Uganda: Conditions for DDT Spray Set

New Vision (Kampala)

January 3, 2007
Posted to the web January 4, 2007

Gerald Tenywa
Kampala

THE National Environment Management Authority has asked the health ministry to obtain an approval from the secretariat of the Stockholm Convention before spraying DDT.

Speaking at a press conference in Kampala yesterday, the executive director of the environment body, Dr. Aryamanya Mugisha, said the ministry should also get an approval from the World Health Organisation to spray DDT to control malaria.

These are some of the conditions the Government watchdog on the environment set after approving that each house will be sprayed with the drug to control malaria spread.

Mugisha asserted that a multi-sectoral and multi-disciplinary monitoring committee should be established to oversee the implementation of the environment concerns of DDT.

"We have approved DDT, but we know it is a deadly chemical which should not be handled carelessly," Mugisha said.

"It will only be applied in the interior of houses and the conditions we have set shall help to ensure that it does not contaminate the environment."

The committee will among others comprise officials from the National Environment Management Authority, the ministries of health and agriculture.

Asked whether the spray of DDT in houses would be voluntary or forceful, Mugisha replied; "The Ministry of Health will cause public awareness to prepare people to accept their houses to be sprayed."

Pilot areas for DDT use will be those worst hit by malaria like districts near Lake Kyoga and south-western Uganda.

Rwanda: No DDT, Ministers Confirm

The New Times (Kigali)

January 4, 2007
Posted to the web January 4, 2007

Innocent Gahigana
Kigali

Rwanda won't use of Dichloro Diphenyl Trichloroethane (DDT) to control malaria, cabinet ministers have confirmed. Lands and Environment Minister Christophe Bazivamo and Dr Innocent Nyaruhirira, State Minister for HIV/Aids and other Infectious Diseases,

said in separate interviews yesterday that the stance was in respect to the international protocols against the use of DDT. "We can't apply DDT yet there are international conventions against its application. The international ban still stands," said Bazivamo.

He added that apart from being dangerous to humans and environment, the chemical's use could cause side effects on agriculture "which our country is keen on developing."

"We have contacted the Ministry of Health to scrutinise the liability of using DDT for malaria control, and we're waiting for their reply. But what I can assure you is that the government hasn't adopted such chemical to fight malaria," Bazivamo said.

Contacted for comment, Dr Nyaruhirira said that his ministry had recommended that DDT shouldn't be used in the country.

This is contrary to last year's recommendation by the World Health Organisation (WHO) that DDT was applicable in the war against malaria in developing countries.

He said that the ministry's recommendation was arrived at after protest against use of the chemical by the Rwanda Environment Management Authority (REMA).

"REMA told us the side effects of using DDT and for the meantime we have proposed the use of pyrethroid type of chemical, 'ICON', which would even help us promote our pyrethrum products," Nyaruhirira said.

He said REMA's arguments were valid. REMA Director General Rose Mukankomeje was the first public official to publicly protest WHO's recommendations on DDT.

Following the world body's resolution some countries including the neighbouring Uganda okayed the use of DDT.

Bazivamo said that DDT had the potential to affect Rwanda's cash crops such as tea and coffee on the international market.

Initial suggestions that that the chemical could not be used in Rwanda came from REMA officials last week.

Kenya: Malaria Vaccine Difficult to Develop

The East African Standard (Nairobi)

December 22, 2006
Posted to the web December 24, 2006

Ochieng Ogondo
Nairobi

New research into the genetic diversity of the deadly malaria parasite, Plasmodium falciparum, indicates that making an effective malaria vaccine may be more difficult than scientists had thought.

Three new comprehensive studies, published online in Nature Genetics this month, investigate the genetic make-up of the parasite to find out which genes vary most in order to identify potential targets for malaria vaccines

The studies by American and British scientists independently characterise the genetic diversity of the parasite that causes malaria.

Malaria is the world's second biggest killer after tuberculosis. Around 300 million people suffer from the disease each year resulting in 1.5 - 2.7 million deaths annually, the majority in sub-Saharan Africa. It is estimated that 1.2 million children in Africa suffer from malaria annually. More than two and a half billion of the world's people live in areas threatened by malaria.

Deciphering the evolutionary history and genetic variation of the parasite is critical for understanding the evolution of drug resistance, identifying potential vaccine candidates and appreciating the effect of parasite variation on prevalence and severity of malaria in humans.

Malaria parasite uses many tools to infect humans

In one study by Wellcome Trust Sanger Institute, the team compared the related parasite Plasmodium reichenowi, which infects chimpanzees, and Plasmodium falciparum and examined the evolutionary differences between the two.

They found that the malaria parasite has many tools to use in its battle to infect humans. The most significant tool was its ability to 'cloak' itself in any one of a suite of cellular disguises.

Past studies on variations of Plasmodium falciparum have either in depth over small genomic regions (up to the size of a small chromosome) or genome wide but only at low resolution. The earlier studies revealed that some genes, and the proteins that they code for, are variable, but the new research shows there are many more variations than were previously recognised. The new studies mapped more than 27,000 variants across the genome - the complete cells of a gene.

"These novel maps are new tools in the fight against malaria," says Dr Matthew Berriman, co-leader of the Wellcome Trust Sanger Institute project.

He said the maps detail areas of variation - the regions where the effects of our defences are marked in the parasite genome.

In humans, the parasite lives in liver and red blood cells, where clinical course of the disease is determined.

Malaria has many variants

The studies show that if one variant of malaria is successfully treated, another might rise from the background making development of vaccines to combat malaria very difficult.

"When we attack, the parasite responds and that is marked by changes in the parasite DNA," said Berriman.

"We found that genes that are active in red blood cells and genes that are predicted to interact with host cells were especially variable," said Daniel Jeffares, a researcher at Wellcome Trust Sanger Institute.

On the positive side, said Jeffares, looking at the evolution of categories of genes can point to those that are essential to the parasite's lifestyle and are likely to be stable - and hence most valuable for new treatments.

"The parasite genome is very plastic. It carries the scars of its battle against its three main challenges - our rapidly evolving human immune system, the defensive responses of the mosquito and the insecticides and drugs we use to challenge it," said Dr Manolis Dermitzakis, co-leader of Wellcome Trust Sanger Institute project. The new mapping of variation can be used alongside maps of human variation to understand how the genome of each has been moulded by the activities of the other and this could be key to the development of a vaccine.

"The human genome carries imprints of our history of infection by malaria. Similarly the genome of the malaria parasite shows how it interacts with the human immune system.

Different strains require different vaccines

Understanding these interactions is key to the development of effective vaccines against malaria, " said Dr Mark Walport, Director of the Wellcome Trust.

The variation studies reveal that the immune response induced by a vaccine made from one strain of parasite may not give good protection against another strain.

Experts say there are many reasons - often related to poverty - why the burden of malaria has not been reduced.

Incidents of malaria can be reduced with simple solutions, such as provision of bednets and proper use of drugs.

But still, new treatments and measures are needed if the global community is to or eliminate the disease.

The studies provide important information on the structure of the malaria parasite, which is bound to help in the control of this infection in the long-term.

Copyright © 2006 The East African Standard. All rights reserved. Distributed by AllAfrica Global Media (allAfrica.com). Click here to contact the copyright holder directly for corrections -- or for permission to republish or make other authorized use of this material.

DDT Public Hearing Answers

By Mr. Michael Okia, Senior Entomologist, Malaria Control Programme/MOH

Quite a number of issues were raised during the DDT Public Hearing held on 21^st November 2006 about malaria vectors, their behaviour and alternative control methods, and the likely impact of DDT use on agricultural exports which I would I would like to address in short.

Malaria vector behaviour

Malaria vectors in Uganda are anthropophilic (prefer feeding on humans), endophagic (feed indoors) and endophilic (rest indoors). That is why residual insecticide indoor spraying (IRS) using DDT and other residual insecticides and the use of insecticide treated mosquito nets (ITNs) are very effective for their control and thus for the control of malaria. If the malaria vectors fed and rested outdoors then the use of IRS and ITNs would be very useless.

Malaria vector control measures:

Control methods for malaria vectors can be divided into 4 categories:

1. Chemical control methods e.g. Indoor residual insecticide house spraying (IRS), ITNs, larviciding, space spraying (using aerosols, fogging or ultra low volume spraying),
2. Personal protective control measures e.g. use of insecticide treated materials e.g. mosquito nets (ITNs), mosquito coils, repellents, etc
3. Environment management or source reduction measures – Environment modification and manipulation (draining, filling in or draining mosquito breeding sites)
4. Biological control measures e.g. using bio-larvicides such as Bacillus thuringiensis israelensis, Bacillus sphaericus, neem oil, using larvivorous fish species.

However, amongst all these control measures, IRS and ITNs are the most cost effective vector control tools available for malaria prevention and control.

Indoor residual spraying (IRS) is the application of long-acting insecticides inside walls and ceilings of human dwellings and underneath furniture where malaria-carrying mosquitoes rest before or after biting human beings. DDT remains the cheapest and longest acting insecticide for IRS. DDT is not going to be used outdoors!

IRS is one of the primary vector control interventions for reducing and interrupting malaria transmission. IRS with DDT was the principle method by which malaria transmission was eradicated or greatly reduced in many countries between the late 1950s and 1980s. IRS using DDT during the Malaria Eradication Programme (1955-1969) led to malaria eradication from Europe, the former USSR, and several countries in Asia and the Caribbean. About 700 million people or more than half of the previously exposed populations were no longer at risk. Since then, decreasing use of IRS and DDT has been associated with resurgence of malaria in many countries. It is estimated that DDT “prohibition” has resulted in the death of over 60 million people due to malaria worldwide. DDT rapidly reduces vector numbers and house resting densities and vector longevity, i.e. fewer vectors survive long enough to be able to transmit malaria. Thus it interrupts malaria transmission very fast. DDT is also effective for several (6-9) months on vector mosquitoes as well other household pests thus controlling malaria for long and reducing expenses for household pest control.

Recent scientific and epidemiological data re-confirms the efficacy and effectiveness of IRS in malaria control in countries where it is done in the right place at the right time and the right way.

Long term effects of DDT:

Someone had also raised the issues about the long term effects of DDT. However, being the oldest insecticide which has been known for the last 60 years or so, DDT is the most studies of all the insecticides for IRS for malaria vector control. DDT is known to have no deleterious human or environmental effects as used in IRS for malaria control. The alternative insecticides are pyrethroids which were produced in the 1980s and less is known about their long term effects than those of DDT.

DDT and its effects on agriculture and the honey industry:

Many also said that DDT will kill off all bees and affect the honey industry. People forget that DDT or Dudumaki as it was then called in Uganda, was massively and indiscriminately used in agriculture in Uganda in the late 1950s to late 1970s without affecting the honey production then in Uganda. Indeed, many appear to know that the pyrethroids many advocate for IRS are more dangerous to bees than DDT! Indeed, the indiscriminate use of pyrethroids by mostly untrained people pose a greater problem to the honey industry than IRS using DDT for malaria control. Many forget that DDT is banned for outdoor use in agriculture but only recommended for indoor spraying for control of vectors of human diseases, and as such will have very little, if ever, on agricultural production.

Alternative mosquito control measures:

Breeding habitats for malaria vectors in Uganda include the following: pools, ponds, burrow pits e.g. brick/murrum/sand pits, rice-fields, roadside pools, rain water collections, stream sides, river bed pools, seepage water, wells, overhead tanks, channels/canals, hoof prints, car tyre tracks, etc.

With such ubiquitous breeding sites, there is no way we can find or reach each and every breeding sites and deal with them either through environmental control measures by either filling in, draining or grading them, or applying chemical or biological larvicides into them. Thus you cannot hope to effectively control malaria vectors with environmental management or larvicidal control measures.

Strategies to limit human and environment exposure to DDT

Public health insecticides including DDT under go WHOPES and national registration authorities and are required to be safe to humans and the environment. Importation is only for use in government malaria control programs. Insecticides are procured in sachets, and stored under security with effective stock control like drugs. Use is by trained and supervised spray operators using stainless steel compression pumps calibrated to deliver the right dosage per square meter. Thus, insecticides used in public health do not contaminate the environment as they are used in low quantities and inside house on walls and ceilings as compared to large-scale outdoor use of insecticides in agriculture. DDT used for IRS is safe to health workers, households and domestic animals. The water from washing sprayer is used for mixing insecticide in following day.

Empty sachets are collected for accountability and safely disposed through incineration. DDT tends to degrade very slowly and accumulate in the environment and has thus raised concerns in the past when it was used in large scale in Agriculture.

Only the MOH will import DDT according to its needs. Importation, labeling, distribution, storage, use and disposal of DDT will conform to the Stockholm Convention requirements and WHO guidelines. MOH will build capacity to effectively implement IRS using DDT. MOH has already developed capacity for IRS in Kabale through PMI (RTI) support using Icon. Further IRS capacity to be built in 6 more districts (Kanungu, Apac, Amuru, Gulu, Kitgum and Pader) in 2007 using Icon. The management of insecticides for IRS is similar irrespective whether you are using pyrethroids, DDT, Carbamates or Organophosphates, i.e. very strict! Indeed, there already exists a critical mass of trained Entomologists, VCOs, HIs & HAs exists at national and district levels who will be re-trained on correct IRS techniques. Training procedures for IRS will ensure the safe and correct application of residual insecticides. Close and effective supervision and monitoring of DDT spraying operations will be conducted by trained Entomologists, VCOs, HIs & HAs. Guidelines on the safe use of DDT will be distributed to stakeholders

DDT will be used INDOORS only. Strategies and regulations to limit human and environment exposure to residual insecticides including DDT will be put in place and enforced according to NEMA and NDA guidelines and procedures. Proper training on safe and correct application of DDT and close supervision and monitoring of spraying operations will be done. A comprehensive plan for using DDT for IRS will be developed.

The MOH will conduct continuous Public Awareness Campaigns through various media before, during and after the spraying programme to ensure community acceptability and cooperation in DDT application. DDT IEC materials will be distributed to stakeholders.

Supervision and monitoring of IRS using DDT activities:

Based on our IRS experience in Kabale District in June to August 2006 using Icon insecticide, the following will conduct supervision and monitoring of the IRS using DDT. The Team Leaders (TLs) who are responsible for 5-7 people will closely supervise Spray operators (SOs), walking with them from house to house. The Subcounty Supervisors (SS) i.e. HIs or HAs, with facilitated Gombolola (Subcounty) Intelligence Security Officers (GISOs) will supervise 2-4 teams in their subcounties using motorcycles. The Vector Control Officers (VCOs) i/c of Health Sub-districts, the District Vector Control Officers (DVCOs) and the District Health Inspectors (DHIs) will also conduct daily supervision of IRS operations throughout the spraying period. The Subcounty chiefs and LC III Chairpersons will also be called upon to address any issues within their areas of jurisdiction e.g. any de-campaigning of IRS exercise. The district leaders (DDHS, CAO, RDC, LC V Chairperson, LC V Secretary for Health and DISO) are facilitated to monitor the exercise at least once a week. The MOH through the MCP will also monitor the exercise. The MOH will establish a Multi-sectoral Monitoring and Evaluation Technical Task Force including representatives from MAAIF, NEMA, etc to ensure that DDT is not used for unintended uses.

With all these measures in place, contamination of the environment and agricultural produce and exports will be minimized to the lowest level!

Thus DDT is a very safe, cost effective and long lasting malaria vector control tool for malaria control which will have no effect on agricultural products and exports.

PROS AND CONS OF DDT USE FOR UGANDA

FACTORS/ ISSUE	PROS (BENEFITS) OF DDT USE IN UGADA	CONS (PROBLEMS) OF DDT USE FOR UGANDA:
ECONOMIC (COST ISSUES)	A recent 1998/99 cost data presented indicate that DDT is still the cheapest insecticide to employ for IRS in vector control programmes on the basis of cost per house per 6 months of control, (provided that its use achieves satisfactory control of Anopheles and malaria). However, the cost differential appears to be declining and may be insignificant in some countries, with cost ratio of DDT to other insecticides varying between 1.4-18.7 (Walker, 2000). The long residual effect of DDT lasting for up to 6 or more months reduces the operational DDT IRS costs.	DDT price has risen already and is expected to rise further as the DDT volume and number of producers declines (only 3 major manufacturers worldwide – 2 in China and 1 in India), coupled with international pressure to ban DDT manufacture and use DDT spraying requires and well trained, motivated (paid) and well supervised team with proper protective wear, thus increasing its operational costs DDT IRS requires effective regulation to avoid its diversion for agricultural purposes and this may increase its operational costs Based on the product weight calculations of US $ 1,100/ton figure (Goodman et.al., 1999, 2000), transportation costs for DDT are higher than some pyrethoids, with DDT shipping costs at US $ 1.76 per house per 6 months compared to US $ 0.06-0.11per home per 6 months for Icon. Local transportation costs of DDT are also higher because of its bigger volume. This increases the operational DDT IRS costs. With DDT (and other coarse abrasive) WP formulations, the nozzle tip (costing ~ US $ 1.00) may have to be replaced after each spray cycle, whereas nozzle tips can be used without replacement for years when spraying the finer WP formulations of some potent pyrethroids that also remain active for 6 months on the sprayed wall surface. This increases the operational DDT IRS costs.
EFFICACY (RESIDUAL EFFECT)	DDT is effective for up to 6 or more months and thus can be applied only twice a year in areas of two rainy season and only once in areas where there is one long wet and 1 long dry season. Despite the development of resistance to DDT in some populations of malaria vector anopheles mosquitoes, DDT remains generally effective when used in indoor spraying against most species of anopheles, due to excitorepellency as well as insecticidal effects.	In view of the availability of alternative insecticides for IRS, some of which may compete with DDT in terms of epidemiological impact, public acceptability, logistic suitability and compliance with specifications issued by WHO, DDT no longer merits being considered the only insecticide of choice (WHO, 2000)
INSECTICIDE RESISTANCE	An. funestus (not An arabiensis) became resistant to deltamethrin in South Africa and because of a serious epidemic in the country, DDT was again used for the spraying of houses to control the epidemic.	High levels of DDT resistance in malaria vectors has been recorded in some countries e.g. Sri Lanka and parts of India and Mexico, requiring the use of other alternative insecticides. There is need therefore to assess DDT resistance status of the major local malaria vectors in Uganda
HEALTH (SAFETY ISSUES)	DDT is poorly absorbed through the skin, making it relatively safe insecticide to handle (Smith et. al 1992). A claimed association between DDE residues with breast cancer have not yet been substantiated (Curtis, 2002) A review of two recent publications suggesting an association between DDT and human cancers, a report on the presence of DDT in breast milk, and two general reviews of the subject by two Expert Toxicologists concluded that the information presented does not provide convincing evidence of adverse effects of DDT exposure as a result of IRS as carried out in malaria control activities (WHO, 2000). A WHO study group concluded that DDT exposure associated with IRS does not constitute a significant health hazard (WHO, 1995). Thus there is very limited evidence that indoor DDT spraying is associated with negative impacts in human health.	There are lingering concerns about the long term effects of chronic exposure (WWF , 1998, 1999) Some research suggests that DDT and its metabolite DDE may interfere with normal functioning of certain hormone mediated process. DDT does not break down quickly and has a persistent effect in the environment and accumulates in human and animal fats for up to 20 years after exposure to DDT ends and is expressed in breast milk. Although Sweden banned DDT use in 1970 and was banned in most other countries in 1972 following clear evidence of the harm it caused to wildlife, nevertheless, high levels continue to be found in the blood or fatty tissues of people around the world. This includes the Innuit people of Greenland, who have not been exposed to DDT in spray form but who eat large amounts of fat from contaminated sea mammals (De Jager et. al. 2003). Recent studies in Chiapas province, Mexico, a rural area where DDT was used to control malaria until the late 1990s, showed that high DDT levels in men could alter male hormone balances and decrease sperm quality, including reduced ability to swim fast, lower than normal semen volumes lower sperm counts. High levels of DDT exposure were found in the blood of the tested men (about 300 times higher than breast milk samples from Canadian women). DDE (DDT metabolite) residues in breast milk has been associated with DDT anti-malaria spraying in South Africa but it is not known whether this is harmful (Bouwman et.al., 1990). There is also a recent report of association of DDE residues with the probability of pre-mature birth and shorter duration of lactation, although no studies in Africa have shown this association (Curtis, 2002; Chen, et. Al., 2003). Proper protective wear required for the spray team using DDT
ENVIRONMENTAL ISSUES	The heavy use of insecticides for IRS could be expected to have an impact on the environment, but there is little information documenting this. Most of the documented environmental damage caused by DDT is associated with heavy use in agriculture (e.g. Wurster et.al. 1965, Risebrough, 1972, Wiemeyer et.al. 1993)	DDT is an organochlorine compound which has a persistent damaging effect in the environment. Agricultural DDT overuse in the 1950s and 1960s devastated some wildlife populations, such as birds of prey, whose effects on these populations are reversing only now. Due to environmental concerns, DDT should only be used in well defined, high or special risk populations, thus restricting areas where it is to be used The washing of spraying equipment and poor disposal of waste DDT solution may cause some risk to contamination of streams of streams and other ecosystems near IRS operations The long persistence of DDT and its metabolites in soil may result in adverse impacts of large scale DDT spray programmes over a long period (WWF, 1998, 1999) Diversion of DDT from public health use to agricultural applications, through pilferage and corruption, also causes various problems, including contamination of export crops with unacceptable insecticide residues (WHO, 1999)
SUPPLY ISSUES		Continued supply of DDT may become a problem as only 3 major DDT production facilities currently in the world continue to operate (2 in China and 1 in India), India does not export its DDT. Thus, countries like Uganda may encounter problems of a constant supply of DDT.
POLITICAL AND ECONOMIC PRESSURES		DDT is being phased out because of its previous widespread use in the environment, and resulting political and economic pressure Some wealthier nations have demanded that poorer countries ban DDT as a condition for receiving foreign aid. USA and EU countries may put pressure on Uganda not to re-introduce DDT by threatening not to import agricultural and fisheries products related goods if DDT is being used in the country. This could easily apply to Uganda’s agricultural Areas to be sprayed may be major tourist destinations where there are game and nature reserves. The knowledge that DDT is used in this environment could potentially turn tourists away who have perceived ideas of pristine natural environment although malaria posses a greater risk to the tourists
SOCIAL IMPLICATIONS	DDT kills other household pests DDT is only effective on porous walls such as mud-plastered walls. Thus its effectiveness will be appreciated by the local communities where mud-plastered walled houses are the main type of houses used. DDT stains walls white and this makes quality control of spraying operations extremely easy.	DDT irritates and increases activities of bedbugs in households that have been sprayed leading to certain household members refusing access to malaria control personnel who are unable to spray. This affects coverage which is very critical for achieving Anopheles mosquito and malaria control Cement and brick houses with plaster and painted walls are unsuitable for DDT. Spraying furniture with DDT could damage it and would be very unpopular. This is likely to reduce coverage rates in villages where many houses are of cement and brick. DDT stains walls white and some householders find the staining unacceptable and tend to re-plaster after the malaria control personnel have left. The re-plastering covers over the DDT and therefore leaves it ineffective

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Chen, A. and Roam W.J., 2003. Nonmalarial infant deaths and DDT use for malaria control. Emerging Infectious Diseases, Vol. 9, No. 8.

Curtis, F.C. 2002. Should the use of DDT be revived for malaria control? Biomedica, 22: 455-61

Goodman, C.A., Coleman, P.G. and Mills, A.J. 1999. Cost-effectiveness of malaria control in sub-Saharan Africa. Lancet, 354:378-385

Goodman, C.A., Coleman, P.G. and Mills, A.J. 2000. Economic analysis of malaria control in sub-Saharan Africa. Strategic Research Series, Global Forum for Health Research. WHO, Geneva

Hargreaves, K., Koekmoer, L.L., Brooke, B.D., Hunt, R.H., Mthembu, J. and Coetzee, M. 2000. Anopheles funestus resistant to pyrethroid insecticides in South Africa. Medical and Veterinary Entomology, 14: 181-9.

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Risebrough, R.W. 1972. Effects of environmental pollutants upon animalas other than man. Proceedings of the 6^th Berkeley Symposium on Mathematical Statistics and Probability, pp 443-463. University of Calfornia Press, Berkeley, CA

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Roberts, D.R., Manguin, S, and Mouchet, J., 2000. DDT house spraying and re-emerging malaria. Lancet, 356:330-332

Smith, A. G. 2000. How toxic is DDT? Lancet, 356, 267-268

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Wiemeyer S.N., Bunck, C.M. and Stafford, C.J. 1993. Environmental contaminants in bald eagle eggs 1980-84 and further interpretations of relationships to productivity and shell thickness. Archives of Environmental Contamination and Toxicology, 24:213-227.

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Try Nets, Not DDT

by Jessie Stone

To many of us in the malaria-control business, it came as no great surprise last week when the World Health Organization recommended wider use of DDT in Africa to combat the mosquitoes that cause the disease, which kills more than a million people a year, most of them children in Africa. The WHO's endorsement of DDT for spraying inside houses has the support of the U.S. Congress and the Bush administration. With the WHO's encouragement, several African nations have approved DDT for use in indoor residual spraying (that is, spraying the walls of huts to kill the mosquitoes that wait there until dark). Uganda's Ministry of Health and National Malaria Control Program, for example, have embraced this approach. Newspaper articles across Africa have assured readers that DDT has gotten a bad rap and is, in fact, safe for use. But people have short memories. Doesn't anyone remember the American bald eagle? DDT brought it to the brink of extinction. In part because of that, the use of DDT was banned in 1972. The Department of Health and Human Services, the International Agency for Research on Cancer and the Environmental Protection Agency have all listed DDT and its breakdown products, DDE and DDD, as possible carcinogens. DDT is a persistent organic compound and can remain in the environment long after its initial use, entering the food chain and accumulating in fatty tissue. Even when the United States instituted spraying in 2000 to kill the mosquitoes that carry West Nile virus, it didn't use DDT. Although DDT helped eliminate malarial mosquitoes in South Africa, the case was unique - that type of malaria was directly related to the length and intensity of the rainy season, when malarial mosquitoes are active - and we still don't know the broader impact of its use there. In the African countries where the burden of malaria is greatest, the disease is endemic. Uganda, where it rains throughout the year, could not be more different from South Africa in terms of malaria, and it is a mistake to apply the same formula here. The use of DDT for indoor spraying will not produce the same results and will almost certainly have dire consequences. And spraying is costly. This year in Kabale, in southwestern Uganda, 100,000 huts were sprayed as part of an indoor spraying project. A permethrin derivative, not DDT, was used and the spraying was controlled and safe. The cost was close to $2 million. Uganda has a population of 28 million, with 7 people on average to a hut. Any comprehensive, nationwide spraying effort would have to reach some 4 million huts, costing more than $80 million, and that's only for the first of several rounds of spraying. With Uganda's resources already overburdened, it makes little sense to embrace an approach that is exceedingly costly from fiscal, human and environmental standpoints. In Uganda, where I run a malaria education, prevention and treatment program, the most effective weapon against the disease is basic education about how people contract it and how they can protect themselves. For instance, insecticide-treated bed nets can reduce the incidence of malaria by at least 50 percent and perhaps as much as 90 percent. Combination- drug therapy along with targeted non-DDT spraying inside huts will also be effective in controlling malaria. DDT is not the magic bullet that will eradicate malaria. We need to refocus resources and attention on something most Africans do not have: basic malaria education and prevention with insecticide-treated bed nets. A mosquito net costs $6.50 and can last up to five years. An average of three people can sleep under it, and the only harmful effect we have heard about, after having distributed 11,000 nets in the Kamuli, Jinja and Kayung districts over the last two years, is people being hot at night. We do not have to reinvent the wheel here. We just have to help educate people - even those with the best intentions. Jessie Stone, a medical doctor, is the founder and director of Soft Power Health, a nonprofit organization in Uganda. Copyright © 2006 International Herald Tribune

Re-Consider DDT Against Malaria

Roger Bate & Mauro De Lorenzo | 10 Jan 2007
American Enterprise Institute

Malaria kills over one million children a year in Africa, more than any other disease. Last September the World Health Organisation (WHO) released new policy guidelines for malaria control that call for increased spraying of insecticides inside houses, or indoor residual spraying (IRS), and encourage the use of DDT, which is the most successful public-health insecticide ever produced.

Indoor spraying is one of the most effective methods of malaria control. It is safe for humans and the environment and is the main method used in most southern African countries. Yet despite its proven efficacy, developing countries - particularly those dependent on foreign aid - were encouraged to dismantle their spraying programmes and concentrate on using insecticide-treated nets for malaria control. Treated nets are an important component of any malaria control programme, but they cannot control the disease on their own.

In the late 1990s, South Africa suffered a disastrous malaria epidemic, largely because it stopped using DDT in its indoor spraying programme. It was only in 2000, when DDT was reintroduced, that the epidemic was brought under control. Other countries, such as Mozambique and Zambia, also restarted their indoor spraying programmes. The result has been a steady decline in malaria cases wherever indoor spraying with DDT is practised.

Rwandans should not fear DDT. It eradicated malaria from Europe and U.S. in the 1940s and 1950s. Sixty years ago over a million dwellings in America were sprayed every year with DDT to save lives. There was not a single case of harm from this spraying, nor to the hundreds of millions of people around the world whose dwellings were sprayed in later decades. America and Europe stopped using DDT after malaria was eradicated. But if an American child died every thirty seconds from malaria (as is the case in Africa), then you can be sure that America would re-introduce DDT.

Last year, the U.S. Agency for International Development (USAID) announced its $1.2bn Presidential Malaria Initiative. Having discouraged indoor spraying for many years, this new initiative is putting substantial resources into such programmes in Angola, Uganda, and Tanzania.

But while the U.S. government is getting things right, most other donors are lagging behind. Few European donors will support indoor spraying and the European Union has set the proverbial cat among the pigeons in East Africa by suggesting that agricultural exports could be turned away from Europe if DDT is used in malaria control.

These threats have been partially retracted, but some damage remains and some exporters in Uganda and Kenya still oppose DDT. We expect that Rwandan exporters are similarly concerned. They really shouldn't be, and with sensible controls (to make sure that the small amount of DDT used is not diverted into farming) DDT will save lives and cause no loss of business. No African produce has been rejected by the EU due to DDT contamination.

Opposition to DDT remains from some extreme environmentalist groups such as Greenpeace, but many, such as the Sierra Club and South Africa's Endangered Wildlife Trust, support indoor spraying using DDT and other insecticides. The WHO and USAID are now endorsing and encouraging what many malaria scientists and governments in southern Africa have been doing for years. Now is the time for other donors, non-governmental organisations, and the private sector to do the same. With more than a million preventable deaths every year, there is no time to lose. Rwanda's current policies will certainly save lives. But many more lives could be saved if Rwanda adopts indoor residual spraying using DDT as part of its malaria control programme.

Roger Bate and Mauro De Lorenzo are resident fellows at the American Enterprise Institute for Public Policy Research in Washington, D.C.

Police stops CP rally

By Herbert Ssempogo

BUSINESS came to a near standstill at Nakasero Market on Friday as the Police stopped Conservative Party boss Ken Lukyamuzi from holding a rally protesting the use of DDT.

Accompanied by his daughter, Lubaga South MP Susan Nampijja, and a few supporters, Lukyamuzi, in the white and purple party colours, arrived at the market at about 3:00pm to chanting from vendors.

However, their joy was short-lived as the Police, led by Central Police Station (CPS) chief Ivan Nkwasibwe, accosted the group that was supposed to address the people.

“You are not supposed to hold a rally here,” Nkwasibwe told Lukyamuzi, who was to address the people on the impending use of DDT to fight malaria.

“It is okay. Let me leave,” Lukyamuzi replied, before taking off with a few of his supporters.

The Police had authorised the rally, but advised Lukyamuzi to hold it at the Clock Tower in order to avoid disrupting business in the city centre. Drama unfolded as vendors tried to resist the arrest of some party members, but the Police overpowered them.

Youth Secretary Semusu Mugobansonga screamed as he was lifted onto a police truck that whisked him off to CPS.

Abdukarim Kiggundu and another unidentified man were also arrested.
People gathered in the roads and a heavy traffic jam developed around the market.

As his party members were being arrested, Lukyamuzi rushed to another street close to the market and addressed a gathering.

“I am here to ask you not let any person to come into your houses to spray DDT.

You are not insects to be sprayed with chemicals,” he said to ululations. “You should not associate with DDT because it will affect the fruits and vegetables you sell.”

Published on: Saturday, 3rd February, 2007