Syndicate content

Add new comment

Having worked in Sudan, Angola and parts of Africa over the past 30 years on malaria control, it is gratifying to see your attribution of lower Infant Mortality to decreases in malaria. As an engineer I would like to offer an additional piece of good news, especially related to water resource development and rehabilitation. Current strategies for malaria control - although apparently effective - are using unsustainable methods such as bednets which last only 3-5 years, and spraying houses with biocides which last only a few months. Drugs in use are quickly provoking resistance in the malaria parasite. As long as mothers force infants to sleep under bednets, the IMR goes down. That is a nice statistic, however adults avoid sleeping under these hot and irritating nets, so the average usage in a community is less than half, and malaria transmission continues, despite the good showing among infants. Thus purchase of nets, drugs and biocides at increasingly expensive prices, will have to continue forever. The good news is that a more sustainable approach, which we demonstrated in the Gezira Irrigation System in central Sudan in the 1980's, is improving the irrigation and drainage system in ways which reduce malaria mosquito breeding. This protects everyone in the community, not just infants for a few years. Also, in a new irrigation project or in a resettlement project related to dam and reservoir construction, investment in screened housing is a much better way than bednets to protect a family from the malaria mosquitoes, and more economical in the long run for a host of reasons. For 10 years we held the malaria prevalence near 0.1% in the 2 million people of the Gezira, under the Blue Nile Health Project. Previous prevalences had exceeded 20%, and had made malaria a crippling public health scourge. We have published this in great detail, and I commend it to you as a way of expanding and sustaining the good news you have reported on malaria. So in construction of new irrigation systems, and in rehab of existing ones, malaria control can be made sustainable and economical, as we showed with the $100 million World Bank loan we received in 1984 for the Gezira Rehabilitation Program. It was developed with our Blue Nile staff along with Graham Clarkson and Nick Prescott from the Bank, and was a singular success is creating sustainable suppression of malaria.