Eritrea cuts malaria rates by switching away from DDT

Posted by Tim Lambert on June 23, 2005
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The World Bank is the largest funder of Eritrea’s anti-malaria program.
The Eritrea Daily
reports on
the good results:

But today Eritrea, one of the poorest countries in the world, stands out as a success story in controlling malaria.

The statistics are compelling. The number of people dying from malaria has dropped by between 55 to 65 percent since 1999. Mortality of children under five years of age dropped by 53 percent, while there was a 64 percent drop in the death rate for older children and adults.

“In 1991, our death toll among pregnant women from malaria was very high” Eritrea’s Health Minister, Saleh Meky says.

Today, it is non-existent.”

And what did they do to get such dramatic reductions? Why they significantly increased the use of insecticide treated nets:

Eritrea has used a range of proven strategies for malaria control. An important part of this is to reduce human contact with mosquitoes. Insecticide treated bed nets have been vital to the program with the use of the nets significantly increased in high risk areas.

Walker says there are now more than 850,000 nets are being used in Eritrea with the numbers increasing.

“It’s become a major very cost effective way of dealing with the problem,” he says.

And stopped using cut back the use of DDT [Correction: They continued to use some DDT. See here]:

“If you go back five years, Eritrea used indoor spraying very extensively. But that’s been cut back a lot with this project,” he says.

“We’ve also introduced other kinds of insecticides which are more environmentally friendly than those they were using. Spraying though still continues, according to the extent of the malaria problem and the behavior of the mosquito in a particular area.”

So what do Roger Bate and Richard Tren of the DDT advocacy group
Africa Fighting Malaria write about the World Bank and malaria? Look:

Almost all of the efforts to prevent malaria cases have focused on providing people with insecticide-treated nets. People, particularly pregnant women and young children–those most at risk–are encouraged to sleep under these nets in order to protect themselves from the Anopheles mosquito. The problem isn’t that these nets don’t work; it is simply that as a sole strategy they haven’t been shown to have any significant large-scale impact on malaria transmission.

Those countries that are making progress against the disease have ramped up their indoor insecticide-spraying programs. These programs entail spraying tiny amounts of insecticide, such as DDT, on the inside walls of houses to repel or kill (or both) the malaria-carrying mosquitoes. This method of control is safe and highly effective: Malaria rates have plummeted in the very poor northern parts of Zambia where this approach is currently employed. Yet RBM and the World Bank, always politically correct, have eschewed this method of control. The World Bank even went as far as to require that its of funding malaria control in Eritrea be conditional on non-use of DDT.

The World Bank did not switch away from DDT in Eritrea because of
“political correctness”. They did so because the alternatives were
more effective. Where DDT spraying is the most cost-effective method,
the World Bank funds it. For example, they fund DDT spraying in India:

In accordance with guidelines from the World Health Organization and also in accordance with the Stockholm Convention on Persistent Organic Pollutants, what the Bank does is to support the program of the government of India with technical sanction from WHO.

Specifically, it means the government of India is using a range of tools including indoor residual spraying. The government of India actually does use DDT because that is what the government of India wants to do.

Bate and Tren’s article is deliberately misleading. One blogger who
was misled by it is Rafe Champion who falsely
claimed that the World Bank
would not fund DDT because of “political correctness”. He then
compounded his error by refusing to correct his falsehood despite repeated requests.

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Comments

  1. #1 Ros
    June 24, 2005

    According to Maurizio Murru (Uganda Martyrs University Health and Policy Development 2 (2) 112-121 2004) Eritrea is one of few exceptions using ddt with money coming from the World Bank. Somalia is or will be also, (funded through GFATM) Same he says with Zambia. Ethiopia , Madagascar and South Africa are funding its use through their own funds

    In brief, Murru thinks there is a “cultural” hoax
    “the environmentalists of the rich world succeeded in disqualifying DDT in the eyes of the public opinion in poor as well as in rich countries.against the use of ddt for malaria prevention. Facts are distorted. Situations are twisted around. Today, donor countries and major donor agencies are very reluctant to provide funds for the purchase and use of DDT for malaria control.

    Donor countries and Donor Agencies don’t want to be associated to DDT in the eyes of public opinion.”

    He does not think it is a magic bullet but rather a useful weapon, as one of the public health measures. He does however think that for it to be a useful weapon its coverage needs to be wide.

    Also
    USAID Health highlights March 2005

    “Eritrea’s National Malaria Control Program (NMCP) reported the number of malaria cases in Eritrea has fallen by 85 percent over the past five years due in part to the increased use of insecticide treated bednets (ITNs). Indoor residual spraying with DDT in high-risk areas also contributed to the overall success. In Eritrea, there are around 2.2 million people who live in the malaria-prone areas. Reported deaths dropped from 176 in 1999 to 16 in 2004.”

    As I understand it spraying is specifically targeted to high risk areas whereas impregnated bed nets and larval control are much more generalised.

  2. #2 J F Beck
    June 26, 2005

    Go ros.

    Here’s a description of the de facto ban for TL:

    In her 297 pages,Rachel Carson never mentioned the fact that by the time she was writing, DDT was responsible for saving tens of millions of lives, perhaps hundreds of millions.

DDT killed bald eagles because of its persistence in the environment. ''Silent Spring'' is now killing African children because of its persistence in the public mind. Public opinion is so firm on DDT that even officials who know it can be employed safely dare not recommend its use. ''The significant issue is whether or not it can be used even in ways that are probably not causing environmental, animal or human damage when there is a general feeling by the public and environmental community that this is a nasty product,'' said David Brandling-Bennett, the former deputy director of P.A.H.O. Anne Peterson, the Usaid official, explained that part of the reason her agency doesn't finance DDT is that doing so would require a battle for public opinion. ''You'd have to explain to everybody why this is really O.K. and safe every time you do it,'' she said -- so you go with the alternative that everyone is comfortable with.

    See at: http://rwdb.blogspot.com/2005/06/silent-spring-killing-rampage.html

  3. #3 Tim Lambert
    June 26, 2005

    JF Troll, it is dishonest for you to claim that there is a de facto ban on DDT when it is used in countries containing billions of people.

  4. #4 J F Beck
    June 26, 2005

    How about you comment on the comment on it’s merits instead of trying to distract with the troll nonsense?

    In her 297 pages,Rachel Carson never mentioned the fact that by the time she was writing, DDT was responsible for saving tens of millions of lives, perhaps hundreds of millions.

    DDT killed bald eagles because of its persistence in the environment. ”Silent Spring” is now killing African children because of its persistence in the public mind. Public opinion is so firm on DDT that even officials who know it can be employed safely dare not recommend its use. ”The significant issue is whether or not it can be used even in ways that are probably not causing environmental, animal or human damage when there is a general feeling by the public and environmental community that this is a nasty product,” said David Brandling-Bennett, the former deputy director of P.A.H.O. Anne Peterson, the Usaid official, explained that part of the reason her agency doesn’t finance DDT is that doing so would require a battle for public opinion. ”You’d have to explain to everybody why this is really O.K. and safe every time you do it,” she said — so you go with the alternative that everyone is comfortable with.

  5. #5 J F Beck
    June 26, 2005

    Sorry, its merits, not it’s.

  6. #6 Meyrick Kirby
    June 26, 2005

    ”Silent Spring” is now killing African children because of its persistence in the public mind.

    Do you have any evidence of this? Where has DDT stopped being used for malaria control at the bequest of public opinion to the detriment of public health?

  7. #7 Ian Gould
    June 26, 2005

    JF Beck:

    You continue to repair claims of a ban on DDT which are simply insupportable in the face of overwhelming evidence of widespread use of DDT as an antimalarial agent in the developing world.

    Any comment even vaguely negative regarding DDT (such as the quite valid comment by the EU that care needed to be exercised not to contaminate export crops with a banned chemical) are seized on by you to try to support these ludicrous claims.

    You’ve now produced a piece from some blog claiming that Rachel Carson never acknowledged the importance of DDT for disease control.

    The quote from Silent Spring provided by Tim prove that this claim is equally false.

    Posting obsessively on a single topic and ignoring contradictory evidence may not be the classic behaviour of a troll but it is boorish and pointless.

  8. #8 J F Beck
    June 27, 2005

    Ian Gould,

    The quote I cited is originally from the New York Times, via the archives of the Eritrean Ministry of Education, not from “some blog”.

    Lambert’s quote form “Silent Spring” is irrelevant because most people won’t have read the book. It is the subsequent chain of events based on the perceptions of DDT created by the book that are important.

    Why would the EU need to “warn” Uganda about using DDT for spraying house walls? Are Ugandans so incompetent that they can’t manage to spray small amounts of DDT inside houses without contaminating export food crops? In any event, there was no need to couch the warning as a threat. The goal was to force Ugandans not to use DDT.

    As for the ban, it was neither total nor totally effective but it was a de facto ban nonetheless. I have never directly discussed tattoos with my kids – all over 18 – but, having heard me express my opinions regarding tattoos in general, they are surely aware that I would not be happy if they were to have themselves tattooed. They would have to think long and hard before getting a tattoo, knowing that I would be unhappy. Thus, there is an effective ban on tattooing within my family. It was much the same with DDT and the pressures put on those who might use DDT.

    I’m not obsessed with DDT; I post on lots of other topics. It’s just that I can’t understand that those on the left refuse to see the obvious. (For obsession, you might want to check and see how many posts Lambert has made on the Lancet Iraq study.)

    Oh yeah, it’s also boorish and pointless for you to liken me to a troll just because I refuse to see things your way.

  9. #9 J F Beck
    June 27, 2005

    In my prior post (above) I incorrectly claim that the article in question is via the Eritrean Ministry of Education. In fact, the Eritrean Ministry of Education merely has a banner ad on the page above the article. The article is actually from the New York Times via the Dehai news archive.

  10. #10 John Quiggin
    June 27, 2005

    “Why would the EU need to “warn” Uganda about using DDT for spraying house walls?”

    Because DDT approved for antimalarial use has, on a number of occasions, been illegally diverted to agricultural uses.

  11. #11 J F Beck
    June 27, 2005

    The warning was a threat meant to discourage and you know it.

  12. #12 Ros
    June 27, 2005

    Who are the signatories to the POP. How is its use illegal in those countries that haven’t signed.

  13. #13 Tim Lambert
    June 27, 2005

    Beck, you are a troll because you have repeatedly posted the same specious argument. DDT is not banned. Your intent is not to persuade but just to get attention. Go away.

  14. #14 J F Beck
    June 28, 2005

    So everything remains neat and tidy here at fact check central, I’ve posted my response at http://rwdb.blogspot.com/2005/06/yours-trolly-on-ddt.html

  15. #15 Ennis
    July 3, 2005

    In Uganda, the issue is that the donors wont pay for the use of DDT, and are actively discouraging it, but that’s still a far way from a ban. You can find some useful discussion of the DDT debate in Uganda in some of their newspapers that get posted on line.

    While this is admittedly not a general solution, India has started a program that uses fish to reduce malaria:

    The theory is simple: find fish which like eating mosquito larvae and put them in ponds, rivers and wells where mosquitoes lay their eggs. The eggs hatch, and the fish eat the larvae.

    Dr VP Sharma, a former director of India’s Malaria Research Institute who now works with the Council for Medical Research, told the meeting that pilot projects in four states have met with remarkable success.

    Introducing fish like guppies, he said, was one of the main reasons why the number of malaria cases each year in India was falling.

    “They were more than two million,” he said. “Now, actually, they have gone down to 1.8 million. The World Bank has a programme in 100 districts using the fish and it will take another five years before the real impact would be known.”

    Dr Sharma told the meeting that fish had virtually eliminated malaria-carrying Anopheles mosquitoes from some districts, though he cautioned that the strategy did not work everywhere.

  16. #16 Ian Gould
    July 8, 2005

    Can any Spanish-speaking readers provide a gloss of the above?