Fighting malaria as well as AIDS is on First lady Laura Bush's agenda as she tours Africa. While the former doesn't grab the same headlines, it far outstrips AIDS as the continent's biggest child killer, claiming one young life every 30 seconds.
The malaria toll is numbing: between 300 million to 500 million cases and 1 million deaths each year. In some African countries, it accounts for up to half of all hospital admissions. Its economic cost is an estimated $12 billion per year.
But slowly, hope is emerging because of better drugs and more powerful anti-mosquito weapons - including the pesticide DDT, long reviled but now rehabilitated by the international health community - as well as more funding from programs such as President Bush's malaria initiative.
During her stay in Mozambique on Wednesday, Laura Bush plans to visit a site near the Mozal aluminum smelter, where authorities want to spray house walls with DDT to ward off mosquitoes, using funds from the U.S. Malaria Initiative that commits $1.2 billion over the next five years. Of the target 15 countries, about half are expected to use some of the money to spray with insecticides.
Last September, the World Health Organization threw its weight behind DDT, notorious because of the environmental damage inflicted by large-scale spraying and banned worldwide apart from specific anti-mosquito applications.
Even the Environmental Defense Fund, which spearheaded the anti-DDT campaign in the 1960s, grudgingly endorsed its limited use. In the fight against malaria, DDT is applied in small quantities on indoor walls only.
"We need DDT because there is no other insecticide which is as effective and can be used so successfully to control malaria," said Pierre Guillet, of WHO's anti-malaria campaign in Geneva.
WHO long promoted insecticide-treated nets as the main preventive weapon against malaria. But the stubbornly high death toll - and the success of DDT-spraying in countries such as South Africa and Swaziland in virtually eradicating the epidemic - prompted the policy U-turn.
In South Africa, the number of malaria cases fell by 65 percent to 3,597 between June 2006 and March 2007, down from 10,418 cases the year before.
Deaths were reduced from 85 to 25. This compared to 62,700 cases and 466 deaths in 1999-2000, when the country was gripped by an epidemic because mosquitoes proved resistant to an insecticide used as an alternative to DDT.
Eritrea and Ethiopia in the Horn of Africa also have managed to tame their malaria problem with the help of DDT, said Guillet. Other countries including Namibia, Zambia and Zimbabwe are following suit, he said.
DDT is relatively cheap and only needs to be sprayed once or twice a year. Other pesticides don't last as long, according to Jaishree Raman, a scientist at South Africa's Medical Research Council, the main center of expertise and advice on DDT in Africa.
Spraying DDT is not a magic bullet. In many instances, insecticide-treated nets are cheaper and better and have slashed incidence of malaria in parts of Kenya and the island of Zanzibar - not to mention large chunks of Asia and Latin America. But the success of nets depends on them being used properly and by the group most at risk - young children and pregnant women.
Nets, though, don't provoke the fears DDT does. In Malawi, plans to use DDT have provoked a fierce national debate between the health lobby and environmentalists who worry about the long-term effects of DDT on water and crops. In Uganda, a coalition has threatened to sue the government, claiming that DDT causes congenital malformation.
Ugandan President Yoweri Museveni, in his state of the nation address earlier this month, dismissed the criticism as ill-informed and "insulting." He said he intended to use funds from Bush's malaria initiative and start spraying with DDT in November.
In Mozambique, Maputo's health director Elsa Nhantumbo said popular resistance to DDT was hampering the government's fight against malaria.
The last spraying campaign, intended to cover 47 of Mozambique's 128 districts, only met 37 percent of its target, she said. In the area Laura Bush will visit, there was a rise in the number of cases between 2005 and 2006 because people refused to have their houses sprayed, Nhantumbo told The Associated Press.
She said local health authorities had teamed up with Mozal to mount awareness campaigns and hoped to start using DDT in the near future.
Bishop Dinis Sengulane, head of Mozambique's Rollback Malaria Initiative, said he hoped Laura Bush's visit would increase acceptance of spraying, which has contributed to an 88 percent fall in cases in the southern tip of the country near South Africa.
In Mozambique, about 150 people die each day of malaria and the disease causes about seven deaths per hour in the nation's hospitals, said Sengulane, who also heads an inter-religious campaign to mobilize the churches against malaria.
"If we engage decisively in spraying, we can make a great deal of difference," he said. "We need to follow the examples which really work."
Associated Press Writer Emmanuel Camillo in Mozambique contributed to this report.