|DDT in Uganda|
|Date: 30 Sep 2004
||To: Richard Tren - AFM
||From: Graham Root - Malaria Consortium
|Graham Root from the Malaria Consortium replies to Richard Tren regarding the use of DDT in Malaria Control. Root confirms that the Malaria Consortium "does its upmost to support the MOH deliver appropriate and effective communicable disease control interventions." read more|
|DDT use in Uganda|
|Date: 29 Sep 2004
||To: Graham Root - Malaria Consortium
||From: Richard Tren - AFM
|The Ugandan Government has stated that it wants to introduce DDT to malaria control. Given that DDT worked very well in Uganda in the 1950s and 60s and is currently working exceedingly well elswhere in Africa, the decision is a good one. AFM was curious to find out how the Malaria Consortium was assisting the Ugandan Government in introducing DDT. read more|
|DDT in Uganda
||30 Sep 2004
Thanks for your email. Indeed the DDT debate in Uganda is very prominent at the moment and has become politicised.
The Malaria Consortium works hand in hand with the Ministry of Health and supports it from policy development through to implementation. This includes both prevention and case management. In terms of IRS, we are supporting MOH with other partners put in place a clear IRS policy and strategy. In the future we may also provide capacity building and implementation support on IRS, if it is deemed appropriate and necessary (and we secured funding for this).
However, it is important to understand that the key question for Uganda is not: do we use DDT? Rather it is - what role does IRS have in Uganda?
The choice of insecticide is a secondary consideration. In fact, answering the second question is considerably easier than the first. With the likely answer being: a mix of insecticides that will (1) be rotated to ensure resistance management, and (2) vary according to the type of structures being sprayed.
In terms of answering the first question - what role does IRS have in Uganda? There are a number of factors that need to be considered including:
1. Epidemiology of malaria: perennial, intense transmission in much of Uganda means very high quality and high coverage rates for IRS need to be achieved. Some may argue that ITNs are a more feasible approach to malaria vector control in such settings.
2. Long-term financing: southern African countries using IRS are in a better position than Uganda to sustain the financing of IRS in the long term. GFATM funds could (and are likely to) be sought for IRS - but one does need to consider what will happen in five or so years time.
3. Health system: Uganda has a highly decentralised and integrated health system. This means establishing an IRS programme will be a major undertaking (and at odds with what is happening in the health sector as a whole). Critically, it does not have an intermediate unit of operation that is functional (ie province/region/zone).
The issue of DDT scaremongering - indeed there is scaremongering by environmental lobbying groups. However, at the same time there are real fears that regulatory systems would not be sound enough to ensure DDT does not leak (ie used) into the agricultural sector. If this happens, (rightly or wrongly) agricultural exports to EU and North America could be jeopardised. We should all be concerned about this given Uganda's main exports are agricultural and fish-based. It is important to understand that regulatory systems in Uganda are on the whole considerably weaker than in much of southern Africa so the risk of this happening is greater than in South Africa, Namibia etc. (Note that Uganda struggles to meet EU hygiene standards concerning fish exports etc already.)
From the tone of the last paragraph of your email, I hope you are not implying the Malaria Consortium is either obstructive or not supportive of the MoH. This is far from the truth. The Malaria Consortium does its upmost to support the MOH deliver appropriate and effective communicable disease control interventions.
I've written this email in good faith. I hope you will accept it in the same spirit.
It is a pity we didn't talk about this while in Gabarone.
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From: Richard Tren [mailto:firstname.lastname@example.org]
|DDT use in Uganda
||29 Sep 2004
Sent: 29 September 2004 18:52
Subject: DDT use in Uganda's malaria control programme
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I understand that you are advising the Ugandan government with their malaria control programme. When I was in Kampala in April this year I attended a conference where the Minister of Health, Brig. Jim Muhwezi clearly set out his governmentís intention to introduce DDT as one intervention, among many others, to control malaria.
My understanding of the situation in Uganda is that there are areas where an IRS programme that uses DDT would be highly effective, as indeed these types of intervention were during the 1950s and 60s. However there seems to be a great deal of misinformation about the way that DDT is used in malaria control. There also seems to be a great deal of scaremongering among the export agricultural sectors, such as coffee producers, about the effect that the IRS programme will have on their industries. I believe that it is crucial to remind the Ugandan public that DDT is only sprayed inside houses and that environmental contamination will be negligible or non-existent. Many countries in southern Africa use DDT in their IRS programmes without any damage to their export industries.
As you are advising the Ministry of Health, could you explain what the Malaria Consortium is doing to assist the government in embarking on DDT spraying for malaria control? Could you also explain what the Malaria Consortium is doing to ensure that good science prevails and that Ugandaís citizens are not misled about the way that DDT will be used? Given the scale of malaria infections and deaths in Uganda, Iím sure that you will agree with me that any mischievous misinformation about DDT will only hamper malaria control and cost lives. The role that you and your organisation play is therefore crucial to improving malaria control in the region.
I hope that you are well and I look forward to hearing from you in the near future.
Africa Fighting Malaria
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