There is need to improve approach to fight malaria

Recently, Health minister Ruth Aceng and State minister for Planning David Bahati launched ‘New approach in fight against malaria’ programme at Butanda Health Centre III. Sophisticated machines for larviciding were shown in the media. Dr Aceng explained that applying “specially treated green materials to places where mosquitoes breed will kill immature forms of the insects, thus reducing the risk of malaria transmission.”

Dr Jimmy Opigo, the National Malaria Control Programme manager, said during an online national media malaria orientation training programme that he had launched a campaign branded ‘Under the net,’ which will see 27 million mosquito nets distributed throughout the country. The Indoor Residual Spraying (IRS) against malaria is on-going in the country. Millions of dollars and resources are drained at both government and community levels to try to keep malaria at bay.

Malaria is the single largest disease and one of the primary causes of poverty in Africa. It is also the disease that receives most donations from developed countries. It is now more than 100 years since an Italian professor, Battista Grassi, discovered that only Anopheles mosquitoes carry malaria parasites. No appreciable progress has been made in developing countries to eliminate the disease. The growing resistance of Anopheles mosquitoes to insecticides is a huge threat to malaria control programmes in Africa.

Malaria can be eliminated by either eliminating the vector or the parasite. For instance, in Brazil, malaria was eradicated by eliminating the breeding sites of the vector. In America and Europe, it was the parasite that was eliminated. In Uganda, it would be easier with the recourses we have, to eliminate the vector. However, we apply larvicides in water bodies such as swamps that do not bread mosquitoes. This is unnecessary if we are targeting malaria eradication; instead we are damaging the environment irreversibly.

Anopheles gambiae Giles, which is the major malaria vector in Uganda, breeds in simple and easy to locate sites, which the community is familiar with. They breed in shallow and small bodies of water, well exposed to sunlight. Many sites are temporary rain puddles which are man-made mosquito habitats. Other habitants include cattle-hoof prints and water edge, clay pits and muddy puddles in brick fields. They also breed in burrow pits and similar excavations associated with building and road-making activities. There is no need to use larvicides in these sites, when in fact, they can easily be filled up with soil.

Anopheles mosquitoes do not breed in discarded tins or artificial water containers. These breeding sites can be eliminated through a concerted community effort. Hunting for breeding sites can be integrated with farming, herding cattle, brick-making, and construction of houses and digging of murram pits.

Integration of community farming activities with malaria control would be achieved for a long-term effect leading to eradication. This approach is relevant to the need for a primary healthcare approach promulgated by the World Health Organisation (WHO), 1982.
The motivation of the community will be their own life affected. There are problems in the prolonged use of insecticide treated nets (ITN) and indoor residual spraying (IRS).

Bed nets only protect users while they are under them, thereby resulting in reduced human-vector contact rates, though they do not eliminate contact completely. The success of ITN and IRS against malaria vectors will also depend on whether or not the mosquitoes are endophilic (indoor biters). Sometimes as a result of prolonged use of IRS and ITN, some populations of endophilic vectors evolve exophilic (outdoor biters) behaviour.

This author developed a cost-effective bed net called safari bed net. The size is about one- third of the ordinary single bed net. It is pocketable and user-friendly in all situations. The bed net works on the principle that a vector mosquito first approaches its victim from the front, attracted by the odour of the breath.

Dr. Okoth is a Researcher, Concerned Citizen and Christian.

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