RECENT reports indicate that the Southern African Development Community (SADC) is going to ignore orders by the United Nations (UN) by starting to produce the insecticide DDT (dichlorodiphenyltrichloroethane) again – as the drug is much needed to reduce the number of premature deaths caused by malaria.
SADC vision is one of a common future, within a regional community that will ensure economic well-being, improvement of the standards of living and quality of life, freedom and social justice; peace and security for the peoples of Southern Africa.
In the last 20 years there have been at least 20 million deaths because of malaria, one million deaths annually, and 250 million cases of fever caused by malaria each year across the globe.
According to the World Health Organisation (WHO) malaria continues to be a major public health problem in the African Region.
It is estimated that 960,000 deaths from malaria occur annually in this Region, which represent 90 per cent of the malaria deaths reported worldwide. A large proportion of the victims are children under the age of five years. The burden of this disease translates into a significant demand for health care services, particularly in the resource poor settings of most African countries.

Last year alone there were over 800 million cases of malaria globally that were recorded and in Guyana alone the incidence of malaria climbed to 17,000 cases.
While locally this was a decrease from the 100,000 cases seen in the 1990s, it was an increase from 2009’s 10,000 cases.

KNOCK-OUT PUNCH

Health Minister, Dr. Leslie Ramsammy, contends that Guyana – and the world over – need what he describes as the ‘knock out punch’ to eliminate the malaria scourge plaguing the health sector and causing unjustifiable deaths.
In the 1940s malaria was rampant, particularly on the coast, at which time DDT was introduced by an Italian Doctor, George Giglioli.
By 1951, malaria and its principal carrier had been completely eliminated from the coastal areas, including Georgetown, by means of a highly focused house spraying campaign.
In the interior, where settlements were widely scattered and difficult to get to, it was impossible to completely eliminate the disease since the mosquito lived in the forest there, not in houses.
However, in 1962, American biologist Rachel Carson wrote Silent Spring. The book cataloged the environmental impacts of indiscriminate DDT use in the United States of America (USA) and questioned the logic of releasing large amounts of chemicals into the environment without fully understanding their effects on the environment or human health. The book suggested that DDT and other pesticides cause cancer and that their agricultural use was a threat to wildlife, particularly birds.
The book produced a large public outcry that led to a 1972 ban in the U.S. and the use of DDT was subsequently virtually banned.
Dr. Ramsammy is of the opinion that there needs to be a review of the perceptions surrounding the use of DDT and pointed out that the non-use of DDT was based on the effects its use had in the agricultural sector – since DDT had a dual purpose, for agriculture and for vector control.
The Health Minister noted that there is no sound evidence which indicates that DDT as a vector control method is a hazard, but agreed that the use of DDT in the agricultural sector will have negative impacts.
“It seems an unwise decision not to consider wider use of DDT in a controlled manner,” he said.
The disease continues to be a major contributing factor to the death toll; be the cause of disability; be the cause of impoverishment in families and within communities; impact national economies; and impact productivity, eapecially in mining and forestry sectors.
Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells. Symptoms of malaria include fever, headache, and vomiting, and usually appear between 10 and 15 days after the mosquito bite. If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs. In many parts of the world, the parasites have developed resistance to a number of malaria medicines.
Key interventions to control malaria include: prompt and effective treatment with artemisinin-based combination therapies; use of insecticidal nets by people at risk; and indoor residual spraying with insecticide to control the vector mosquitoes.

DOUBLE TROUBLE

However, while the world debates a solution to a disease that has plagued the health sector for decades, Dr Ramsammy contends that the world has another major health sector problem that must be addressed.
Guyana, like countries the world over, has made significant progress in reducing the number of deaths caused by infectious agents by using anti-microbials (which include anti-biotics), but over the years science has shown that the bacteria causing infectious disease are developing resistance to the drugs.
According to him, the devastating impact of malaria and the issue of anti-microbials resistance are both equally threatening.
Anti-microbial resistance (AMR) is resistance of a microorganism to an antimicrobial medicine to which it was previously sensitive. Resistant organisms (they include bacteria, viruses and some parasites) are able to withstand attack by antimicrobial medicines, such as antibiotics, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist and may spread to others. AMR is a consequence of the use, particularly the misuse, of antimicrobial medicines and develops when a microorganism mutates or acquires a resistance gene.
In response, Guyana has a national survey ongoing to detect and monitor resistance and has engaged public health stakeholders at several levels.
“This is not a small problem, but a big problem that has not had big enough space on the global health agenda,” the Health Minister posits.