[afro-nets] Mosquito and Malaria Control (46)

["Peter Burgess" <profitinafrica@gmail.com>]

Mosquito and Malaria Control (46)
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Dear Colleagues

Thank you, Tom O'Connell for the information you provided in your recent message [Afro-Nets] Mosquito and Malaria Control (45)
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I have started to go through the material you suggested would be useful to read and learn from ... it is not a 2 minute exercise!

*>>>>>>>>>> Those honestly seeking to control and eliminate malaria in SSA recognize that Africa is NOT a homogenous set of identical countries with identical disease patterns. No single intervention works in all environments. The appropriate mix of scientifically proven and locally appropriate malaria control interventions depends on the specific epidemiological setting: this varies within countries as well as between countries. See http://rbm.who.int/wmr2005/html/1-3.htm for a table showing how WHO and RBM have used evidence to help countries choose control strategies appropriate to their epidemiological needs. Infrastructure and country capacity to afford routine maintenance varies widely: many countries currently are unable to finance routine vehicle maintenance for public health centers and programs, like EPI. So affordability matters, including training costs and the costs of explaining to communities the risks of interventions. >>>>>>
*
I totally agree with these sentiments ... but get very frustrated when I try to find hard data in the WHO webspace. The table referred to, as far as I am concerned, was merely a measure of the rather poor reporting practices and policy statements that have been going on in various countries in Africa in the multilateral policy space. I could not find anything that even remotely started to address the question of how much interventions were costing and what results were being achieved. I might not have found hard data ... but methinks there is not very much of it that people are willing to publish (an issue of transparency).

*>>>>>>>> There exists an extensive body of correctly done, peer-reviewed research that decisively shows the effectiveness of insecticide treated bednets (ITNs) for greatly reducing the burden of malaria. >>>>>>>*

Frankly, I thought this was the case, but I do not find the reports I have read make the case very well. If you sleep under a net, it appears you get less malaria ... one report suggested 20% less malaria. For someone getting malaria 10 times a year, this now means getting malaria 8 times a year. Progress ... yes ... but not my idea of what a good malaria control initiative is trying to do.  Most of the reports seem to have a focus on how many nets have been distributed and the unit cost of distributing the nets ... and seem to draw a lot of encouragement that distribution costs have dropped from (say) $8 each to $4 each as the volume has gone up ... and in most cases I am never sure whether the cost of the net itself is in these numbers or not, which makes a huge difference. This should be absolutely clear in order for these reports (peer reviewed or not) to be valuable.

*>>>>>>>>>> Please see the article ïSocio-economic inequity in demand for insecticide-treated nets, in-door residual house spraying, larviciding and fogging in Sudanï [Malaria Journal. 2005 Dec 15;4:62]; ** http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16356177&query_hl=6&itool=pubmed_docsum * >>>>>>>>>>>>>*
**
This is an interesting report, and while it is peer reviewed, which is good, it represents a rather modest dataset (a sample of 720 households). As I have mentioned several times in my messages, I am a management accountant more than I am a statistician and economist, and good accountants do not use small samples to do accounting and then try to conclude what the results are within plus or minus some rather large percentage. In any event the results were interesting, including the idea that ordinary people indicated considerable willingness to pay for larviciding with chemicals (LWC) and space spraying (SS), even where these interventions would be done in public space while indoor residual house spraying (IRHS) and insecticide treated nets (ITN) were interventions that reached private space. Otherwise the results were not surprising.

But the question of how effective any of these interventions were in actually reducing the prevalence of malaria was not on the agenda, nor the cost of achieving some reduction in the prevalence of malaria. So while this report is an interesting read, I do not have any incremental knowledge that I can use to improve the design of the Tr-Ac-Net integrated mosquito and malaria control (IMMC) model.

My guess is that there are people and organizations that have some data about malaria prevalence spatially and as a time series that could very usefully be correlated to the money spent on different IMMC interventions (or lack of) in the various neighborhoods. If we could mobilize this information, I believe we would start to make some solid progress towards the design and implementation of a least cost most effective IMMC program. And I am also fairly certain that there are a good number of people who are already doing this in a fairly comprehensive way. The fact that I do not know about it, certainly does not mean that it is not being done.

>>>>>> USAID, the USA's CDC and the WHO, among many other respected organizations, have repeatedly stated that ITNs are an important part of a  SUITE of interventions. >>>>>

True ... and our IMMC initiative picks up on this, but though they call for suites of interventions, as a practical matter most of the interventions actually funded seem to be single intervention interventions. Accountants like to follow the money, and the bottom line seems to be that talk is cheap, and multiple intervention suites have not yet been embraced as being the best way to go and funded. I argue that multiple intervention suites are lowest cost in terms of results being achieved ... but no matter how hard I try ... I cannot get decent reliable numbers about this. Is this because the numbers do not exist or because people are not wanting to share this important information (again a transparency question)

I will plod through the various pieces of information that have been recommended for reading. Certainly those of us who are "honestly seeking to control and eliminate malaria in SSA" do recognise that Africa is NOT a homogenous set of identical countries ... especially those of us who have spent a good number of years in and out of Africa. However, having said that, I find that bad management of resources, and using resource ineffectively seems to happen all over the world. It is, however, especially bad when the resources are very limited as they are in SSA and the human impact of bad decisions is, simply put ... faster mortality.

Sincerely

Peter Burgess
Transparency and Accountability Network
New York
mailto:profitinafrica@gmail.com