his actual trip to Sudan, to call attention to the campaign against genocide?

World Blog – The race to contain drug-resistant malaria

January 23, 2011

NBC News’s World Blog carried a series on malaria and fighting it around the world.  Here’s part I:

PAILIN, Cambodia – The border crossing between Thailand and Cambodia at Pailin has a rather bleak feel about it at the best of times. In the heavy monsoon rain, the dingy checkpoints are reduced to gray smudges.

Vodpod videos no longer available.

World Blog – The race to contain drug-resistant…, posted with vodpod

 

See more video information from NBC, here.


President’s Malaria Initiative: Plans for FY 2011

December 14, 2010

Barack Obama continued George W. Bush’s Africa-oriented fight against malaria.  The President’s Malaria Initiative (PMI)continues to target malaria for control and, if possible, eradication.

PMI announced today plans for work in 2011, country by country:

Malaria Operational Plans for Fiscal Year 2011

These Malaria Operational Plans have been endorsed by the U.S. Global Malaria Coordinator and reflect collaborative discussions with the national malaria control programs and partners in country. If any further changes are made to these plans, it will be reflected in revised postings.

How long before some wag complains that Obama’s program is anti-Africa because it doesn’t propose enough poisoning of the place?  “Not enough DDT!” they will complain, I wager.  And, for the record, I make this prediction not having read any of the country operational plans — in nearly complete ignorance of what the plans actually propose.  Can you find “enough” DDT in any country’s plan?

More:


Mandy Moore Talks Mosquito Nets – ABC News

December 13, 2010

Don’t ask me what work she’s done, because I couldn’t tell you.  I can tell — based on the headlines of the clipping services — that Mandy Moore is popular.

Ironically, in her brief tour of Africa and — shall we label it? — probably-shallow understanding of the issues, Ms. Moore has a deeper understanding of malaria and how to fight it than the most erudite of the DDT denialists, like Michael Crichton, or Rutledge Taylor.  Innocence wins.

For ABC News, the actress talked about charity work in Africa:

Vodpod videos no longer available.

Mandy Moore Talks Mosquito Nets – ABC News, posted with vodpod

It’s a case of a celebrity doing “Do a Good Deed” duty, most likely.  In the video, Mandy Moore puts DDT denialists to shame.  In writing?  Moore doesn’t come off as well.  (Did she write that piece herself?  Maybe she should write what she talks.)


BBC News – Malaria ‘cannot be eradicated’

November 29, 2010

BBC report: Experts say control, not eradication of malaria (short advertisement precedes news video):

Vodpod videos no longer available.

BBC News – Malaria ‘cannot be eradicated’, posted with vodpod

More, and resources:

Lancet map, showing nations where  malaria eradication may be possible, and those where control may be the best solution

Map from The Lancet, accompanying article: "Malaria is caused by five species of a parasite that can be carried from human to human by mosquitoes. Over the last 150 years, the portion of the world where malaria is still endemic has shrunk, but the disease is still endemic in 99 countries. However 32 of these countries, most of them on the edges of the endemic zone, are attempting to eradicate the disease, while the rest are trying to reduce infections and deaths though control measures."


Lancet special issue on malaria eradication: No call for more DDT

October 30, 2010

Lancet is one of the premiere research journals in the world for all of science, but especially for issues of health and medicine.

Image from Lancet illustrating malaria story

Image from Lancet –
Mother and child under a mosquito bite-preventing bednet.

On October 29, 2010, Lancet published a special report, “Malaria Elimination.”  Much science.  Much history.  No call for more DDT.

A plan for research is laid out.  Plans to eradicate malaria from more than 90 nations are laid out, explained and debated.  Calls for more research are made.  Calls for disciplined action from nations and health care organizations, and donor organizations.

But no call for more DDT.

Go take a look at the issue.  Several of the articles are available for no charge, out from behind the usual Lancet paywall.

Get the real science, real history, real policy.  Environmentalists are not evil villains there.  malaria is the villain in that story, and serious health care researchers and deliverers discuss serious methods to beat the disease.  Consequently, DDT has only a bit part.

Resources:


Malaria deaths in India under-reported? Bad news for pro-DDT partisans

October 22, 2010

Malaria hotspots in India. Image from Nature magazine, 2010. News report on Lancet study that suggests mortality from malaria in India may be significantly higher than WHO reports indicate.

Good news from the war on malaria has been that annual deaths are calculated to be fewer than 1 million annually, as low as 880,000 a year — the lowest human death toll from malaria in human history.

Researchers in India suggest that deaths there are grossly underreported, however — not the 15,000 estimated by the World Health Organization, but closer to 200,000 deaths a year, nearly 15 times as great.

Reading that news, DDT partisans might get a little race of the pulse thinking that this might improve the urgency for the case for using more DDT, as advocated in several hoax health campaigns and media, such as the recent film “3 Billion and Counting.”

The problem, though, is that India is one of the few places where DDT manufacturing continues today, and India is one of the nations where DDT use is relatively unregulated and heavy.  In short, if DDT were the miracle powder it’s claimed to be, any finding that malaria deaths are 15 times greater than reported by WHO is nails in the coffin of DDT advocacy.

Bloomberg News reported:

Researchers based their estimate on interviews with family members of more than 122,000 people who died between 2001 and 2003. The numbers “greatly exceed” the WHO estimates of 15,000 malaria deaths in India each year, the researchers wrote in the study, published today in the journal The Lancet.

“It shows that malaria kills far more people than previously supposed,” said one of the study authors, Prabhat Jha of the Center for Global Health Research in Toronto, in a statement. “This is the first nationwide study that has collected information on causes of death directly from communities.”

Remote regions may have an undocumented malaria burden, because conventional methods of tracking the disease are flawed, according to the authors. In India, the government malaria data, which is used by the Geneva-based WHO, only counts patients who had tested positive for the disease at a hospital or clinic. Others who died of symptoms closely resembling the malady but didn’t get a blood test aren’t included, co-author Vinod Sharma of the Indian Institute of Technology in New Delhi said in an interview today.

The lack of accurate data may hinder efforts by governments and aid organizations to provide diagnosis and treatment to the population at risk, the authors said.

Watch.  Advocates of poisoning Africa and Asia will claim scientists and environmental activists are somehow to blame for any underreporting, and they will call for more DDT use, claiming a ban has made India a refuge for malaria.  Those reports will fail to mention India’s heavy DDT use already, nor will they suggest an ineffectiveness of the nearly-sacred powder.

The article in the Lancet became available on-line on October 21 — it’s a 4.5 megabyte .pdf document:  “Adult and child malaria mortality in India: a nationally representative mortality survey.” A team of researchers is listed as authors of the study:  Neeraj Dhingra, Prabhat Jha, Vinod P Sharma, Alan A Cohen, Raju M Jotkar, Peter S Rodriguez, Diego G Bassani, Wilson Suraweera,Ramanan Laxminarayan, Richard Peto, for the Million Death Study Collaborators.

Accurate counts of infections and deaths provide essential information for effective programming of the fight against the disease.  Researchers point no particular fingers, but make the case in the article that better methods of counting and estimating malaria deaths must be found.

There are about 1·3 million deaths from infectious diseases before age 70 in rural areas in which fever is the main symptom. If there are large numbers of deaths from undiagnosed and untreated malaria in some parts of rural India then any method of estimating overall malaria deaths must rely, directly or indirectly, on evidence of uncertain reliability from non-medical informants and, although our method of estimating malaria mortality has weaknesses, indirect methods may be even less reliable. The major source of uncertainty in our estimates arises from the possible misclassifi cation of malaria deaths as deaths from other diseases, and vice versa. There is no wholly satisfactory method to quantify the inherent uncertainty in this, and indeed the use of statistical methods to quantify uncertainty can convey a false precision. However, even if we restrict our analyses to deaths immediately classifi ed by both physician coders as malaria, WHO estimates (15 000 deaths per year at all ages)1 are only one-eighth of our lower bound of malaria deaths in India (125 000 deaths below the age of 70 years; of which about 18 000 would have been in health-care facilities).

Our study suggests that the low WHO estimate of malaria deaths in India (and only 100 000 adult malaria deaths per year worldwide) should be reconsidered. If WHO estimates of malaria deaths in India or among adults worldwide are likely to be serious underestimates, this could substantially change disease control strategies, particularly in the rural parts of states with high malaria burden. Better estimates of malaria incidence and of malaria mortality in India, Africa, and elsewhere will provide a more rational foundation for the current debates about funding for preventive measures, about the need for more rapid access to malaria diagnosis, and about affordable access in the community to effective antimalarial drugs for children and adults.

More:


“3 billion and counting” — the errors one makes when using Howard Stern as a science advisor

October 7, 2010

“3 Billion and Counting” premiered at a tiny New York venue a couple of weeks ago, the latest skirmish in the War on Science. Physician-to-the-stars Dr. Rutledge Taylor claims that malaria could be eradicated if only DDT had not been banned from Africa.

What?  No, no, you’re right: DDT has never been banned from Africa, not even under the 2001 Persistent Organic Pollutants Treaty.  The film comes out of Hollywood, starring a Hollywood physician.  Perhaps that should clue us in that it is not a serious documentary, and not to be taken at face value.

Nor at any value.

Taylor engaged a publicist and conducted a national campaign to launch the movie.  In that campaign he someone appeared on Howard Stern’s radio show.  [There’s a guy in comments who claims it wasn’t Taylor, though Taylor wrote it in the first person.  Odd as hell.]

How silly are the claims in the movie?

A post at the movie’s blog revealed that Ronnie, Stern’s limousine driver, had a fight with bedbugs, and that Stern thinks DDT should be brought back.  That’s how bad this movie is:  Howard Stern is the science advisor.

Yes, yes, you’re right:  DDT stopped working against bedbugs in the 1950s (see Bug Girl’s recent post).  That doesn’t stop the publicists from defending the movie at the movie’s blog.  “Royce” [who claims not to be a publicist for the movie] said:

The problem with DDT is that it worked too well in stomping out malaria. The science proves that it minimally impacted the environment. But this information was suppressed. Wonder why and by whom? This movies addresses and uncovers the answers to these questions..Questions that many of us had about this issue.

I tried, without success I’m sure, to set him straight:

Royce,

First, DDT was not the weapon that eradicated malaria in the U.S.  We worked for 30 years to improve medical care, beef up the Public Health Service and county public health officers, educate people on how to drain mosquito breeding areas near their homes, be certain people with malari were fully treated to a cure, and to raise incomes to improve housing so that people could live in a home where mosquitoes could not enter at night (the times malaria-carrying mosquitoes bite).  By 1939, malaria was essentially eliminated from the U.S.  DDT was not available for use for another seven years.

Earlier we had defeated malaria and yellow fever in Panama, during the construction of the Panama Canal — long before any insecticide existed.  Beating malaria is possible with discipline, accurate information, and sustained effort.  No pesticide is necessary.

Second, DDT has never been out of use in Africa since 1946, nor in Asia.  DDT is in use right now by the World Health Organization (WHO) and at least five nations in Africa who have malaria problems.  If someone told you DDT is not being used, they erred.

Unfortunately, overuse of DDT by agricultural interests, in the early 1960s, bred mosquitoes that are resitant and immune to DDT.  DDT simply is not the effective pesticide it once was, and for the WHO project to eradicate malaria, this problem was the death knell.  WHO had to fall back to a malaria control position, because pro-DDT groups sprayed far too much of the stuff, in far to many places, mostly outside.

Third, all serious studies indicate that DDT greatly affects environment, with doses of the stuff multiplying from application through the top of the trophic levels in the ecosystem.  A minimal dose of DDT to kill mosquito larva in an estuary, for example, multiples many times as zooplankton and the mosquito larva soak it up.  The next level of consumers get about a ten-times dose from what was sprayed, and that multiplies exponentially as other creatures consume the lower-level consumers.  By the time an insect or crustacean-eating bird gets the critter, the dose is millions of times stronger, often to fatal levels for the bird.

If the dose is sub-lethal, it screws up the reproduction of the bird.  DDT in the egg kills the chick before it can fledge from the nest, often before it can hatch.  If by some miracle the chick does not die from acute DDT poisoning, the eggshells produced by a DDT-tainted female bird are often too thin to survive the growth of the embryo — either way the chicks die.  (There are a couple of studies done on plant-eating birds which showed that the chicks did not die before hatching — they died shortly after hatching.)

DDT is astoundingly effective at screwing up the reproduction of birds.

Fourth, studies show that humans exposed to DDT rarely get an acutely toxic dose, but that their children get screwed up reproductive systems, and there is a definite link from DDT exposure to the children of the mother — the cancer goes to the next generation.  DDT is not harmless to people at all — it is just not acutely toxic, generally.

Fifth, as I note above, DDT is no longer highly effective in controlling mosquitoes.  Where once it killed them dead, they have developed immunity, and now digest the stuff as if it were food.  There are studies that show DDT is also weakly repellent, but there are better, less-toxic repellents, and there is no reason to use something so deadly to all other creatures in the ecosystem to get a weak repellent effect.

Because of the biomagnification, DDT kills the predators of mosquitoes much more effectively, and for a much longer period, than it kills mosquitoes.  This sets the stage for mosquitoes to come roaring back, with all the natural checks on mosquito population out of commission.

Why use a poison that is not very effective, but very deadly, when there are better alternatives available?

Malaria death rates are the lowest they have been in human history.  There is no good case to be made that more DDT could provide any benefit.

DDT is still manufactured in astonishing quantity in North Korea, for one.  DDT is used in Africa and Asia, but no one with any sense uses it to eradicate malaria — DDT screwed up that chance 50 years ago.

Rutledge’s movie appears to be sinking from release (it’s played two theaters that I can find, for less than a week at each).  It may be far underwater already.  It would be to DDT whatExpelled” was to creationism, but it lacks the cloying, gullible religious fanatics to push it.

Thank God.

Malaria-fighting pesticide sprayers in Africa - publicity still from "3 Billion and Counting"

Mystery photo: If spraying pesticides to fight malaria isn't allowed in Africa as Rutledge Taylor argues, why are these pesticide sprayers pictured in this photo? Publicity still from "3 Billion and Counting" via Rotten Tomatoes website

Also see, at Millard Fillmore’s Bathtub:


Truth in a fair fight: Eli Rabett explains Gates Foundation’s good work against malaria

September 21, 2010

Good works are oft’ interred with the bones of the good workers, according to that Brutus Mark Antony guy — and at Watts Up With That, many work to bury any good workers, too.

So, a specially-scrubbed carrot is due Eli Rabett, who details the good works of the Gates Foundation against malaria, just to counteract the clamor of the howling at WUWT.

. . . since this started with an attack on Bill Gates, it is important to understand at least some of the interesting things that the Gates Foundation is doing to help fight malaria.

Among these, Affordable Medicines for Malaria (AMFM), is one of the cleverest, and may even work. The idea is that AMFM will buy ACT (artemisinin combination therapy – something else the Wattoids didn’t know about) drugs directly from the manufacturers in huge amounts at deep discount, and pass the drugs on to the distributors, public health agencies, private wholesale pharmacies, and NGOs at so far below cost that even counterfeit drugs cost more. The private wholesalers can take their profit.

One may hope someone will find the magic bullet to fight malaria.  There’s the Ghost of Santayana pacing the chalkboard again, however:  Our experience shows that magic is not real, no magic bullet has ever existed against malaria, and DDT is not now the magic bullet it never was in the first place.  “Those who cannot remember the past are condemned to repeat it,” Ghost of Santayana mutters.

A special place in hell is reserved for those who remember the past, but tell false tales about it instead.


Annals of DDT: 880,000 died from malaria in 2008

August 26, 2010

Once upon a time I easily found a chart from the World Health Organization (WHO) which provided a year-by-year tally of malaria deaths, worldwide, from the 1940s to the present.

Of course, now that I need that chart to note that malaria deaths are much lower today than they were when DDT was overused generally and sometimes misused in the fight against malaria, I can’t find it.  So, we’ll take the figures where we can find them.

In 2008, worldwide there were over 880,000 deaths from malaria.  This is significantly lower than the usual claim of “millions of deaths each year.”  We can find this figure in a document from the Global Environmental Facility (GEF), the organization that organizes the work of 182 nations to work for solutions to environmental problems, including fighting malaria, in a report on the 2009 meeting of the Stockholm Convention focused on fighting malaria,  “Countries move toward more sustainable ways to roll back malaria.”

However concern over DDT is matched by concern over the global malaria burden in which close to 250 million cases a year result in over 880 000 deaths. Thus any reduction in the use of DDT or other residual pesticides must ensure the level of transmission interruption is, at least, maintained.

Numbers here may be estimates not updated from current-year records.  The figure “over 880,000 deaths” looks and sounds awfully close to numbers reported in 2006, as you can see in this report from the Kaiser Family Foundation on U.S. global health policies:

Number of Annual Malaria Cases Worldwide Decreases, Disease Still Remains a Challenge, WHO’s World Malaria Report 2008 Says

Thursday, September 18, 2008

There were about 247 million malaria cases worldwide in 2006, according to the World Malaria Report 2008, which was released by the World Health Organization on Thursday, Reuters reports (MacInnis, Reuters, 9/18). According to the report, 3.3 billion people worldwide were at risk for malaria in 2006, and the disease remains a major burden among children younger than age five and in many African countries (AFP/Google.com, 9/18).

The report included reduced estimates of the global malaria burden that were calculated with new surveillance measures for non-African countries. The estimate of 247 million malaria cases is lower than the estimated 350 million to 500 million annual malaria cases reported in WHO’s World Malaria Report 2005. The new report estimated there were 881,000 malaria deaths in 2006, down from the previous estimate of one million deaths. The reduced figures are the result of new calculation methods, and it is unknown whether malaria cases and deaths actually declined from 2004 to 2006, WHO said (Reuters, 9/18). Although malaria control efforts have helped reduce the global malaria burden, most malaria-endemic countries are not meeting WHO targets for malaria control, the report said, noting that there is “no evidence yet to show that malaria elimination can be achieved and maintained in areas that currently have high transmission” (Bennett/Doherty, Bloomberg, 9/18).

WHO attributed the revised malaria estimates to new assessment measures in Asia, where data used for the 2005 report had not been updated for 40 years. According to Mac Otten — coordinator of surveillance, monitoring and evaluation at WHO’s Global Malaria Program — factors such as deforestation, urbanization and malaria control efforts have affected malaria estimates in Asia (Blue, Time, 9/17). Cambodia, Laos, the Philippines, Thailand and Vietnam all reported a decline in malaria deaths in 2006 (Bloomberg, 9/18).

WHO’s surveillance methods in Africa, which estimate malaria prevalence by using climate data and sample surveys, have remained the same since the 2005 report, the report said (Reuters, 9/18). According to the report, 45 of the 109 malaria-endemic countries worldwide are in Africa, and more than half of the continent’s malaria cases in 2006 occurred in the Democratic Republic of Congo, Ethiopia, Kenya, Nigeria and Tanzania (AFP/Google.com, 9/18). The report noted that malaria interventions have helped reduce malaria cases and deaths by more than 50% in Eritrea, Rwanda, Sao Tome and Principe, and the Tanzanian island of Zanzibar (Time, 9/17).The report found that about 40% of people at risk for malaria in Africa had access to insecticide-treated nets last year, compared with 3% in 2001 (Bloomberg, 9/18). The report also found that the number of ITNs distributed to national malaria control programs was enough to cover 26% of people in 37 African countries but that most African countries did not meet WHO’s target of 80% coverage for the four main malaria treatments: ITNs, artemisinin-based combination therapies, indoor-insecticide spraying programs and treatment for pregnant women (AFP/Google.com, 9/18).

Note also that this total of 880,000 is more than the previously reported 863,000.  Hmmm.