The Observer (Kampala)
Devapriyo Das
10 September 2008
(Page 2 of 2)
While supporting this multi-sectoral approach, Dr. Acana also feels it is necessary to "strengthen the lower level units so that patients would get attention at primary level."
To tackle the insufficiencies of existing medical structures, he suggests "collaboration with private partnerships. There are so many private health practitioners who have the knowledge to treat and check for malaria."
Ultimately, he believes correct diagnosis will remain central to fighting malaria. And gesturing towards Apac Hospital brimming with patients, he says, "I still believe we need more doctors, because malaria cuts across all these wards".
DDT conundrum
Even with these interventions, Dr. Emer explains, medical workers in Apac discovered they were only saving a few lives, leaving the malarial burden on the people intact.
So when the idea of DDT came, "we thought that was the best we could do. In fact it is the most cost-effective vector control strategy which exists in the world".
But it's also the most controversial. DDT is recognised as one of 12 persistent, toxic chemicals by the Stockholm Convention on Persistent Organic Pollutants (to which Uganda became a party in July 2004). The USA and the European Union banned its use in the 1970s after having used it for decades as an agricultural insecticide. But in September 2006, the World Health Organisation approved DDT use for indoor-spraying; on walls, roofs and ceilings of buildings.
USAID, under the banner of the US President's Malaria Initiative, has since approved funding for IRS using DDT in Uganda, commencing with Lango sub-region, owing to its remarkably high incidence rates.
"As for now, the funding is from development partners. It is a huge amount of money because it's the first time we're using such an intervention here," Dr. Emer explains.
District health officials intend to promote mosquito net usage and medical interventions alongside yearly spraying.
Indeed several houses in Oyam and Apac districts have been sprayed with DDT until a High Court injunction in June 2008 halted the process.
The Uganda Network on Toxic Free Malaria Control (UNETMAC), an anti-DDT lobby, argues before the court that DDT will damage the long-term health and livelihood of Ugandans. It also argued that essential guidelines set by the National Environmental Management Authority (NEMA), were not followed during the spraying process, thus prompting the injunction.
Mosquitoes are a resilient species, and for now, they look set to keep Apac in the record books.
The next part in this series on malaria in Apac will examine the impasse over DDT usage in Lango sub-region.
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