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09/30/2006

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owinok

The application of DDT in combination with other forms of vector control is imperative in saving lives in the future but it is highly unlikely that the malaria mosquito can be led to extinction. The correct approach ought to be the reduction in the number of mosquitoes to such a level that there is a break in transmission of the parasite. The pursuit of the extinction of mosquito may be tempting as a decisive solution but the odds are that it is virtually unattainable.

Robert Chung

1. Although sterile insect techniques (SIT) can be a very useful tool in controlling certain types of pests, they never lead to complete extinction.

2. There are four different malaria parasites with vastly different lethalities -- the type of malaria endemic in Sub-Saharan Africa is deadliest to chldren under the age of five but actually doesn't kill many adults (though it makes them quite sick, and repeatedly). This is not to deny the tremendous human toll of the disease; it is only to point out that it is hard to say exactly how many lives are lost (or saved) without specifying exactly which strain of parasite one is discussing.

3. A reasonable estimate of the material cost of IRS (interior residual spraying) vs. LLN (long-lasting insecticide treated nets) was included in a relatively recent Ugandan Ministry of Health report. That report estimated the 6-month material cost of DDT at around $2 per household, while the cost of a LLN (which lasts about 4 to 5 years) was about $6. IRS needs to be repeated every 6 months, and the cited cost is only for the insecticide itself and does not include the cost of spraying. It is generally acknowledged that the logistical cost of arranging an army of sprayers who can visit an area twice a year is considerable. The distribution cost of a LLN is quite a bit lower: basically, an entire truckload of LLNs can be delivered by one man while that same man with a sprayer can cover about eight dwellings per day. IRS can be especially effective when malaria is episodic and short-term protection (for, say, one season) is needed in order to "break" an epidemic. WHO has always supported this particular use of IRS. In Africa, LLNs work especially well because even one net in a household can be targeted to the children under age five.

Jose Costa

When it's malaria, it's Africa! So we better leave these old fashion approaches. We will never solve the African problem with DDT or even a vaccine without a political change in Africa. I am from Angola and there they say malaria is a problem of urbanism! In fact, those who live in "slum villages" are more likely to get ill than those who live in better places. Personally i believe DDT could solve part of the problem, but better governance is the key, because malaria is really simple to be treated and avoided.

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