Down with Malaria – Again!

Barely a month ago, I came down with malaria and lost 4 days of productivity. Given that I have Sickle Cell trait, I’m one of the more ‘fortunate’ ones to present less severe symptoms of the disease but that does not affect the rate of infection. So far, I’ve lost two days of productivity and missed part of my cousin’s wedding. In my crude estimation based on number of cases reported, Ghana alone loses almost a hundred million dollars to the disease each year – this does include the cost of diagnostic testing and the lost productivity.

So I began thinking about how I might reduce my infection rate and the first thing that came to mind was treated bed nets. I have used these a couple of times in the past – particularly in secondary school. Most people I know do not use them and have a repulsive attitude towards it. I would say the main reason for this is practicability. It’s sometimes too hot and I often work deep into the night at my desk. Well, for all it’s trouble, it reduces episodes of malaria by half.

Currently, the country’s main measure against malaria is case management (in practice). Have we forgotten that prevention is better than cure? By the way, case management is being thwarted increasingly by counterfeit drugs and even at optimal case management, we would still have a huge economic burden from the disease including loss of productivity. So case management as a dominant strategy, I’m afraid is not the way to go.

There is the issue of sanitation when it comes to malaria. Greater sanitation will yield a reduction in the population of mosquitoes but that also is not a silver bullet. Most complex problems do not have a silver bullet and that includes malaria.

I think a better strategy will be to give us a boost in the fight against malaria with Indoor Residual Spraying which has been proved to be effective many times over not only for prevention of the disease but also for its elimination. The controversy that surrounds this technique mostly has to do with the harmful effects of DDT insecticide. These fears have to do with the suggestions that high levels of DDT can have adverse effects on human health based on oral ingestion in rats and agricultural use. This is pitting a potentially smaller health problem with a real epidemic with very high mortality rate. Areas that have used DDT for malaria control have not had reports of significant effects on human health but rather the deaths of pelican birds (which resulted from agricultural use of the pesticide!). In fact, only sub-Saharan Africa has not had a DDT intervention and is the region with over 80 percent of malaria deaths. Contrary to what many believe,  DDT use is not banned worldwide. It is banned only in one country – USA, where they have already eliminated malaria with the chemical. IRS does not even have to use DDT. There are alternatives such as malathion and the other pyretheroids used in bed nets. There is a compelling case of using IRS combined with other strategies at Obuasi with impressive results.

Resistance of the malaria parasites is beginning to surface for the only viable drugs currently available. This makes it a more pressing matter to eliminate malaria in Ghana & Africa. Failing to do so coupled with zero treatment options will be apocalyptic. There’s no reason to wait out such fate.

Personally, I intend to get IRS with DDT or a pyretheroid and will be asking my doctor about Intermittent Preventive Treatment (IPT). I will also be giving bed nets another try. My goal – to have zero incidence of malaria for a year!