Bed Nets and artemisinin dramatically decrease malaria

The World Health Organization has a new report showing dramatic decreases in malaria in Rwanda and Ethiopia following the large-scale distribution of long-lasting insecticidal nets (LLINs) and artemisinin-combination therapy drugs (ACTs) :

Our investigation showed that declines of malaria cases and deaths
were dramatic in Rwanda and Ethiopia (>50%) and occurred within 12-24
months of nationwide 11 distribution of LLINs and ACTs. In fact,
declines in in-patient cases and out-patient laboratory-confirmed
cases occurred within 60 days of nationwide distribution in Rwanda
(Figure 4). In both Rwanda and Ethiopia, similar declines (>50%)
occurred for impact measures that required malaria laboratory
testing–out-patient laboratory-confirmed cases and malaria slide
positivity rate. In Rwanda, all 19 health facilities performed malaria
smears on all suspected malaria cases. The decline in in-patient and
out-patient laboratory-confirmed malaria cases occurred in the face of
increases in out-patient and inpatient non-malaria cases in most
countries during 2001 to 2004-2005 due to introduction of health
insurance schemes, resolving civil conflict, and improvement of health
services.

The Washington Post story has some reactions:

“This is a genuinely historic achievement,” said Richard G.A. Feachem, former director of the Global Fund to Fight AIDS, Tuberculosis and Malaria who is now the director of the Global Health Group at the University of California at San Francisco. “This is not theoretical. We do not have to wait for a vaccine or new drugs. If we implement today’s technologies aggressively on a national scale, we will have a big impact.”

And The Economist reports

Based on the new results, Dr Kochi reckons that a five-year campaign costing about $10 billion would be enough to bring malaria under control in most of Africa, reducing the death rate to a matter of thousands a year.

Eliminating malaria altogether, though, would be a far harder task, involving destroying mosquitoes in the remaining pockets of infection. That is controversial: some — not least Dr Kochi — see it as a dangerous distraction until the easier job of bringing the disease under control is completed. Others want to aim straight away for elimination. In the long run, that should surely be the objective. But, as the old saying has it, the best can often turn out to be the enemy of the good. And the good now looks to be in sight.

Comments

#1 Eli Rabett
February 2, 2008

This is both exciting and anticipated news. If the resources can be found the first stage objective can be reached in short time.
#2 Dano
February 2, 2008

Artemesia is a very useful genus. Wormwood makes absinthe. So we can lower malaria incidences and get drunk toasting our success.

Best,

D
#3 ChrisC
February 2, 2008

It’s great to hear some GOOD news for a change!

Dano, wormwood does a little bit more than get you drunk. It can cause pink elephants to materialise from the ether.
#4 Eli Rabett
February 2, 2008

Thems are large PINK bunnies Chris. Contrary to rumor Eli is merely an allusion among denialists caused by ingesting arguments full of wormwood.
#5 luminous beauty
February 2, 2008

Just reading Rimbaud can cause pink elephants to materialize from the ether.

Broadcast spraying of DDT scarcely slowed mosquito populations in California. Vector control works. We’re taking it to Africa.

http://www.ucmrp.ucdavis.edu/news/malariaawarenessevent.html
#6 ben
February 2, 2008

Now if Robert Mugabe would materialize into a pink fly so we could squish him, Africa would have everything.
#7 Dano
February 3, 2008

Wormwood was fuel for lots of good art, too.

Best,

D
#8 Marion Delgado
February 3, 2008

ChrisC:

I’ve never before contradicted you on a scientific point, but I am uncomfortable with those theorists who want to bring back the ether, however defined. It smacks of, at best, a Laplacian cosmology.
#9 Dave Briggs
February 4, 2008

This is both exciting and anticipated news. If the resources can be found the first stage objective can be reached in short time.

Posted by: Eli Rabett | February 2, 2008 11:33 AM

I agree wholeheartedly! This disease has been such a hardship on so many millions for so long. It is great to see strides being made to alleviate the suffering!
Dave Briggs :~)
#10 David Kane's friend
February 4, 2008

Dr Kochi reckons that a five-year campaign costing about $10 billion would be enough to bring malaria under control in most of Africa, reducing the death rate to a matter of thousands a year.

Wow. $10 billion ($2 billion / year for 5 years) does not at all sound like a lot of money for what we’re talking about. For instance, it’s a tiny fraction of the cost to the US of the Iraq War.
#11 ben
February 4, 2008

Wow. $10 billion ($2 billion / year for 5 years) does not at all sound like a lot of money for what we’re talking about. For instance, it’s a tiny fraction of the cost to the US of the Iraq War.

Which makes me wonder where all the food will come from in Africa to feed all those people who didn’t die. I hope that is at least being considered and planned for.

I suppose with fewer sick folks, the food supply should increase naturally, but I don’t know much about those dynamics. Plus, is sex-ed still being flogged in Africa? More people on the earth means more stress on the environment, right?
#12 Barton Paul Levenson
February 4, 2008

ben writes:

[[Plus, is sex-ed still being flogged in Africa?]]

If not, it should be, since it has been shown to reduce teenage pregnancies.
#13 James Haughton
February 4, 2008

Re Ben’s rather callous comment: part of the problem with diseases like AIDS and Malaria is they have high morbidity, ie people are sick for a long time and are unable to work before they eventually die. So they are still a drain on the food supply even when they are sick/dying. Curing them drastically increases their productivity so there is a net benefit in terms of food and other resource generation.
#14 z
February 4, 2008

If it doesn’t involve ddtit can’t be any good.
#15 ben
February 5, 2008

Callous? Why? I just hope that more people don’t end up suffering there. I think you are right though, James, that decrease in disease will be overall beneficial. Still, don’t all of you say we should prepare for the worst with AGW? Well then, why not prepare for the potential unintended consequences of lower death-rate in Africa?
#16 Barton Paul Levenson
February 5, 2008

ben posts:

[[Callous? Why? I just hope that more people don't end up suffering there. I think you are right though, James, that decrease in disease will be overall beneficial. Still, don't all of you say we should prepare for the worst with AGW? Well then, why not prepare for the potential unintended consequences of lower death-rate in Africa?]]

What is your point with this series of posts? That we should not fight malaria in Africa? That global warming will actually be beneficial if we just leave it alone? I’m mystified as to what you’re trying to accomplish here. What it looks like you’re saying is that we should let the black people die. Maybe that isn’t what you meant, but it comes off that way.
#17 ben
February 5, 2008

ARgh!

All I meant was what I said. Be prepared for anything that might happen. Hopefully it will be nothing but good. Probably it will be nothing but good. But maybe something bad might happen, like more people to feed than food available. I don’t know. I just hope someone is crunching numbers somewhere to make sure. Why is that so hard to understand?
#18 David Kane's friend
February 5, 2008

Does anyone have a view on the effectiveness of Population Services International? (On malaria and otherwise.) I’ve given to them in the past, so it’s not an entirely academic question. GiveWell likes them fwiw.
#19 Eli Rabett
February 5, 2008

One of ben’s problems is that he is historically ignorant. Malarial lands are also very productive agriculturally. The way that this was gotten around in the US and Caribbean, was to leave the slaves to die, while the owners fled up river. (See S. Carolina and VA). If you can eliminate malaria, agricultural production will rise.
#20 ben
February 5, 2008

If you can eliminate malaria, agricultural production will rise.

That is excellent to know. There is one exception: Zimbabwe… if you could eliminate Robert Mugabe, agricultural production would rise.
#21 Eli Rabett
February 5, 2008

An important point is that ACT is artemisinin combination therapy, which combines other drugs with artemisinin to improve the therapy and suppress emergence of resistance. The key to reducing costs and increasing effectiveness will be to decrease the cost of the most effective drugs used in combination with the artemisinin.

The key to improving ben remains to be found.
#22 z
February 5, 2008

I recall something in social studies class long ago that some African tribes saw the tsetse fly as a god that kept the white man out by killing their cattle (native cattle having become immune)
#23 dhogaza
February 6, 2008

The way that this was gotten around in the US and Caribbean, was to leave the slaves to die, while the owners fled up river.

Hey, that’s not the way the Antebellum South told it. They swore those black slaves died because they were naturally weaker than whites …
#24 lucia
February 9, 2008

ben,
My younger sister almost died of malaria when she was around 4. The normal incubation period is a week to a month. Our family physician cut his vacation short to fly back from New Orleans to El Salvador.

If your worried about the population in Africa, birth control is a better way to curb growth than letting kids die of malaria.
#25 feral sparrowhawk
February 9, 2008

Ben,

One of the major reasons for the high birth rates in African countries is that with the toll from malaria and AIDS parents decide to have several children to make sure one survives. By reducing infant mortality you (after a delay) also tend to reduce the birthrate. The result is happier, healthier people, but not necessarily more of them, other than those born in the period between when the death rates fall and when people catch on that this is happening.
#26 Ian Gould
February 10, 2008

“Which makes me wonder where all the food will come from in Africa to feed all those people who didn’t die.”

Ever hear of the demographic transition Ben?
#27 Ian Gould
February 10, 2008

So if we buy the right wing “Greens hate black people and that’s why they banned DDT” conspiracy theory, green groups should now come out in favor of banning bed nets and artemisins.

Personally I think that’s as likely as the American far right admitting they’ve been spreading vicious baseless slanders on this issue for the past several decadess.
#28 2 tanners
February 11, 2008

Ben,

Without slinging mud, your argument reads “Perhaps we shouldn’t save them now, in case they die later.”

As it happens, all will die later, many of preventable causes and at a much younger age than you or I can reasonably expect. The rules of engagement are first: “Do no harm”, which this seems to qualify under, and second: “Good enough is good enough. Best can be worse” which again this seems to fit.

Go for it. I live in a malaria prone country and the loss to human life and to productivity is quite stunning to witness. It literally can keep a country poor. I can afford preventative drugs which most can’t, but they can’t be used for ever. I’m not looking forward to going off them and being exposed.
#29 i
April 18, 2008

play a game to send a net for free to struggle malaria:

http://www.nothingbutnets.net/its-easy-to-help/wmd

P.S: Note that Funds will be released for nets through April 25th while funds last, up to $200,000