A recent WHO publication, Preventing Disease through Health Environments, addresses environmental factors responsible for malaria spread and control. Malaria contributed 10% to the environmental burden of disease for children aged 0-14 years worldwide. Specifically, “An estimated 42% of the global malaria burden, or half a million deaths annually, could be prevented by environmental management.” According to the document, There are three main approaches to the environmental management of malaria:
- Modify the environment. This approach aims to permanently change land, water or vegetation conditions, so as to reduce vector habitats.
- Manipulate the environment. This approach temporarily produces unfavourable conditions for vector propagation and therefore needs to be repeated.
- Modify or manipulate human habitation or behaviour. This approach aims to reduce contact between humans and vectors
Although some elements of individual and household behavior are involved in environmental control, it would be be an exercise in victim blaming to assume that individuals and households can take the main responsibility for taking environment measures. Water supply, drainage, road construction, river and stream control and other environmental measures are the responsibility of institutions and governments. Unfortunately such infrastructural improvements are costly, and one does not see them addressed in major malaria control programs like GFATM and PMI.
The World Bank has noted that, “Malaria affects millions in the East Asia and Pacific (EAP) region and impedes economic development, particularly affecting the rural poor. In the early 1900s malaria was controlled in many parts of the region using environmental management (EM) for vector control. EM is where the environment is modified or manipulated to reduce malaria transmission by attacking local vector mosquitoes and requires an understanding of the ecology of these species. Today malaria control is based on drugs and insecticides…” Because of questions of sustainability and resistance, the possibility of a return to environmental management is raised.
The World Bank’s Malaria Booster Program document does consider some elements of environmental management, but many of these fall more in line with integrated vector control measures in country examples like IRS, larviciding, and larvivorous fish. Some mention is made of filling spots of standing water. The larger infrastructural issues are not addressed. This is not to say that wider World Bank projects don’t address such issues, but what is needed is a more integrated approach that the malaria control potential of infrastructural projects is assessed and planned. Other development partners need to join in this effort.