Clearly no one wants to argue against efforts to curb a deadly disease. The question is whether the approaches to doing so have any negative consequences that can be easily ameliorated.
Vector control gets the most attention. One concern is the plastic bagging in which long-lasting insecticide treated nets are packaged. Rwanda, which has outlawed commercial use of plastic bags for shopping, is taking the LLIN packaging seriously.Â The photo shows net packaging that has been removed at a health center and stored for later incineration. Clients take their nets home in paper bags and are encouraged to hang them immediately.
Another net concern is disposal of old, used, damaged nets. LLINs do not have under ‘normal’ conditions the 5-year lifespan originally hoped. Plans for proper disposal are not fully developed in most settings, but the massive distribution of nets to achieve universal coverage from about 2009-12 are about to need replacement. It is possible that some of the net misuse reported in the media is actually repurposing of old nets. More information from communities and local health authorities is needed.
Insecticides for indoor residual spraying usually are the first thought that comes to mind concerning environmental impact of malaria control. While arguments primarily focus on DDT, it is important to note that WHO has approved over a dozen different insecticides for IRS.Â The problem is not so much the use of chemicals for actual IRS, but the misuse outside approved spraying programs for farms and fish kills. At present IRS is a highly geographically focused activity in most countries, and control of the activities seems to be working for the large part, but even the process of preparing for and cleaning up after a spraying exercise can results in spills and contamination. Guidelines exist, but are they followed?
Then we get to the issue of medical waste from rapid diagnostic tests.Â Some health centers sharps and waste boxes for short term disposal and as pictured here in Burkina Faso, have incinerators tor final disposal.Â Community health worker use of RDTs is usually accompanied by sharps and disposal boxes that can be returned to health centers.Â All of this needs careful monitoring.
One must even think about packaging of artemisinin-based combination therapy medicines which are prepackaged by age group. These packets are small and are sent home with patients and care-givers. The paper may be burned or composted, but there are also plastic blisters in the packet. This may not account for much on an individual family basis, but on the community level it may be substantial.
Readers may think of other environmental concerns from their own experiences and share success stories for environmental management accompanying malaria control in their countries.Â So, as noted, we will not stop malaria control efforts on Earth Day, but at least we can be more conscious of the materials used, whether they can naturally decompose in the environment and thus make some contribution to a healthier planet.