Africa Not Fighting Malaria

Ed Darrell has been looking at what Africa Fighting Malaria spends its money on:

Looking at the IRS Form 990s for the organization from 2003 through 2008 (which is organized in both the U.S. and South Africa), it seems to me that the major purpose of AFM is to pay Roger Bate about $100,000 a year for part of the time, and pay Richard Tren more than $80,000 a year for the rest of the time.

Can anyone tell me, what has Africa Fighting Malaria ever done to seriously fight malaria?

One could make the argument that if you sent $10 to Nothing But Nets, you've saved more lives than the last $1 million invested in AFM, and more to save lives than AFM in its existence.

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AFM looks more like a scam than anything else!

AFM is refreshingly open in the 990-filings (search engine linked over at Ed Darrel's post). In the 2003 form they list under _"Statement of Program Service Accomplishments"_
>
Promotes the discussion of using sensible solutions to prevent, treat and fight the spread of malaria and other diseases. Conducts research, hosts conferences and seminars, and writes media commentary on the political economy of diseases and disease control in developing countries.

They never claim that they actually try to fight malaria.

This Canadian organization has raised $5 million to buy 500,000 insecticide-treated nets which they say covers 2.5 million children; starting in 2006 to April 2010. They get good publicity from the comedian Rick Mercer on his weekly CBC show, which also sponsors contests in schools to buy nets, etc.

http://www.spreadthenet.org/default_en.aspx

Less discussion, more action.

By Holly Stick (not verified) on 13 Jun 2010 #permalink

To be fair, they are called "Africa fighting Malaria" and they are most decidedly not Africa.

Are we back at the "nets" argument again. I would like to see the impact nets are having generally on reducing malaria in Africa (not the results of a study in a spsific area where nets seemingly had an impact). Provide us with facts on the overall impact (disease reduction) in africa! Compare this with IRS using DDT - this is amongst other what AFM is trying to get into the skulls of some people

By Malaria fighter (not verified) on 13 Jun 2010 #permalink

Or there's the Cochrane review:

Lengeler C. Insecticide-treated bed nets and curtains for preventing malaria. The Cochrane Database of Systematic Reviews 2004, Issue 2.

Main Results

Fourteen cluster randomized and eight individually randomized controlled trials met the inclusion criteria. Five trials measured child mortality: ITNs provided 17% protective efficacy (PE) compared to no nets (relative rate 0.83, 95% confidence interval (CI) 0.76 to 0.90), and 23% PE compared to untreated nets (relative rate 0.77, 95% CI 0.63 to 0.95). About 5.5 lives (95% CI 3.39 to 7.67) can be saved each year for every 1000 children protected with ITNs. In areas with stable malaria, ITNs reduced the incidence of uncomplicated malarial episodes in areas of stable malaria by 50% compared to no nets, and 39% compared to untreated nets; and in areas of unstable malaria: by 62% for compared to no nets and 43% compared to untreated nets for Plasmodium falciparum episodes, and by 52% compared to no nets and 11% compared to untreated nets for P. vivax episodes. When compared to no nets and in areas of stable malaria, ITNs also had an impact on severe malaria (45% PE, 95% CI
20 to 63), parasite prevalence (13% PE), high parasitaemia (29% PE), splenomegaly (30% PE), and their use improved the average haemoglobin level in children by 1.7% packed cell volume.

Authors' conclusions

ITNs are highly effective in reducing childhood mortality and morbidity from malaria. Widespread access to ITNs is currently being advocated by Roll Back Malaria, but universal deployment will require major financial, technical, and operational inputs.

And may I add, behaviour change. Sleeping under a net that is impregnated in in good condition, provides protection to the individual, plus a certain amount of impact on vector longevity at commuity level. Sprayed house is like a big ITN, protecting all those inside the house, even earlier evening when all are still outside their "bed", coupled with a dramatic impact on vector longevity. Secondly, I do not question the trial results. What I am looking for is a wider impact at country level, over a sustained period. Many reports mention "so many nets distributed" with very few talking about the real impact.

By Malaria fighter (not verified) on 14 Jun 2010 #permalink

#9 "What I am looking for is a wider impact at country level, over a sustained period."

Did you read the Cochrane Review?:

"Fourteen cluster randomized and eight individually randomized controlled trials"

All you have to do is copy the Citation (Lengeler C. ... Reviews 2004, Issue 2) into google & you'll find it.

"Sprayed house is like a big ITN protecting all those inside the house, even earlier evening when all are still outside their "bed", coupled with a dramatic impact on vector longevity"

Setting aside the [resistance problem](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804687/), the fact that the vector Culex pipiens fatigans shows [little or no reaction to DDT](http://journals.cambridge.org/action/displayAbstract?fromPage=online&ai…) and that Anopheles shows a behavioural response that allows them to feed inside DDT sprayed houses [without resting long enough to absorb a lethal dose](http://journals.cambridge.org/action/displayAbstract?fromPage=online&ai…) how exactly does a sprayed house act like an ITN?

Personally I think the technique of allowing the mosquitoes to [apply the insecticides themselves](http://www.rothamsted.bbsrc.ac.uk/Research/Centres/PressReleases.php?PR…) could be an extremely effective control measure.

And while you're at it Malaria fighter, precisely what are you doing to fight malaria?

I have started a new not-for-profit entity "Ben Fighting Africa Fighting Malaria." Please send money.

Are we back at the "nets" argument again.

No, we questioning what Africa Fighting Malaria has ever done to seriously fight malaria.

Compare this with IRS using DDT - this is amongst other what AFM is trying to get into the skulls of some people.

Could you provide more detail about this operation? Does it differ significantly in quality, tone, and effectiveness from your post here? And about the "other", what is that aside from accusing Rachel Carson of being a mass murderer?

By truth machine (not verified) on 14 Jun 2010 #permalink

From http://www.fightingmalaria.org/news.aspx?id=1446

My own explanation for the biased editorial policy of Science and others is that the journals are run by science nerds, who were likely unpopular in their youth, and feel that they can become popular and cool as adults by embracing fads of the in-clique.

By truth machine (not verified) on 14 Jun 2010 #permalink

The Romans went to great lengths, even draining the Pontine Marshes, to eliminate malaria some 2,000 years ago. But if temperatures continue to increase (seems inevitable) expect malaria to re-emerge in southern Europe. Will this result in the use of DDT and nets? Seems unlikely.

As an analyst, comment #15 immediately strikes me as being of a familiar style...

By Vince Whirlwind (not verified) on 14 Jun 2010 #permalink

Thanks, Eli! I should have included links to yours and Tim's stuff to begin with. (Didn't wake up any Krakens, but that odd Beck guy from Australia's whining again.)

I'm just a poor educator working part-time, you know.

Though, if your group would like me to set up a 501(c)(3) called "Rachel Was Right" and pay me US$100,000 annually to run it, I could be persuaded.

In the meantime, we depend on the eagle eye of Eli -- er, uh, rabbit eye of Eli, to keep us accurate.

From the link truth machine provided:

http://www.fightingmalaria.org/news.aspx?id=1446

"[DDT detractors] argue that if mosquitoes develop resistance to DDT and it no longer kills them, the chemical has no use for reducing malaria. They would be right if DDT were primarily a toxic agent, but in fact it is primarily a repellent that acts secondarily as an irritant and lastly as a toxic agent. This means it is still useful in malaria control even in the presence of resistance to toxicity. Thus, a lack of understanding of how DDT works has resulted in it not being used and lives being lost."

That is so rediculous that it hardly merits refuting. Why was DDT never described previously as insect repellent rather than insecticide before? Because that claim is not true, of course!

And libeling Rachel Carson decades after her death is just hitting below the belt.

"The authors acknowledge that some robins died as a result of acute toxic exposure to DDT, and MSU felt that this was worth it, given their efforts to save thousands of trees from Dutch elm diseaseâa fungal condition spread by the elm bark beetle."

What idiocy! There were no other insecticides that could have done the job and were not so harmful to robins? Scientific research could have found them and used them, but I guess the makers of DDT would still have lost their profits. LOL!

"Carson's fantasy world did not end with the robin, however. She also claimed that DDT was behind the decline in bald eagle populations. The authors devastate this nonsense under the cold light of reason, with copious authoritative citations."

Let me translate that to the truth:

{Carson's testimony did not end with the robin, however. She also claimed that DDT was behind the decline in bald eagle populations. The authors attack this evidence under the cold light of self-serving prejudice, with lies backed up by fakery.}

And that was before the profoundly unprofessional quote truth machine provided.

Africa Fighting Malaria is a fraud and should be put out of business!

Dale@18: The bits you picked out regarding Carson illustrate quite well a common fallacy that exists amongst the anti-science movement. Within any given field they don't like, if you have a landmark work that people keep referring back to, they seem to get this boneheaded notion that if they can disprove the original work, everything that has happened since will somehow come tumbling down like a house of cards. This is completely ignoring the fact that these works only get to become regarded as landmarks with the gift of hindsight, after they have achieved mainstream acceptance through independent verification.

Other good examples of this include creationists having a pop at Darwin and the climate denialists' attacks on Hansen's 1988 Senate testimony. Their obsession with old science just goes to show how out of step with reality they are.

But if temperatures continue to increase (seems inevitable) expect malaria to re-emerge in southern Europe.

But...but...but...international conspiracy of scientists! ClimateGate! AAAAAAAAAALLLLLLLLLLLL GOOOOOOOOOOOOOORRRRRRRRRRRRRRRE!

Within any given field they don't like, if you have a landmark work that people keep referring back to, they seem to get this boneheaded notion that if they can disprove the original work, everything that has happened since will somehow come tumbling down like a house of cards.

Darwin's understanding of inheritance. Modern genetics.

Evolution proven wrong, world 6,000 years old, blah blah blah!

Yes, the common anti-science approach is to assume science is like an arch - remove the keystone, and all of science will fall down.

ben wins the thread. Credit, where credit is due.

I agree with this. After a couple of years for searching for Ben's brain, it appears that Ben has found it.

Bisous, besos, etc (on the cheeks, Ben, don't get too excited)

She also claimed that DDT was behind the decline in bald eagle populations. The authors devastate this nonsense under the cold light of reason, with copious authoritative citations

Yes, it wasn't the *only* reason, yet is a reason.

And, of course, the bald eagle isn't the only species negatively impacted by DDT and related insecticides.

There's a reason the Osprey has recovered, in areas where there's been no need to build nesting platforms, etc.

That is so rediculous that it hardly merits refuting. Why was DDT never described previously as insect repellent rather than insecticide before? Because that claim is not true, of course!

But what about Müller's Nobel Prize "for his discovery of the high efficiency of DDT as an insect repellant and irritant"?

By truth machine, OM (not verified) on 15 Jun 2010 #permalink

James A@20: The bits you picked out regarding Carson illustrate quite well a common fallacy that exists amongst the anti-science movement. Within any given field they don't like, if you have a landmark work that people keep referring back to, they seem to get this boneheaded notion that if they can disprove the original work, everything that has happened since will somehow come tumbling down like a house of cards.

Although in the case of DDT and Carson, I suspect it is mainly a matter of wanting to smear the environmentalism movement. And of course the EPA.

By Lars Karlsson (not verified) on 15 Jun 2010 #permalink

David Petley, your satire detector and perhaps your general ability to read for comprehension is busted. I of course know how Müller's citation reads -- AFM quotes it on the same page I cited where they idiotically -- and contrary to that citation -- assert that "DDT ...is primarily a repellent that acts secondarily as an irritant and lastly as a toxic agent".

Sheesh.

By truth machine, OM (not verified) on 16 Jun 2010 #permalink

Can malaria be controlled? Inherent in this question is implicit recognition that the disease increasingly requires innovative approaches that comply with the challenges of today and prepare for those of tomorrow.

ADVOCACY FOR A RESPONSE-TO-DEMAND APPROACH
Personally, I think that the malaria response stands at a cross-roads. Especially noteworthy is the fact that an effective response to malaria critically depends on sustained growth in targeted investments until the disease is controlled in terms of mortality ratios. At the same time, advocacy to improve governance and leadership remains essential (1,2). Also essential is making far better use of available resources, be they human resources, information, financing or infrastructure. That means streamlining the flow of financial resources to the frontlines of the disease and putting it to optimal use.

SPENDING MONEY WHERE IT MOST HELPS
Today there is substantial body of evidence on the comparative advantages, in terms of efficiency and effectiveness, of strategies centred on environmental safety. For example, those low- and middle-income countries that spend the least on environmental safety are also those countries that experience the full impact of malaria. In many regards, available evidence reveals that environmental safety is at least equal to, and often more efficient and effective than, care infrastructures in addressing malaria on a global scale. Historically, this stems from the fact that no country has ever controlled - and still less eradicated - malaria as a result of purely medical approaches. Yet, in many, if not most sub-Saharan African countries (starting with Congo-Brazzaville, my native country), resource allocation still clusters around struggling curative services, neglecting the potential of disease protection and health promotion. At the same time, African governments lack the expertise to mitigate the adverse effects on health from other sectors. Consequently, in a context where money is often tight and needs are always high, the money currently spent on providing malaria-exposed populations with the full range of bnasic services is far short of expectations. More importantly, it does not come close to meeting the requirements not only because of the constant shortfall in the funding flows available (particularly in the worst-hit countries). Briefly and simply, it is also because there is often a mismatch between where money is most needed (hygiene and sanitation) and where money is predominantly spent (antimalarials, counterfeit drugs included).

Based on the above-mentioned facts, I'm convinced:
- that time has come for exploding the long-standing myth that care infrastructures must be at the forefront of tackling malaria;
- that African health authorities have to make malaria a priority in their budget allocations;
- that African governments gain to develop country-wide systems for continually gathering, analyzing and reporting data on malaria-related spendin, in all sectors, not just the health sector (broad vision for the response to malaria);
- that most of the money spent on mitigating the impact of malaria should go towards improving hygiene and sanitation - e.g. waste disposal;
- that "Malaria Observatories", innovative structures that have yet to be established, can be helpful in promoting the multisectoral and collaborative response of a disease of critical concern.

Doctor Michel ODIKA (Congo-Brazzaville, Central Africa)

1. Michel ODIKA, Advocacy for a Malaria Observatory (http://www.booksie.com/health_and_fitness/article/michel_odika/advocacy…)
2. Michel ODIKA, Malaria Observatory (http://www.slideboom.com/presentations/183737/Malaria-Observatory)

By Doctor Michel ODIKA (not verified) on 28 Jun 2010 #permalink