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Tackling Malaria in Africa: Miracle or Mirage?

posted Oct 7, 2010, 7:10 PM by Ghana Medical Volunteers
“Every human should not have to suffer from Malaria. Not with the knowledge and technology that is out there now” – Richard Howe, Founder, Airwolf Malaria Vector Control Research Institute There is the formation at Florida, a not-for-profit research institute, with the name Airwolf Malaria Vector Control Institute. This organization is dedicated to the elimination of malaria in Africa, simply by eliminating the mosquito. The methods currently used only achieve modest reduction in parasite transmission, and will never eliminate malaria in Africa. The time has come, with recent advances in the development of aerosol generators, as a practical matter, to accomplish this task. Mosquito control consists of two elements, physics and chemistry.

There is not one institution devoted to training aerial applicator pilots in the art and science of dispensing mosquito control insecticides. I have more experience than anyone in the States and was given no training at all before I was issued a license 24 years ago, for this purpose. The physics of insecticide aerosol cloud propagation is simply not well understood and never will, if someone does not take the lead in researching this most important aspect of the art. The chemistry fares a little better than the physics of mosquito control. The most famous and most important chemical tool in the fight against malaria is of course DDT. DDT got a bad reputation in the 1960’s, with the publication of Silent Spring - a book written by Rachel Carson. I have read her book and was surprised to find that she was not so much against the use of chemical insecticides, as she was against the abuse of these products. Not much has changed since her day. The mosquito control industry, in spite of the mountain of EPA regulations is stuck in the 50’s. The overuse and abuse of chemistry is still with us to the detriment of the environment. The overuse of chemical insecticides is what induces resistance, not the under use. If used responsibly DDT still has a future in malaria vector control. I would like to recommend a series of projects for consideration that address the application of insecticides, and the formulation of new compounds, for vector control. In the area of aerosol cloud propagation, there is not much known, except the insecticide cloud floats downwind of the aircraft. However the optimum release height, lane interval spacing, system flow rate variables needed to establish the most equal cloud density and the most optimum droplet spectrum, are all variables, that in my opinion are in need of extensive study. At present what is done to optimize application efficiencies is just educated guesswork. In order to do this properly, someone is going to have to invent a system of remote sensing stations, that in addition to measuring insecticide cloud densities, also has the ability to conduct a mosquito population survey as well. Once this is accomplished, a minimum insecticide aerosol cloud density, necessary to obtain good control, can be established to avoid wasting insecticide. In addition to studying the physics of aerosol cloud propagation, I would like to see a concerted effort in the area of chemistry. We have the old fashioned poisons like DDT, permethrin, malathion and naled. These products affect the nervous system of the insect and in effect turn out the lights and cause the mosquito to die. Methods that have never been used to my knowledge are synergizing insecticides, using surfactants to reduce surface tension of the droplet, allowing insecticide to penetrate the insect and become systemic. Insecticides are effective without the surfactant, the advantage of this method will allow for a reduction of insecticide. Using a descant to dissolve some of the wax coating on the insect and allow it to “bleed” to death is another method that should be studied. Research into the use of biological insecticide formulations has the potential of providing a cheap and environmentally safe method for dealing with malaria. Another alternative would employ the use of irritants. This would constitute an indirect method, smoking the mosquito into the open, to get a clear shot at it. Mosquitoes are not strong fliers, for aerosolized insecticides to work, mosquitoes have to be flying. Some insecticides like DDT and permethrin are natural irritants and could be used in conjunction with descants and biological compounds. A method of dispensing more than one compound at a time is another approach that could act as a force multiplier. Insecticide compounds should not be dispensed mixed together with the exception of a surfactant used as synergist. These compounds in my opinion should be dispensed, using individual aerosol generators, for maximum effectiveness. In conjunction with independent aerosol generators, the ability to vary delivery rates using multiple units, will lend itself to optimization of product usage. BASIC CONSIDERATIONS Now let’s get down to basic details of the mirage of contemporary malaria control strategies. Despite the increased interventions to decimate malaria especially in the Africa region, the costs of malaria continue to inflict unwarranted health, economic and social burden on livelihoods. Even with the advancement of new strategies including long-lasting insecticide-treated bed nets, along with a renewed use of indoor residual spraying and development of new effective medicines called artemisinin-based combination therapies (ACTs), malaria and its complications exact huge costs on the already poor and renders budgets ineffective. In Ghana, according to the study conducted by the Ministry of Health in 2008, estimated annual economic cost of reported malaria cases alone in Ghana is US$772.4 million where the figure is hovering around GH¢30.04 or US$32.65 per person. Considering the budget for Ministry of Health which stands at about GH¢20,000,000 a year, it means that the total economic cost of malaria, embracing the cost of treatment and the productive time lost under the spell of the disease is several times greater than the ministry’s annual budget. In furtherance of this argument, as stated by the Global Fund, every year, between 350 and 500 million people get sick with malaria. More than one million of these die (most of them infants and children in Africa). There is no doubt that current malaria control efforts are focused more on containing and limiting the disease than complete eradication of mosquitoes as was seen in the 1950’s and 1960’s. It is therefore not surprising that despite the avalanche of funds released to fight the disease especially in Africa, thousands of millions of people are still reeling under the deadly threats of malaria. The Global Fund alone as of December 2006 had distributed 18 million insecticide-treated bed nets to protect families from malaria and reached 5.3 million patients with artemisinin-based combination therapies (ACTs) for malaria. These have been mostly been channeled to Africa. There is no doubt these interventions have barely contained this growing epidemic since Africa still records highest malaria cases and deaths. CONCLUSION It is in the light of the above that Airwolf Malaria Vector Control Research Institute and Osagyefo Network for Rural Development (OSNERD) believe the strategy of aerial application that decimates malaria parasite is the most efficient and economical. Regardless of the bad reputation attached to the strategy of aerial application, this strategy has been tested and known to be the most cost-effective approach in eradicating malaria that has bedridden already worst economies in the world. The system that has been developed over the past 11 years is the only one that meets the science and has a theoretical increase in efficiency of 2000 to 1 over the systems in use today in the US. For years the populated areas of Palm Beach County have been treated in only 3 hours and 20 minutes saving the County $200,000 dollars in insecticide use and malaria eradication. Now the reduction of product use for this application is only 7.5 to 1. Indeed, there is a miracle when it comes to effective malaria control. We have started the awareness of this strategy and it behoves Africa economies especially Ghana to adopt this effective and economical method towards malaria eradication. We cannot afford to waste funds on malaria when it could be invested in profitable ventures to soothe the threats of abject poverty. Eradicating malaria is not only impossible but costly with the contemporary use of bed nets and ACTs. The use of indoor residual spraying, though effective, has failed to reduce costs as compared to the aerial application that covers large areas within a short period. It is imperative we educate ourselves in the Physics and Chemistry of mosquito vector control: to work smarter and not harder. We have a worthy adversary, the anopholine mosquito. Let’s all support this landmark project in Ghana and Africa at large to build malaria-free economies, if the Millennium Development Goals (MDGs) are to be met.

This article is co-authored by Richard Howe of Airwolf Malaria Vector Control Research Institute, in Florida, at www.killmosquito.org and Stephen Yeboah of Osagyefo Network for Rural Development (OSNERD), Kumasi, at www.osnerdghana.org. Contact (richard@killmosquito.org) OR (stephenyeboah110@yahoo.com)
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