Category Archives: water

Malaria News Today 2020-09-23/24

Today the issue of water is important for malaria mosquito propagation, both in irrigation and flooding. Artificial skin enables testing of mosquito biting. Fake medicines for malaria and other conditions threaten Africa’s health. Archived RDTs can aid surveillance. Finally there is concern for co-infection with both malaria and dengue leading to severe disease. Follow links below to read details.

Impact of sugarcane irrigation on malaria vector Anopheles mosquito fauna, abundance and seasonality in Arjo-Didessa, Ethiopia

Despite extensive irrigation development in Ethiopia, limited studies assessed the impact of irrigation on malaria vector mosquito composition, abundance and seasonality. This study aimed to evaluate the impact of sugarcane irrigation on species composition, abundance and seasonality of malaria vectors. Adult Anopheles mosquitoes were collected using CDC light traps from three irrigated and three non-irrigated clusters in and around Arjo-Didessa sugarcane irrigation scheme in southwestern Ethiopia.

Overall, 2108 female Anopheles mosquitoes comprising of six species were collected. The ongoing sugarcane irrigation activities in Arjo-Didessa created conditions suitable for malaria transmitting Anopheles species diversity and abundance. This could drive malaria transmission in Arjo-Didessa and its environs in both dry and wet seasons. Currently practiced malaria vector interventions need to be strengthened by including larval source management to reduce vector abundance in the irrigated areas.

Prevalence of and risk factors for severe malaria caused by Plasmodium and dengue virus co-infection

A systematic review and meta-analysis examined co-infection with both Plasmodium and dengue virus (DENV) infectious species could have serious and fatal outcomes if left undiagnosed and without timely treatment. The present study aimed to determine the pooled prevalence estimate of severe malaria among patients with co-infection, the risk of severe diseases due to co-infection, and to describe the complications of severe malaria and severe dengue among patients with co-infection. Relevant studies published between databases between 12 September 1970 and 22 May 2020 were identified and retrieved.

The present study found that there was a high prevalence of severe malaria among patients with Plasmodium and DENV co-infection. Physicians in endemic areas where these two diseases overlap should recognize that patients with this co-infection can develop either severe malaria or severe dengue with bleeding complications, but a greater risk of developing severe dengue than severe malaria was noted in patients with this co-infection.

South Sudan: Flooding deepens a humanitarian crisis in Pibor area

Today, however, the Pibor River has swelled to make parts of the town inaccessible and is threatening the clinic. Many neighborhoods cannot be reached by foot, and a local ferry is too expensive for many who live in the area. A mobile MSF team is providing medical care in hard-to-reach areas. “Our focus is now on malaria, measles and flooding,” said Josh Rosenstein, MSF deputy head of mission. “Today we are reaching out to the community through our daily mobile clinics, treating the most severe illnesses. We’re also implementing our flood contingency plan, which includes building additional flood defenses around the clinic to ensure we can continue to provide medical services, as the water level is rising at an alarming speed.”

Stratifying malaria receptivity in Bangladesh using archived rapid diagnostic tests

Surveillance of low-density infections and of exposure to vectors is crucial to understand where malaria elimination might be feasible, and where the risk of outbreaks is high. Archived rapid diagnostic tests (RDTs), used by national malaria control and elimination programs for clinical diagnosis, present a valuable, yet rarely used resource for in-depth studies on malaria epidemiology. 1022 RDTs from two sub-Districts in Bangladesh (Alikadam and Kamalganj) were screened by qPCR for low-density Plasmodium falciparum and Plasmodium vivax infections, and by ELISA for Anopheles salivary gland antibodies as a marker for exposure to vectors.

Concordance between RDT and qPCR was moderate. qPCR detected 31/1022 infections compared to 36/1022 diagnosed by RDT. Exposure to Anopheles was significantly higher in Kamalganj despite low transmission, which could be explained by low bed net use. Archived RDTs present a valuable source of antibodies for serological studies on exposure to vectors. In contrast, the benefit of screening archived RDTs to obtain a better estimate of clinical case numbers is moderate. Kamalganj could be prone to outbreaks.

New tool mimics human skin to allow detailed study of mosquito biting

eLife: Researchers develop a human skin mimic to study mosquito biting in high resolution without using humans as ‘bait.’ The tool, which uses an artificial blood meal and a surface that mimics human skin, will provide detailed understanding of blood feeding without using human subjects as bait. It can also fit conveniently into a backpack, allowing the study of mosquitoes in laboratory and natural environments.

Blood feeding is essential for mosquitoes to reproduce, but it is during blood feeds on human hosts that they pass on pathogens such as malaria. It consists of a bite ‘substrate’ – a transparent, temperature-controlled surface that mimics body temperature to attract mosquitoes. An artificial meal is applied on top of this and covered with a commonly used membrane that mosquitoes can pierce. The meal resembles blood, allowing mosquitoes to engorge and increase their weight by two to threefold. This bite substrate is then placed in a transparent cage, and an external camera records the mosquitoes’ behaviour. The team tested biteOscope with four medically important species of mosquito.

Counterfeiting of Fake Drugs in Africa: current situation, causes and countermeasures

The more desirable a product is the higher the tendency to replicate it and meet that parcel of consumers that want to join the trend but cannot pay the price. Profit is one of the many reasons that make counterfeit an attractive business for many.  Africa, unfortunately but not surprisingly, is one of the most affected continents, comprehensible since its markets have become a huge target for second generation goods, with a major focus on pharmaceutical drugs.

The World Health Organization (hereinafter, WHO) stated that 42% of all fake medicine reported to them between the years of 2013 and 2017 was linked to the African continent and we expect that these numbers fall short of reality. Africa is seriously affected by it and one clear example is the anti-malarial medication. Anti-malarials and antibiotics are amongst the most commonly reported as fake or substandard medical products.

COVID19 Challenges for African Researchers

Not surprisingly COVID-19 related travel restrictions and bans now occur throughout the world, and for African researchers, this means inability to travel for research related collaborations, planning meetings and conferences. Thus, it becomes necessary to ask, “What can we do here at home,” especially considering increasing restrictions on local movement and gatherings.

In the very short time since COVID-19 was finally and officially recognized in China, many research articles have been published. Although these obviously focus on China, they raise possible research questions that need to be addressed in Africa, especially those countries still at the early stages of the epidemic.

Obviously, studies on the clinical management are needed, and one group of Chinese researchers are examining “biological products have broadly applied in the prevention and treatment of severe epidemic diseases, they are promising in blocking novel coronavirus infection,” especially based on reports from previous coronavirus experiences like SARS and MERS.[1] Other studies have examined the role of managing blood glucose levels[2], anticoagulant treatment[3] and the potential of antiviral treatment,[4] among others. What aspects of clinical management will become important to African patients’ survival?

In the process of requesting adequate diagnostic, monitoring and treatment supplies and equipment generally for the country, the tertiary and research hospitals need to ensure they have made requests for the equipment and supplies that are needed not just to provide life-saving treatment, but also to test appropriate approaches in the local setting. Each setting is different and must be studied because already there are anecdotal reports of younger age groups being affected by severe disease in the USA compared to earlier reports from China.

Taking a lesson from the Ebola epidemic in West Africa, there is need to study how COVID-19 will affect the delivery of health care, especially malaria services. Patrick Walker and colleagues[5] modeled the effects of health systems disruption on malaria including challenges in receiving based treatment when clinics were overwhelmed, seen as possible sources of disease and finally shut down as health workers themselves died. Outreach services like insecticide-treated net distribution were also stopped, and the efforts of community health workers were curtailed. To what extent is that happening with COVID-19?

Until there are proven drugs and vaccines, it is extremely important to learn about local epidemiology[6] in order to develop appropriate strategies to prevent the spread of COVID-19. This effort should involve researchers from many disciplines such as public health specialists, anthropologists, sociologists, educationists, and psychologists.

While the medical research mentioned above is carried out in hospitals and clinics, people conducting social and epidemiological studies ideally should be in the community where we can observe people washing their hands or not, gathering in groups or not, and finding out why they do these things. We need formative research to help develop health education, and at the same time ensure social and educational scientists can gather information to evaluate whether the health education as appropriate and worked.

Likewise, research is needed on health systems[7] and must involve political scientists, economists, public administrators, and of course public health specialists, also. A great danger exists for people who cannot keep a social distance from themselves such as those incarcerated in prison and living in camps for refugees and internally displaced people,[8] a common problem throughout the continent. They too need to get into the organizations and systems that provide care and learn what the policy makers and decision makers are thinking.

As Bronwyn Bruton has observed,[9] “Some 40 percent of Africans live in water-stressed environments in which obtaining access to clean water—let alone soap—is an insurmountable daily hurdle, and for those populations, even simple measures to prevent the spread of the virus, such as frequent handwashing, will be out of reach.” In addition he asks difficult questions about what happens to children who are home and cannot go to school, the vast numbers of people in the informal economy who cannot rely on a salary, if they stay home, and the many people in conflict zones. These are questions that urgently need to be studied in Africa.

Answers to our COVID-19 research questions are needed urgently, probably much sooner than funding can be found to support such research.  The question for our African research colleagues is what can be done now with resources at hand in an environment where movement is restricted? We will definitely need speedy responses from our Institutional Ethics Review Boards and be creative in our use of research methods.

Roxana Elliott[10] reports that data collection in the diverse African region “is difficult, especially when measuring statistics such as mobile penetration, which require face-to-face data collection in order to include those who cannot be reached via mobile. Language barriers, lack of infrastructure, and the sheer number of people throughout Sub-Saharan Africa make collecting face-to-face data nearly impossible due to cost and time constraints, especially in rural areas.” She, therefore, suggests that mobile-based surveying methodologies can alleviate these issues. She also recommends a country-by-country approach, and hence we see that in 2017 an estimate of 32% of the population had a smartphone 48% a basic phone, and 20% no phone.

How can social and health researchers design studies using this mobile resource to answer vital COVID-19 questions in the nearest future? If our students are now at home, can they, for example, be contacted to observe, at a safe distance, the human health related actions in their communities? Can they interview family members to learn why people practice prevention or not? Can they relate family experiences seeking health services for suspected respiratory illness?  Can they report on the water supply situation in the rural and urban areas where they are staying?

There are the questions which African colleagues can debate at a proper social distance (via phone, zoom, Skype, WhatsApp, and others), and come up with creative ways to find answers to prevent a worsening epidemic in Africa.


[1] Yan CX, Li J, Shen X, Luo L, Li Y, Li MY. [Biological Product Development Strategies for Prevention and Treatment of Coronavirus Disease 2019. Article in Chinese] Sichuan Da Xue Xue Bao Yi Xue Ban. 2020 Mar;51(2):139-145. doi: 10.12182/20200360506. (English abstract in PubMed).

[2] Ma WX, Ran XW. [The Management of Blood Glucose Should be Emphasized in the Treatment of COVID-19. Article in Chinese]. Sichuan Da Xue Xue Bao Yi Xue Ban. 2020 Mar;51(2):146-150. doi: 10.12182/20200360606.

[3] Tang N, Bai H, Chen X, Gong J, Li D, Sun Z.Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020 Mar 27. doi: 10.1111/jth.14817. [Epub ahead of print]

[4] Wu J, Li W, Shi X, Chen Z, Jiang B, Liu J, Wang D, Liu C, Meng Y, Cui L, Yu J, Cao H, Li L. Early antiviral treatment contributes to alleviate the severity and improve the prognosis of patients with novel coronavirus disease (COVID-19).J Intern Med. 2020 Mar 27. doi: 10.1111/joim.13063. [Epub ahead of print]

[5] Patrick G T Walker, Michael T White, Jamie T Griffin, Alison Reynolds, Neil M Ferguson, Azra C Ghani. Malaria morbidity and mortality in Ebola-affected countries caused by decreased health-care capacity, and the potential effect of mitigation strategies: a modelling analysis. Published online April 24, 2015

[6] Luan RS, Wang X, Sun X, Chen XS, Zhou T, Liu QH, Lü X, Wu XP, Gu DQ, Tang MS, Cui HJ, Shan XF, Ouyang J, Zhang B, Zhang W, Sichuan University Covid-ERG.[Epidemiology, Treatment, and Epidemic Prevention and Control of the Coronavirus Disease 2019: a Review. Article in Chinese]. Sichuan Da Xue Xue Bao Yi Xue Ban. 2020 Mar;51(2):131-138. doi: 10.12182/20200360505.

[7] Philip Obaji, Kim Hjelmgaard and Chris Erasmus Coronavirus infections in Africa are rapidly rising. Its weak health systems may buckle. USA Today. Updated 27 March 2020, Accessed 29 March 2020.

[8] Nick Turse. In West African Coronavirus Hotspot, War Has Left 700,000 Homeless and Exposed. The Intercept. March 26 2020, 5:33 p.m.

[9] Bronwyn Bruton. What does the coronavirus mean for Africa?. Atlantic Council. Tue, Mar 24, 2020.

[10] Roxana Elliott. Mobile Phone Penetration Throughout Sub-Saharan Africa. GeoPoll (In Market Research, Tech & Innovation). Posted July 8, 2019

Comprehensive Cholera Prevention and Control: Lessons Learnt from the United Republic of Tanzania

Dafrossa Lyimo of the Ministry of Health, Tanzania presented Tanzania’s experience in preventing and controlling cholera at the 4th African Regional Immunization Technical Advisory Group (RITAG) meeting in Johannesburg, 5-8 December 2017. Those experiences are summarized below.

Cholera outbreak in Tanzania started with the index case detected in Dar es Salaam Region on 6 August 2015. The World Health Organization was notified by Ministry of Health on 15 August 2015. By 31 December 2015 the outbreak spread to 22 out of 26 regions in Tanzania Mainland. Zanzibar started reporting cholera cases on 20 September 2015 from Urban West District in Unguja Island. By December 2015, the outbreak spread to all 10 districts of Pemba and Unguja.

Cumulative cases on the Tanzania Mainland were 12 619 cases with 199 deaths (CFR 1.57%) in 2015, 11 360 cases with 172 deaths (CFR 1.5%) in 2016, and up through Nov 2017, 3 615 cases with 61 deaths (CFR 1.7%). Likewise the Cumulative cases in Zanzibar were 1 143 cases with 15 deaths (1.31%) in 2015, 3 187 cases with 53 deaths (CFR 1.66%) in 2016 and as of Nov 2017, 358 cases with 4 deaths (CFR 1.12%). The last case reported 11 July 2017

Best practices for controlling cholera in the country fall in four domains. In the area od Coordination Tanzania established a Public Health Emergency Operations Centre (PHEOC) in the Ministry of Health. To support this the Ministry appointed an Incident Manager, Deputy Incident Manager, and a PHEOC Manager for the cholera outbreak response. The National Task force Team was established with a wider composition which meeting every Friday discussing issues and giving way forward. National Rapid Response Teams were trained. these teams worked based on national response guidelines which were developed and distributed to all districts.

In the domain of Surveillance, the Ministry initiated a Daily Situation Report (SITREP) for sharing a daily cholera status in the regions and districts , on going interventions and gaps. This group conducted twice a country wide data validation/verification of the reported cases in 17 regions, which also confirmed under-reporting of cases. A Cholera reporting line list register was designed and printed in booklets and distributed to 26 regions in the Tanzania Mainland, to standardize reporting from districts and regions.

The third domain consisted of Water Sanitation and Hygiene interventions. The country distributed 21,600,000 aqua tablets of water guards in 514,285 households. Also distributed were 50 drums 45kg each of 70% High Test Hypochlorite to 83 district water authorities for bulk chlorination. Twenty hand pump boreholes were installed in hotspot villages of Mara and Mwanza regions, thereby Improving the access to clean and safe water. One hundred HACH chlorine testers were distributed for monitoring free residue chlorine in cholera reporting districts.

Social Mobilization was the fourth domain. Cholera leaflets and fliers were designed and distributed in reporting districts. Cholera messages were developed and aired through community media and mobile phone messaging. Community engagement and owning cholera interventions was undertaken using the community social networks and peer groups who focused on Hand washing, Use of treated water, and Use of toilets behaviors.

Cholera control and prevention efforts addressed various Challenges
in Tanzania. one concern was a weak surveillance system starting at the district level in several districts. Lack of reporting cholera cases, under-reporting and late reporting occurred. In some districts that had laboratory capacity, only positive cases were reported, but generally there was inadequate laboratory capacity to test and confirm Vibrio. This meant that samples had to be transported to regional laboratories (long turn around time)

A second challenge was Weak coordination at the region and District level. A third was Inadequate and poor access to WASH. this included a Limited supply of clean and safe piped water in most of districts. Thus 52% of rural population get water from unimproved sources. (Shallow wells, river, lakes and few deep wells). In urban settings, water utilities can supply water not more than 50% and still chlorination is not regularly done. there was low latrine coverage especially in rural areas. About 73% of rural population use unimproved latrines and 13% with no latrines. A fourth challenge was the Misconceptions about cholera causation and some of the interventions.

In the process of addressing these challenges several Lesson were learnt. First, a well established surveillance system helped to in the early notification of cases and quick response. Strong coordination at all level of response is important to ensure the control of outbreak is done on time. Effective social mobilization and community engagement helped in the behaviour change towards the control of cholera. Finally Adequate and good access to WASH ensured the control of spread of cholera

Tanzania has put together a comprehensive cholera prevention program based on surveillance, coordination, water & sanitation and social mobilization. While cases have reduced, Tanzania is not relenting in implementing these key interventions.

World Water Day: Water and Neglected Tropical Diseases

The United Nations introduces us to the challenges of water. “Water is the essential  building block of life. But it is more than just essential to quench thirst or protect health; water is vital for creating jobs and supporting economic, social, and human development.” Unfortunately, “Today, there are over 663 million people living without a safe water supply close to home, spending countless hours queuing or trekking to distant sources, and coping with the health impacts of using contaminated water.”

Haiti: Importance of Water to prevent STH

Many of the infectious health challenges known as Neglected Tropical Diseases (NTDs) have issues of water associated with their transmission. This may relate to scarcity of water and subsequent hygiene problems. It may relate to water quality and contamination. It may also relate to water in the lifecycle of vectors that carry some of the diseases.

Even though water is crucial to the control of many NTDs, it is not often the feature of large scale interventions. The largest current activity against five NTDs is mass drug administration (MDA) on an annual or more frequent basis to break the transmission cycle.  Known as diseases that respond to preventive chemotherapy (PCT) through MDA, these include lymphatic filariasis (LF), trachoma, onchocerciasis, schistosomiasis and soil transmitted helminths (STH) has been undertaken for over 10 years.

We have recently passed the Fifth Anniversary of the London Declaration on NTDs, which calls for the control of ten of the many these scourges The Declaration calls for “the elimination “by 2020 lymphatic filariasis, leprosy, sleeping sickness (human African trypanosomiasis) and blinding trachoma.” Another water-borne NTD, guinea worm, should be eradicated soon. Two of the elimination targets are part of MDA efforts, LF and trachoma.

Cameroon: mapping the community to detect NTD transmission sites

Ministries of Health and their donor and NGO partners who deliver MDA against the 5 diseases in endemic countries express interest in coordinating with water and sanitation for health (WASH) programs. People do recognize the value of collaboration between NTD MDA efforts and WASH projects, but these may be located in other ministries and organizations.

The long term implementation of WASH efforts is seen as a way to prevent resurgence of trachoma, for example, and  strongly compliment efforts to control STH and schistosomiasis. Hopefully before the 10th Anniversary of the London Declaration the vision of “ensuring access to clean water and basic sanitation,” can also be achieved.

Finally as a reminder our present tools for the control of Zika and Dengue fevers relies almost entirely on safe and protected household and community sources of water to prevent breeding of disease carrying Aedes aegypti mosquitoes. If we neglect water, we will continue to experience neglected tropical diseases. Hopefully the topic of water and NTDs will feature prominently at next months global partners meeting hosted by the World Health Organization.


The quantitative impact assessment of community health projects in selected African countries by using Lives Saved Tool

Park 1Chulwoo (Charles) Park who has been undertaking the Masters of Science in Public Health at the Johns Hopkins Bloomberg School of Public Health is sharing herein his experiences with the LiST tool in African countries.

The Lives Saved Tool (LiST) is a computer-based tool that estimates the impact of scaled up health intervention packages in a quantitative manner. By modeling complex mathematical relationship of coverage difference among interventions for maternal, neonatal and child health (MNCH), LiST shows us quantitative results, such as mortality rates, incidence rates, number of cases averted, percentage of stunting and wasting, number of cause-specific death and lives saved.

Especially, LiST can project and run multiple scenarios for subnational target population in the country not only to evaluate existing MNCH project but also prioritize investments for the future based on the quantitative results. World Vision International (WVI) has implemented LiST analysis to strengthen its evaluation and strategic planning methods for MNCH projects since 2013.

Recently, the mid-term evaluations for Access to Infant and Maternal (AIM)-Health project in Kenya, Mauritania, Sierra Leone, Tanzania, and Uganda were conducted through mixed methods analysis, both qualitative research (in-depth interview and focused group discussion) and quantitative research (LiST) from June to September of 2014.

Park 2Subsequently, LiST was solely utilized to quantify the retrospective impact of Water, Sanitation, and Hygiene (WASH) project in Southern Africa Region (SAR), Malawi, Mozambique and Zambia between 2010 and 2014. The significant impact indicates that the combined effect of all five WVI WASH interventions (improved water source, home water connection, improved sanitation, hand washing with soap, and hygienic disposal of children’s stools) have prevented 989,745 diarrhoeal cases among the under-five target population of 506,019 children.

In other words, every single young child prevented 1.96 cases of diarrhea, and prevention rate for diarrhoea was 13% throughout the implementation period. Another results indicate that WVI’s WASH project contributed a 209% mean increase in percentage of under-five lives saved and 15.5% mean decrease in under-five mortality rates across SAR.

  • Chulwoo (Charles) Park, MSPH ’15
  • Johns Hopkins Bloomberg School of Public Health, Department of International Health, Division of Global Disease Epidemiology and Control
  • For more information write to e-mail:

Satellite Mapping, an important step toward malaria control and elimination in Nigeria

Omede Ogu of Nigeria’s Federal Ministry of Health reports on efforts to undertake mapping of malaria in the country as a basis for better planning of control and eventual elimination efforts.

surface water 1The National Malaria Elimination Program (NMEP) has been meeting with the team from the National Space Research and Development Agency (NASRDA). Progress on pilot malaria mapping in Niger State is being reviewed, though the study is yet to be concluded. NMEP is also looking at opportunities that exist to expand their initial mapping to cover the whole of the country. Discussions are underway on next steps and development of a road map or a framework for the study going forward.

NASRDA explained that the current mapping effort was aimed is to use satellite-based technology to map surface water for Malaria Control in North-central Nigeria with Niger State as a Pilot study. They noted that data in inaccessible locations such as the marshy areas, thick forests, rugged terrain etc. were previously unavailable for relevant environmental policy and decision making in the region and Nigeria.

In addition is will be possible to do infrastructural mapping and inventory of health care facilities, in order to identify and assess the state of health care facilities, how accessible and future areas of need provision of these facilities in the country.

So far NASRDA has identified settlements, and locations of hospitals and health centres throughout Niger State using Global Positioning System (GPS). They have also identified water bodies and wetlands locations throughout the state.

Finally they are developing a map of Surface Water and wetlands in the state showing these in relation to locations of settlements, hospitals and health centres. NMEP is planning to link with colleagues doing similar mapping in Kenya.

NMEP plans to have the final report of the study ready by October for dissemination. Major partners with funding lines in their 2014 work plans for this study are the National Primary Health Care Development Agency (NPHCDA) and NASRDA. Additional funding and support is being sought.

Kenya already is using its mapping to focus appropriate malaria interventions. All countries will benefit in better mapping for targeting their malaria control and elimination efforts.

Water for Malaria

As today is World Water Day it is time to reflect on the relationship between water and malaria. As USAID notes, “The impact of water on all aspects of development is undeniable: A safe drinking water supply, adequate sanitation and hygiene, management of water resources, and improvement of water productivity can help change the lives of millions.”

DSCN9055aThe key to the relationship between water and malaria is the word safe. The breeding of the malaria carrying anopheles mosquito species certainly depends on unsafe collections of “clean” but unmoving sources water that could range from a village pond to a cow hoof print. During certain seasons these are ubiquitous.

Seid Tiku Mereta and colleagues showed us recently that humans may be their own worst enemies when it comes to producing mosquito larval breeding sites.  They found that Anopheline mosquito larvae showed a widespread distribution and especially occurred in small human-made aquatic habitats… In contrast, anopheline mosquito larvae were found to be less prominently present in permanent larval habitats. This could be attributed to the high abundance and diversity of natural predators and competitors suppressing the mosquito population densities.”

The drier parts of northern Benin Republic were studied by Renaud Govoetchan and team.  They also found that human activity created water sources in urban areas in the dry season thereby “maintaining the breeding of anopheles larvae and the malaria transmission.” In the rural areas village ponds provided opportunity for dry season mosquito breeding. Although transmission was lower in the dry season and in the urban areas, it still persisted thanks to human water use behaviors and persistence of unsafe rural water sources.

DSCN8908From the above we can see that safe water alone would not prevent malaria. Water use behaviors must also be targeted. That said, it is interesting how water may also be related to other malaria interventions such as insecticide treated nets and case management with local herbs.

A major factor that influences the durability of the so-called long lasting insecticide treated nets (LLINs) is how often people wash them.  Frequent washing of curtains, bed sheets and of course personal clothing is so routine that villagers may not even consider this hygenic behavior to be harmful. In fact it reduces the potency of the insecticide-treated nets.

Virgile Gnanguenon and co-researchers found that LLINs that might be expected to last 3 years if they were only occasionally washed were in fact only likely to be functional for two years or less. Water issues were prominent among the five factors that predicted net integrity and survival: “washing frequency, proximity to water for washing, location of kitchen, type of cooking fuel, and low net maintenance.”

Finally because primary health care does not reach all, community members still use their indigenous herbs to treat malaria. A recent study by Sabine Montcho and colleagues found an unexpected risk from the herbs. In Benin the plant Senna rotundifolia Linn. is commonly used for malaria treatment. Unfortunately the researchers learned that it was contaminated with lead and cadmium. “In terms of risk assessment through the consumption of Senna, the values recorded for lead were nine times higher with children and six times higher with adults than the daily permissive intake.” Polluted water does not have to be drunk directly to harm people.

Our relationships with water and malaria and the connection between the two are complex. World Water Day should provide us an opportunity to consider how our interventions ranging from appropriate use and care of LLINs, to provision of appropriate malaria treatment to larvae control and environmental management need to take into consideration the importance of water to human survival and disease prevention.