by Halimah Abdallah Kisule
– Uganda –
The numbers are staggering. Dr Myers Lugemwa, officer in charge of malaria research at the Ministry of Health’s Department of Malaria Control Program says, “Malaria is the greatest killer in this country: 320 people, mainly children and women, die daily.” He says that number excludes those who die outside public hospitals.
In Uganda alone, 50 million man-hours are lost per year and 43% of school absenteeism can be attributed to malaria. The country’s Ministry of Health spends 10% of its annual budget on malaria efforts; 23-40% of all outpatient clinic visitors and 50% of all inpatient admissions are for malaria. And pregnant women are especially at risk: they are four times as likely to contract malaria than their non-pregnant counterparts; malaria can also lead to miscarriages. Over 100,000 people in Uganda die preventable deaths each year.
Therefore, in Uganda, preparations are now in high gear to launch a pilot program that would hopefully eliminate malaria-carrying anopheles mosquitoes. In an effort to abide by the Stockholm convention (which limits DDT use to malaria control), the country’s National Environmental Management Authority gave the go-ahead to perform ‘Indoor Residual Spraying’ (IRS) with a new and more expensive insecticide, ICON.
The World Health Organization’s Pesticide Evaluation Scheme (WHOPES) evaluated and endorsed ICON, calling it a “technically advanced pyrethroid insecticide highly active against mosquitoes.” WHOPES noted that ICON “kills mosquitoes instead of just repelling them, and that very low doses not only provide rapid mosquito knockdown and kill, but that is followed by a long residual, protective action.” It said that properly formulated, it was suitable for indoor use, outdoor space spraying, and even treatment of bed nets and curtains. It noted that ICON also controls a wide range of other pests including cockroaches, ants, fleas, ticks, and flies.”
Clearly Ugandan officials have decided to accept the WHOPES recommendations. Ongoing protests from environmentalists and the business community have done little to slow the program in its aim to spray the interior walls and surroundings of homes throughout the country.
Nonetheless, environmentalists claim the insecticide causes illness, environmental degradation and possibly infertility. Those in the business community fear that the country will hastily swap ICON for its cheaper cousin, DDT, spelling disaster for exports. The European Union (EU) has been very clear that it will boycott Uganda’s fish, flowers and coffee if certain levels of the pesticide are detected.
Though cheap and effective in battling malaria, DDT use was banned worldwide in 1972 after Rachel Carson’s 1962 book, Silent Spring, was published detailing the poisonous side-effects of the pesticide, such as infertility in women.
“[Pesticides are] not safe for any living organism. Soils accumulate salts that cause infertility. [They] can cause liver cancer, kidney problems and blindness. [Their] hard core fumes [can even] cause brain damage [from chronic] headaches,” says former member of parliament and environmental activist, Mr Ken Lukyamuzi, a politician whom the organization Africa Fighting Malaria (AFM) accuses of “scaremongering” and spreading “false information”. However, because of his continued campaign against pesticides, some people now refuse to have ICON sprayed in their homes, resistance that may negatively affect the overall success of the new program.
Surprisingly, the medical community stands behind the program after results from a 2005 study were released last year. The research established the levels and effects of DDT on the human body as well as the environment in Kigezi (Western Uganda). Nearly fifty years ago, in 1959, the British colonial government sprayed DDT in this area to control malaria. (In Eastern and Northern Uganda, DDT was also sprayed on cotton farms.) The findings revealed that people there did indeed have traces of DDT in their bodies. “Lake Victoria has DDT. Insecticides have DDT. There is DDT in the soil and [in our] fish. [But even] some products from Europe and America have DDT, ” says Dr Lugemwa, the officer in charge of research at the Ministry of Health’s Malaria Control Program.
Lugemwa points out that by the time DDT was globally banned, the US and countries in Europe had already eradicated malaria by using DDT in Indoor Residual Spray programs; the US even used the pesticide in massive quantities on farms. He says the results of the 1959 spraying campaign in Uganda are encouraging because the most important result – a decline in malaria parasites – was evident in all age groups. For example, before spraying, those in the 2-4 year age group had a 53.3% parasite rate; after spraying, the same group dropped to 3.7%.
“The results so far obtained in Kigezi indicate the possibility of malaria eradication in the area within a short time. Preliminary surveys in other parts of western and central Uganda indicate that [the malaria has been eradicated], thus showing that the [widespread] eradication of malaria in Uganda is possible,” reads the report.
Professor Wilson Byarugaba of Makerere University Medical School was himself a subject in the 1959 spraying. “Our house was sprayed; I have DDT in my blood but I am normal,” he says.
So far, the ICON spraying program is also yielding promising results without poisonous effects. Byarugaba said that researchers did pre-spray and post-spray tests on sprayers by taking blood and urine samples. Though ICON was present in their bloodstreams, the traces were negligible.
And as for its effects on mosquitoes and malaria, Lugemwa explains that there has been a remarkable decline in malaria cases in the first three districts where spraying was performed. At Kabale, a referral hospital in Western Uganda, malaria cases dropped from 20% to 3%. Doctors tested 1000 patients who came in with signs of malaria after the ICON spraying and found that only 30 actually had it. Lugemwa attributed the remarkable decline to the spraying of ICON in combination with the administration of the new anti-malarial drug, Artemisinin.
Lugemwa explains that ICON, a much more expensive chemical than DDT, is being used in the pilot program because “ICON is an offer from President Bush’s Malaria Initiative.”
In 2006, the US government extended a $10 million (USD) grant to fight malaria in Uganda, Tanzania and Angola. That same year, Uganda started spraying ICON.
Last year, African ministers of health met in Congo Brazzaville and discussed ways of reintroducing DDT in their malaria control programs after the World Health Organization publicly supported the use of the pesticide for IRS in September 2006.
This dialog was spurred by the considerable financial burden that malaria imposes on many African economies. Most recently, South Africa, Zanzibar, Sri Lanka, Mozambique, and Botswana have managed to control malaria by using DDT.
Lugemwa says that in Uganda, it is difficult to truly quantify the cost of the malaria burden.
Similarly, he says the official financial figures do not account for costs incurred transporting medication, funeral expenses and time spent dealing with the inconveniences of malaria. He asserts that policy-makers have yet to analyze the true economic effects of the illness.
In any one year, Uganda spends $640 million (USD) on malaria programs; an amount much higher than the earnings from all her major exports combined. This is precisely why some in the medical profession feel that the protracted debates on the use of DDT are business driven.
“It is public knowledge that pharmaceutical companies based in these developing countries own patents and are the manufacturers of anti-malarial drugs. They stand to lose a lot of money if malaria is wiped off in the face of the earth,” says Dr Samson Kibende of Uganda’s national referral hospital, Mulago.
Though DDT has a long record of safe and effective use, additional resources for testing and education will be needed to facilitate its use. The WHO has been clear to point out that its decision last year to endorse DDT for IRS programs was based on the thorough and ongoing review of all available scientific literature on the subject. Yet this qualification is relentlessly undermined in Uganda by subversive politicians. Uganda’s academics, environmentalists and popular newspapers also mislead the public. [Emmanuel Kihaule’s article in The Monitor] “DDT: Survival Weapon or Threat?” is a typical example of authority figures scaremongering based on nothing more than DDT’s persistent nature. Ken Lukyamuzi, a former Minister of Parliament who was barred from standing for re-election for failure to declare his wealth, has made opposition to DDT a platform issue in his opposition to the Ugandan government. Among other false claims broadcast by Mr. Lukyamuzi, at a rally in Kampala, he told the crowd that DDT caused blindness and kidney failure, that DDT was responsible for children born with deformities in Vietnam.
This would seem to settle the debate. Given the humanitarian crisis posed by malaria, where over 100,000 people in Uganda die preventable deaths each year, the time has come to assess what is feasible and what can be done quickly to stop malaria, whether that means challenging corporations or challenging politicians spreading disinformation and trying to alarm the public in order to serve their own aims.
The choice is now up to Ugandans: die today of malaria or take a chance on pesticides.
About the Author
Halimah Abdallah Kisule is a journalist from Northern Uganda. She is married with two children.