Posts or Comments 28 September 2021

Monthly Archive for "October 2012"



Emergency &Surveillance Bill Brieger | 28 Oct 2012

Hurricanes and Malaria

As deadly Hurricane Sandy has traipsed across the Caribbean and heads for the US East Coast, we think about the equally dangerous aftermath of such tropical storms.  Below are excerpts from articles that examine the devastating effect hurricanes afterwards by increasing malaria and other mosquito-borne diseases.

sandy-14-20121025-203625p_sm-2.gifScientific American reports that so far, “Sandy killed at least 66 people as it made its way through the Caribbean islands, including 51 in Haiti, mostly from flash flooding and mudslides, according to authorities.” If it is like other storms it may also leave disease in its wake.

Kouadio and colleagues stress the need for risk assessment because, “Natural disasters including floods, tsunamis, earthquakes, tropical cyclones (e.g., hurricanes and typhoons) and tornadoes have been secondarily described with the following infectious diseases including diarrheal diseases, acute respiratory infections, malaria, leptospirosis, measles, dengue fever, viral hepatitis, typhoid fever, meningitis, as well as tetanus and cutaneous mucormycosis.”

Immediately after a tropical storm Anopheles species may temporarily decrease, while other disease carrying mosquitoes may increase, but public health officials need to remain on guard. In contrast two mosquito-borne Infections, malaria and West Nile, were found after Hurricane Jeanne in Haiti in 2004. Campanella referred to the challenges for infectious disease surveillance and the reliability of the results under such post-storm conditions as happened after Hurricane Mitch in Nicaragua.

Reliable surveillance and response is crucial as countries, especially in the Americas, move closer to pre-elimination. Natural disasters can not only destabilize control and surveillance operations, but may enhance disease spread.  Emergency preparedness and response should always include a focus on the diseases that storms leave behind.

Community &Environment &Epidemiology Bill Brieger | 28 Oct 2012

Malaria Related Presentations at APHA Conference 2012 San Francisco

aphabanner-75.gifThe APHA schedule search turned up 31 presentations, panels and posters related to malaria. If you are attending the American Public Health Assocation 140th annual meeting, take advantage of these.

1.    Barriers to practicing healthy behaviors for malaria prevention and child nutrition in Zambia: A qualitative study 263984 Barriers to practicing healthy behaviors for malaria prevention and child nutrition in Zambia: A qualitative study Wednesday, October 31, 2012 Lovemore Mwanza , Research, Monitoring, and Evaluation …

2.    Prevalence of Malaria in Pregnancy as Rwanda Moves towards Malaria Elimination
265783 Prevalence of Malaria in Pregnancy as Rwanda Moves towards Malaria Elimination Tuesday, October 30, 2012 : 3:00 PM – 3:15 PM Corine Karema …

3.    Malaria diagnosis: Perspectives from caregivers and health staff, Makarfi, Nigeria 261566 Malaria diagnosis: Perspectives from caregivers and health staff, Makarfi, Nigeria Tuesday, October 30, 2012 : 8:35 AM – 8:50 AM Olufemi …

4.    Impact of climate and land use influencing the spatial and temporal distribution of malaria risk in the Amazon 261531 Impact of climate and land use influencing the spatial and temporal distribution of malaria risk in the Amazon Tuesday, October 30, 2012 Beth J. Feingold, PhD, MESc, MPH , Department of Earth and Planetary …

4c_sm_apha_20128.gif5.    Measuring Malaria Advocacy Outcomes 270759 Measuring MalariaAdvocacy Outcomes Monday, October 29, 2012 : 11:30 AM – 11:45 AM Marc Boulay, PhD , Center for Communication Programs, …

6.    How can we Accelerate Programming for Malaria in Pregnancy? 274603 How can we Accelerate Programming for Malaria in Pregnancy? Monday, October 29, 2012 : 11:30 AM – 11:50 AM William R. Brieger, MPH, CHES, DrPH , Jhpiego, …

7.    Improper maternity wear, mean providers, and vomiting: Barriers to timely IPTp uptake for malaria prevention during pregnancy in rural Zambia 266032 Improper maternity wear, mean providers, and vomiting: Barriers to timely IPTp uptake for malaria prevention during pregnancy in rural Zambia Tuesday, October 30, 2012 : 3:15 PM – 3:30 PM Hilary Schwandt, PhD, MHS …

8.    How local government health workers in Nigeria manage suspected malaria cases 265691 How local government health workers in Nigeria manage suspected malaria cases Tuesday, October 30, 2012 : 2:45 PM – 3:00 PM Bright Orji, MPH , Nigeria, Jhpiego, Baltimore, MD William …

9.    Challenges of implementing intermittent preventive treatment in Zambia for malaria prevention in pregnancy 263075 Challenges of implementing intermittent preventive treatment in Zambia for malaria prevention in pregnancy Tuesday, October 30, 2012 : 2:30 PM – 2:45 PM Peter Mumba, MD, MSc , Zambia Integrated …

10.    Contemporary Issues in Malaria in Pregnancy: Why worry now? 274600 Contemporary Issues in Malaria in Pregnancy: Why worry now? Monday, October 29, 2012 : 10:30 AM – 10:50 AM Mary Nell Wegner, EdM, MPH …

11.    Community-based Interventions for Malaria in Pregnancy: Findings from Mozambique 274602 Community-based Interventions forMalaria in Pregnancy: Findings from Mozambique Monday, October 29, 2012 : 11:10 AM – 11:30 AM Leonardo Chavane, MD, MPH , …

12.    Spatial access to malaria treatment in Kenya and its impact on health seeking behavior: A GIS based study 270764 Spatial access to malaria treatment in Kenya and its impact on health seeking behavior: A GIS based study Monday, October 29, 2012 Brittany Goettsch, …

13.    Challenges of Addressing Malaria in Pregnancy through Antenatal Care Services: A Nigerian perspective 274601 Challenges of Addressing Malaria in Pregnancy through Antenatal Care Services: A Nigerian perspective Monday, October 29, 2012 : 10:50 AM – 11:10 AM Oladosu …

14.    Invited Panel: Malaria in Pregnancy: An urgent yet solvable problem uniting the maternal health and malaria communities in Africa 3150.0 Invited Panel: Malaria in Pregnancy: An urgent yet solvable problem uniting the maternal health andmalaria communities in Africa Monday, October 29, 2012: …

15.    Malaria & Vector-Borne Diseases 4320.0 Malaria & Vector-Borne Diseases Tuesday, October 30, 2012: 2:30 PM – 4:00 PM Oral Moderator: Pablo Aguilar, MD MHSc 2:30pm Challenges of implementing …

16.    Poster Session: Nutrition … 2012: 8:30 AM – 9:30 AM Poster Organizer: Mike S. Bailey, MA / Co-Chair Board 1 Barriers to practicing healthy behaviors for malaria prevention and child nutrition in Zambia: A qualitative study Lovemore Mwanza, Rikki Welch, MA, John Manda, Samantha Herrera, Ana Claudia …

17.    *Poster Session*: Emerging issues in environmental public health … MCP and Devon Payne-Sturges, DrPH Board 4 Impact of climate and land use influencing the spatial and temporal distribution of malaria risk in the Amazon Beth J. Feingold, PhD, MESc, MPH, Benjamin Zaitchik, PhD, Victoria Shelus, BSc and William Kuang-Yao Pan, …

18.    Innovation in Technology: Public Health Models Posters 2 … practices serving underserved communities Kristina Vasileva, MPH, Mandy Smith Ryan, PhD and Mariceli Comellas, MA Board 10 Spatial access to malaria treatment in Kenya and its impact on health seeking behavior: A GIS based study Brittany Goettsch, MPH Candiate See individual …

19.    Infectious Disease Epidemiology 2 … AM – 10:00 AM Oral This session will provide new findings in the area of infectious disease epidemiology including the areas of malaria, TB, and influenza. Session Objectives: Assess the adequacy of zip code tabulation areas as a proxy for census tracts when …

20.    Advocacy & Global Health … Kovach, MPH, A. Elisabeth Sommerfelt, MD, MS, Alice Nkoroi, MS, Robert Mwadime, PhD and Ferdousi Begum, MBBS, MS 11:30am Measuring Malaria Advocacy Outcomes Marc Boulay, PhD, Claudia Vondrasek, MPH, Matt Lynch, PhD and Sarah Dalglish, MPH See individual abstracts for presenting …

21.    Seeing the obscured: A social epidemiological assessment of malaria’s reemergence in deforested regions 269174 Seeing the obscured: A social epidemiological assessment of malaria’s reemergence in deforested regions Tuesday, October 30, 2012 Beth Phillips, MPH , Mel and Enid Zuckerman College of Public Health, …

22.    Factors associated with completion of Intermittent Preventative Therapy (IPT) among pregnant women in Malawi … Sciences for Health, Arlington, VA Allison Zakaliya , Baylor Children’s Foundation, Baylor Children’s Foundation, Lilongwe, Malawi Misheck Luhanga , National Malaria Control Program, Ministry of Health, Lilongwe, Malawi Johnes Moyenda , Mpemba Health center, Ministry of Health, Blantyre, Malawi Doreen Ali…

23.    Designing a translational epidemiologic study: Chloroquine and breast cancer chemoprevention in Returned Peace Corps Volunteers … present the design of a novel translational epidemiologic approach to confirm preclinical data on the chemopreventive potential of a well-characterized anti-malarial drug. BACKGROUND: Exposure to chloroquine, an off-patent anti-malarial drug with a 60-year history of use by millions, reduces the incidence…

24.    Exploratory assessment of alternative use of bed nets within the Arisi zone in Ethiopia: Findings from household interviews and observations … Thaddeus Pennas, MS , C-Change, FHI360, Washington, DC Background: Distribution of long lasting insecticide-treated nets (LLINs) is one of four malariaprevention interventions being scaled up in sub-Saharan Africa. Correct and consistent use of LLINs by households is central to the …

25.    Young and vulnerable: Comparing delivery care, domestic violence, and child undernutrition between adolescent girls and women in Bangladesh … and Asia on topics related to evidence-based advocacy to improve nutrition, reduce maternal mortality, increase newborn survival, and decrease the malariaburden; written on child health and nutrition; and domestic violence against women. Carried out the data assessment and analyses. Have …

26.    Determinants of insecticide treated bednet (ITN) use by households in Nigeria … tying ITN to nails on the wall, and frequent washing of the ITN. The number of times a child had malaria in past 6 months, where child slept at night, and use of other malaria control measures were also associated with …

27.    Measuring the competencies and skills of midwives in an accelerated training program in Zambia … 25% felt they were not competent to treat patients with pneumonia while only 2% felt incompetent to manage patients with malaria; neither were statistically associated with duration of service (X2=61539;2=3.163, p=0.075; X2=61539;2=0.002, p=0.962 respectively). Conclusions: The assessment showed that the certified …

28.    Community Health Workers and Prevention: How to measure effectiveness of preventive community health programs centered on CHW … effectiveness of their preventive messages and adapt them for maximum results. With an effective tool to measure the effectiveness of malaria and HIV prevention and messages on hand washing and adequate nutrition, CHW receive immediate feedback on the challenges their communities …

29.    Improving access to preventive healthcare in Haiti: A community based approach … under five years of age, prevention messages delivered through skits, micronutrient supplementation, mosquito nets to pregnant women to help preventMalaria in Pregnancy, and blood pressure checks for all. Preliminary data have shown increased uptake of services and better maternal and …

30.    Mobile technology-based approach for facilitating health data collection, sharing, analysis and use in Uganda … of health centers through UHIN including monthly HMIS reports, disease surveillance data, and specific reports related to HIV/AIDS, TB, and malaria. Rural hospitals use UHIN for capturing data on electronic daily registers such as PMTCT, in-patient, lab, HIV counseling, and ART …

31.    Climate change and blood safety … transmission of dengue fever occurred in France in 2010. Other infectious agents are of concern such as Hanta virus, leishmaniasis, malaria, tick-borne encephalitis and their relationship to climate change and blood safety will be discussed. These insights call for changes in …

Policy Bill Brieger | 24 Oct 2012

After 50 Years Political Will Still Needed to Improve Child Health

On the Fiftieth Anniversary of the formal creation of the Department of Pediatrics at the University College Hospital of Ibadan, Nigeria Dr Tony Marinho shared observations about the status of child health and the need for greater political will to meet the challenges. He has provided an excerpt of his talk of 18 October 2012 below.

dscn0254a.JPGPoliticians must learn that the elimination of malaria and other health problems is their heavy responsibility, not costly conferences and four wheel drives, but funded health delivery chains, 20million posters and advertising because IGNORANCE ELIMINATION and EDUCATION ARE KEYS TO GOOD HEALTH.

Are there Health/Media Outreach Budgets, Health Ministries/ Media houses meetings and CSR ‘free’ airtime for ‘life-skill’ message advertisements? The UN Secretary General should annually select 50-100 life-skill messages for advertising agencies, the ‘Global Fund Membership’, ‘UN life-skills Partners’ and ‘Global Fund Advert Moral Media’ to disseminate on commercial packaging with UN incentives eg Annual Prizes for ‘Best life-skill Message’, ‘Best Corporation in Life Skill Dissemination’? Only a fool depends on Bill Gates to buy local airtime to save his children. A UN recommended ‘60 minutes of free airtime in 30 second slots’ should be the ‘free message’ contribution from the airwaves.

Commercial Messages out-number ‘life-skill health and social’ messages by 100-1000:1. We need ‘Annual UN/WHO/UNICEF Moral Media Campaigns’ for ‘ignorance elimination’ strategies? Let every commercial message carry a ‘piggyback’ ‘Unrelated Life-skill Message’ free.  Why is pre-pregnancy folic acid, malaria and typhoid information, not taught in schools?

Health messages are a human right. Why cannot Nigerian fathers buy ITNets for their children? Do markets, schools and religious houses have 20m posters with health messages? Politicians make 10m personal posters for votes. A picture IS worth a 1000 words, except in Africa.

Our problems are the CINS of politicians – Corruption, Incompetence, Negligence and Selfishness. There is a lack of political love which works against the malaria-ous child.

Annual professionals’ meetings should provide a feared ‘pressure group’  annual ‘State Of The State, Nation- An Audit’ The current ‘save one million lives’ may help achieve the MDGs. The original MDG team deserve a Noble Prize in Preventive Medicine for saving millions.

Malaria in Pregnancy Bill Brieger | 17 Oct 2012

WHO Updates Guidance on Intermittent Preventive Treatment of Malaria in Pregnancy

Intermittent preventive treatment for pregnant women (IPTp) with sulfadoxine-pyrimethamine (SP) remains a powerful tool against malaria in countries with moderate to high stable malaria transmission. Yet there has been confusion, lapses and very poor coverage with this intervention with little progress toward the Roll back malaria target of 80% coverage with two doses during pregnancy.  WHO has recently revisited this strategy and has issued revised recommendations reproduced fully below. Importantly, these also address some of the myths about IPTp with SP. Please share these widely with program managers and health workers.

cdd-service-community-iptp1a.jpg——————

Updated WHO Policy Recommendation (October 2012) on Intermittent Preventive Treatment of malaria in pregnancy using Sulfadoxine- Pyrimethamine (IPTp-SP)

During the last few years, WHO has observed a slowing of efforts to scale-up intermittent preventive treatment of pregnant women (IPTp) for malaria with Sulfadoxine- Pyrimethamine (SP) in a number of countries in Africa. While there are several reasons for this, confusion among health workers about SP administration for IPTp may also be playing a role. For this  reason, WHO is clarifying its  recommendations, and urging national health authorities to disseminate these recommendations widely and ensure their correct application.

In several countries in Africa, some Plasmodium falciparum parasites carry quintuple mutations linked to SP resistance which are associated with in vivo therapeutic failure to SP. IPTp  with  SP  remains  effective in preventing the adverse  consequences  of malaria on maternal and fetal outcomes in areas where a high proportion of Plasmodium falciparum parasites  carry these  quintuple  mutations [1].  Therefore,   IPTp  with  SP  should  still  be administered to women in such areas.

All possible efforts should be made to increase  access to IPTp with SP  in all areas with moderate-to-high transmission in Africa, as part of antenatal care services. Based on new evidence the following updated recommendations are provided.

In areas of moderate-to-high malaria transmission, IPTp with SP is recommended  for all pregnant women at each scheduled antenatal care visit. WHO recommends a schedule of four antenatal care visits.

  • The first IPTp-SP dose should be administered as early as possible during the 2nd trimester [2] of gestation
  • Each SP dose should be given at least 1 month apart
  • The last dose of IPTp with SP can be administered up to the time of delivery, without safety concerns
  • IPTp should ideally be administered as directly observed therapy (DOT)
  • SP can be given either on an empty stomach or with food
  • Folic acid at a daily dose equal or above 5 mg should not be given together with SP as this counteracts its efficacy as an antimalarial [3]
  • SP should not be administered to women receiving cotrimoxazole prophylaxis

In some countries where IPTp with SP is currently being implemented, transmission of malaria has been reduced substantially.  In the absence of information on the level of malaria transmission  below which IPTp-SP is no longer cost-effective,  such countries should not stop IPTp. [4]

There is currently insufficient evidence to support a general recommendation for the use of IPTp-SP outside Africa.

Monitoring of IPTp-SP effectiveness and safety of multiple doses is essential and should continue. Research is ongoing to define the best methodology for such monitoring; this will be shared when available.

Footnotes:

[1] The findings  of an observational  study  in Tanzanian women in an area with high levels of quintuple mutation strongly associated with drug resistance and where the parasite  dhps resistance mutation of codon 581 was also present showed increased placental  parasite  density  and inflammatory changes  in women reporting IPTp with SP  use. This needs  further investigation although it is important to note that this specific dhps resistance mutation is currently not common.

[2] IPTp administration should be avoided during the 1st  trimester of gestation but should start as soon as possible in the 2nd trimester.  The fact that a woman has entered the second trimester  can be determined  by the onset of quickening or by measurement of fundal height by ANC health personnel.

[3] WHO recommends daily iron and folic acid supplementation in pregnant women at the dose of 30-60 mg of elemental iron and 0.4 mg of folic acid, to reduce the risk of low birth weight infants, maternal anaemia and iron deficiency at term.

[4] Cost-effectiveness modelling studies are ongoing to address this question. Risk-benefit of SP administration needs also to be taken into account when considering recommendations on IPTp implementation.

Advocacy &Private Sector Bill Brieger | 15 Oct 2012

Healthy workers can be malaria champions in their communities

Emmanuel Fiagby of the VOICES for a Malaria-Free Future in Ghana shares a recent workshop of the Ghana Revenue Authority at Kpetoe, Volta Region, Ghana. Below are his experiences.

slide1.JPGThe Ghana Revenue Authority has made a giant stride in the implementation of its Employee Wellbeing Program (EWP) by initiating a program which will result in the development and implementation of a Malaria Control Strategy and Program of Action for the Authority. A total of 45 officials of the GRA mostly EWP Focal Persons participated in the program.

Launching the program at the Customs Excise and Preventive Services (CEPS) Academy here, the Commissioner General of the  GRA Mr. George Blankson stated that the GRA has since its establishment shown tremendous commitment towards the welfare, health and wellbeing of its staff who are its most valued asset and therefore finds the theme for its Malaria Control strategy development exercise, “Turning Revenue Makers in to Malaria champions; a true demonstration of corporate social responsibility,” an apt reflection of what the GRA stands for.

Mr. Blankson emphasized that, the aim of the GRA in setting up its EWP of which malaria is becoming a key component is to set the pace as a leading healthy workplace in Ghana where staff and management work together to protect and promote the health, safety and wellbeing of its over 7,000 staff and almost 30,000 community members on a sustainable basis. “Today we stand at the threshold of expanding the frontiers of the Employee Wellbeing Program (EWP) to encompass malaria control programs for our staff and the wider community which GRA serves. I am extremely certain that this effort will lead to the total obliteration of the 25% absenteeism of our workforce attributed to malaria and the random deaths this disease wrecks on our institution,” the Commissioner General reiterated. He called on all officers selected to lead the malaria program and noted that by becoming champions for malaria control, they will be “contributing to sustaining a stronger workforce, a stronger community and therefore a more productive and taxpaying community.”

slide1.JPGIn her key note remarks, Dr. Kezia Malm, Deputy Manager of the National Malaria Control Program (NMCP) stressed that Ghana has made tremendous progress in the fight against malaria and it’s only through the collaborative efforts of parastatal institutions such as the GRA and others that the country would be able to sustain the gains. “Our journey to eliminating malaria can only end successfully if the support of every sector of our development effort – the public sector, private sector, NGOs, and the donor community is sustained,” she concluded.

The two day GRA Malaria Control Strategy development and action plan development program was organized by the Johns Hopkins University Center for Communication Programs Voices Project in collaboration with the Ghana Revenue Authority and the National Malaria Control Program. In setting the stage for the program, the Country Director of the Voices for a Malaria-free Future Project, Mr. Emmanuel Fiagbey pointed out that the GRA, a non-health institution becoming a champion for malaria control should be an effort worth emulating by other powerful parastatal institutions. “That the ‘Revenue Makers’ our tax officials have become malaria advocates and mentors for their colleagues should not only result in preserving the health of the GRA Workforce against malaria, it must also lead to speedy action on malaria commodities and their documentation that come to the tables of the tax officials in the course of their work,” Mr. Fiagbey emphasized.

slide1.JPGThe Ghana Revenue Authority is a major parastatal institution in Ghana made up of the Customs Excise and Preventive Service, the Internal Revenue Service and the VAT Service. Fifteen senior officers of the Authority including Mr. K. E. Enyimayew the Deputy Commissioner HR, Deputy Directors of the three arms of the Authority, Service Commanders/Commissioners and the Director of the CEPS Academy also participated in the opening activities of the program.

Malaria is often a major cause of absenteeism – either for the sick worker or the worker who has to stay home with a sick child or relative.  The GRA sets a great example how malaria training for members of the workforce can improve occupational, family and community health.

ITNs &Malaria in Pregnancy &Monitoring &Treatment Bill Brieger | 12 Oct 2012

Tanzania, an example of the challenges of achieving malaria targets

malaria-indicators-in-tanzania-nets-sm.jpgPreliminary results of the Tanzania indicator survey for HIV and Malaria have been released. This makes it possible to track over time some of the basic indicators for success in malaria programming using various Demographic and Health as well as Malaria Indicator Surveys.  The trends recall concerns of more than a decade ago when USAID organized the Malaria Action Coalition to address the relative ‘neglect’ in malaria case management and malaria in pregnancy program components.  At least in Tanzania, ten years on, the problem persists.

We can see clear progress in insecticide treated net use by vulnerable populations over time. The push for universal coverage since 2009 seems to have paid off in Tanzania.  We hope this victory is sustainable, but more and more we are receiving reports that the duration of the long lasting aspect of LLINs is far from the hoped for 5 years.  Eighteen months is more realistic.

So after a major campaign to achieve the targets seen in the attached figure we have to ask whether Tanzania is positioned to do massive replacement, either through routine services like immunization programs and antenatal care, over the next several years.

A depressing finding is the last of progress in intermittent preventive treatment for pregnant women as seen below.

  • 2008 – 30%
  • 2010 – 26%
  • 2012 – 32%

malaria-indicators-in-tanzania-act-child-sm.jpgReports over the years have singled out procurement and supply problems arising after Tanzania switched from sulphadoxine-pyrimethamin (SP) to ACTs as its first line antimalarial drug. SP fell off the radar in many places.  One wonders also what this says about Tanzania’s overall commitment to maternal health.

Case management is similarly in the doldrums. This is ironic because Tanzania was one of the beneficiaries of the Affordable Medicines Facility malaria (AMFm) pilot effort that was generally credited with enhancing access to quality malaria drugs.  Tanzania has also pioneered an accredited drug outlet program aimed at upgrading the quality of the typical patent medicine shop.

As is often the case, much soul searching is needed to look at the health systems – especially those delivering child health and maternal health services – to find the bottlenecks to this problem.  Neighboring countries like Rwanda that want to move toward pre-elimination will find it difficult if their neighbors fall behind in implementing the basic malaria interventions.

Environment &ITNs Bill Brieger | 08 Oct 2012

What to Do with Old Insecticide-Treated Nets?

Recently Matt Lynch of the Johns Hopkins Center for Communications Programs and the USAID NetWorks Project was asked about the challenges of disposing old ITNs. His response has been shared on Malaria Update, but we thought readers on Malaria Matters, who are not Update subscribers, could also learn from Matt’s Ideas. Matt urges that each country and community needs to find its own economic and ecological solutions as seen below.

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I would urge a careful look at all the options (including leaving the nets in the households) before leaping into actions which may end up with worse consequences than no action at all.

Much that I have heard on this topic begins with the assumption that nets must be collected – this is not necessarily true, and no one has been able to adequately describe to me exactly what the problem of leaving the used nets for households to re-purpose might be.  They are, on the other hand, very ready to describe the massive costs associated with collecting the nets, and the problems which will follow from concentrating enough old nets in one spot to actually have insecticide and plastic concentrations which do become quantifiable problems.

As far as I can tell from asking the manufacturers, most pyrethroids decay when exposed to UV light, and are broken down by soil bacteria.  This is why pyrethroids are so popular in agriculture – they don’t persist in the environment.  They are apparently quite toxic to fish, so that’s worth exploring in the island environments.  Dumping them into the sea is probably not a great idea.

commob-pics-068sm.jpgIn Africa, one frequently sees old, holed nets being used to cover plants, chicken coops, or to screen windows.  Such uses, as far as I can tell, do no harm and probably some good (who knows, the residual insecticide may help control chicken mites?).  In addition, they provide an opportunity for the UV light and soil bacteria to begin breaking down the insecticides.

One might expect polyethylene nets to pose more of a problem in terms of solid waste, but I have not seen any reports of drains being blocked by old bednets (plastic bags, frequently!).  Polyester nets are even more difficult to imagine as a serious solid waste problem – after all, there were millions of pretty toxic-looking polyester leisure suits sold in Africa through the 1980’s and no one seems concerned about their disposal…

So, I don’t mean to trivialize the issue;  I think we need a clear description of precisely what the problem is with letting households dispose of their worn-out nets through their usual practices.  There may well be harmful disposal practices that need to be addressed, but I do think we need a clear description of the problem before we rush into complicated, expensive and potentially hazardous “solutions”.   I personally doubt the optimal solution will be to collect the nets.