Africa must review its malaria fight strategy

THE African Malaria Report launched on the World Malaria Day last April 25 by Kenya’s Vice-President, Michael Wamalwa, is, to say the least, disturbing. It is in fact an indictment of the continent, for it shows that the disease continues its relentless march, taking an unacceptably heavy toll, especially on children.
Any disease that claims an estimated 93 children in a single day cannot be said to be under control. This is why some people are questioning the world’s commitment to controlling this scourge.
While the launch was in itself a colourful occasion, graced by a number of dignitaries, one reading between the lines quickly discerned that the subject of the launch was an indictment. Short of admitting total failure, the report says that, according to statistics, the battle to annihilate one of the globe’s- and indeed Africa’s- deadliest scourges is far from being won.
The theme of the celebration was Insecticide-Treated Nets and the Effective Malaria Treatment for Pregnant Women and Young Children by 2005. But the data presented in the report on the coverage of women and children by the insecticide-treated nets (ITNs) shows that there is really nothing to sing about.
By last January, less than 5 per cent of African children were sleeping under ITNs and fewer than 15 per cent used any nets at all. The net problem, the report adds, is the gap between what nets cost and what families can pay. Yet, all this is against a backdrop of a commitment by 44 African malaria-endemic states that met in Abuja in 2000 to reducing or waiving taxes and tariffs on nets and insecticides to scale up their use.
Only 19 of the 44 countries have taken any positive action. But even as these nets are being touted as the best means of protection against malaria, a number of experts are increasingly questioning their efficacy and sustainability. As they age, there is no doubt that the nets start having holes wide enough for the mosquitoes to bite through.
The experts suggest that in such a scenario, the presence of the net concentrates body odours, in effect attracting more mosquitoes. This results in more bites, beating the very function for which they were initially meant.
The other aspect of net use causing concern to experts is the development of the vector’s resistance to the synthetic pyrethroids- permethrin and deltamethrin -that are being used to impregnate the nets. Their argument is that with the very short generation time of the mosquito and the constant exposure to the insecticide, it is just a matter of time before resistance develops.
Others are questioning the use of synthetics yet Kenya is the world’s largest producer of pyrethrum, whose growers are incidentally among the most wretched in the country.
Exit the net critics and enter the DDT proponents. Armed with impeccable facts, the latter are arguing that the very Western countries that spearheaded the ban on DDT used the same pesticide to eradicate malaria from their backyards. The kingpin of their argument is the fact that a country that has not used DDT cannot succeed in eradicating malaria. Is there any surprise then when conspiracy theorists argue that the DDT ban was a grand plan by the West to keep the African populations in check?
The time is ripe for Africa to sit down and review its strategies on malaria control. For a disease that costs an already deprived continent of $12 billion a year in missed social and economic development, this is not just a necessity. It is an emergency.