Malaria is a killer disease. Since 2000 there has been a massive expenditure on reducing the prevalence of malaria, but the results achieved have been quite modest relative to the cost. Using an integrated approach would be more cost effective. This slideset describes the various components that go into an integrated approach to mosquito and malaria control.
2. CONTEXT
This slideset is a Work-in-Progress
and will be updated from time to
time. It is part of a series that aims
to enable better metrics for the
complex socio-enviro-economic
system that we all live in. Metrics
are powerful, but they must be the
right metrics.
TRUE VALUE ACCOUNTING
3. ABOUT THIS SLIDESET
The following slides were prepared in 2005
by Peter Burgess in connection with the
work of the Integrated Malaria and
Mosquito Consortium in collaboration with
the Transparency and Accountability
Network (Tr-Ac-Net), a precursor of
TrueValueMetrics.
TRUE VALUE ACCOUNTING
5. Transparency and Accountability Network
IMMC Components
The concept of Integrated Mosquito and
Malaria Control (IMMC) is that very much
more cost effective results can be
achieved through a multi-intervention
approach than any single intervention
approach.
Integrated Mosquito and Malaria Control (IMMC)
Modern science gives us the tools to have rapid and low cost
success ... but only if the program is driven by science and
facts about the situation, and the performance of program
interventions.
The goal is to reduce the negative impact of malaria in African
communities ... rapidly and at lowest possible cost.
6. Transparency and Accountability Network
IMMC Components
A critical parameter of success is
reduction in the rate of re-infection.
No matter how good the malaria
therapy, malaria will remain a
socio-economic problem of major
proportion as long as there is a
continuing cycle of re-infection.
This is one of the reasons for the
build up of resistance to drugs, and
the reason that limited anti-malarial
programs do not succeed.
Disrupting the Continuing Cycle of Re-infection
7. Transparency and Accountability Network
IMMC Components
The IMMC Components
● Collect data (entomological data, environmental data, spatial
data, medical data, cost data) and do thorough, rapid analysis
to define and optimize interventions and program activities.
● Do environmental cleanup and get community involved.
● Use interior residual spraying (IRS) to control mosquitoes near
human beings. Use best available insecticides, including DDT.
● Use larvicides to control (stop) the maturation of mosquitoes.
● Kill / control flying mosquito population using aerial and ground
application of adulticides.
● Medical - malaria case management to improve health situation
and reduce malaria parasite in the area.
● Use insecticide impregnated bednets to limit mosquito bites.
8. Transparency and Accountability Network
IMMC Components
Management Process
Collect data
Do analysis
Make operational decisions
Collect more data
Do more analysis
Revise operational decisions
Publish performance to all stakeholders
9. Transparency and Accountability Network
IMMC Components
Collect data – get it from the habitat. Not comfortable, but
very important. Learn WHERE and what is going on with the
mosquito: larva ... mosquito population ... prevalence of
malaria in the mosquitoes ... etc.
Collect Data: Entomology
10. Transparency and Accountability Network
IMMC Components
Left picture: A satellite image of Monrovia, Liberia, West Africa showing
15,000 acres of marsh within the main urban area (dark brown area)
Right picture: Aerial image of part of the urban area ... very congested
and difficult to access by vehicle.
Collect Data: Geographical
11. Transparency and Accountability Network
IMMC Components
Keep score ... the goal is to reduce the prevalence of malaria, and to do it
at least cost and in the most sustainable manner. Part of this requires
knowledge of issues like resistance and the cost and effectiveness of
various forms of therapy.
Collect Data – Malariology
12. Transparency and Accountability Network
IMMC Components
Everyone needs to have access to treatment ... it is important for two
reasons: (1) the patients need treatment to get better and avoid getting
worse; and (2) good public health policy requires that there is a lowering of
malaria prevalence as fast as possible to give a sustainable outcome.
This child did not get adequate treatment ... this clinic did not have effective medications ... as reported in the
New York Times in June 2006
Collect Data – about malaria and treatment
13. Transparency and Accountability Network
IMMC Components
Data is used to determine what interventions are most likely to give rapid
sustainable progress towards the ultimate goal of reducing malaria prevalence. A
cost and operations model suggests that best practice using multiple interventions
is several times more cost effective than any other approach.
Data analysis, cost and value optimization
15. Transparency and Accountability Network
IMMC Components
Stagnant water facilitates mosquito breeding. Cleanup is something
that people in all communities should undertake as a civic
responsibility. It takes education, leadership and motivation.
This can be organized through community groups like churches
and mosques, youth groups, soccer teams, etc.
This should be one of many IMMC interventions.
Environmental Cleanup
16. Transparency and Accountability Network
IMMC Components
Interior Residual Spraying (IRS) has been very effective in reducing the
incidence of malaria ... and especially when DDT is used as the primary
insecticide. IRS operates in three ways: (1) as a repellant that keep
mosquitoes outside the living space; (2) as an irritant that accelerates exit
of mosquitoes; and, (3) toxicity that kills mosquitoes.
Interior Residual Spraying (IRS)
17. Transparency and Accountability Network
IMMC Components
The best time to eliminate the mosquito vector is BEFORE the
mosquito can fly. This can be done with knowledge about the
environment and larviciding to kill larva before they become flying
mosquitoes.
Various approaches to larviciding are possible ... manual, with
mechanized support and, in some cases, using aerial application.
Larviciding
18. Transparency and Accountability Network
IMMC Components
● Aerial spraying makes
rapid treatment of large
and/or inaccessible areas
possible.
● Aerial operations are
expensive per hour, but
LOW COST in terms of
work done.
● Ultra Low Volume (ULV)
spraying does NO
environmental damage.
● Treatment strategy
determined by
entomological analysis.
Aerial Treatment – ULV, Adulticiding, Larviciding
19. Transparency and Accountability Network
IMMC Components
Ultra Low Volume (ULV) and aerosol ground fogging is common
practice in places where malaria has been controlled. It serves to
reduce mosquito populations in areas reached by insecticide
sprays and limit malaria transmission.
A variety of chemicals are used that are highly toxic to mosquitoes
but safe for humans, animals and the environment. By varying the
chemicals used build up of resistance is minimized.
ULV Ground Fogging – mechanized and manual
20. Transparency and Accountability Network
IMMC Components
The need for malaria treatment is
enormous ... over 400 million cases a
year in Africa. But most do not get
effective treatment.
Public funding for programs is small,
and most individuals do not have their
own resources. Untreated malaria can
be fatal.
Use effective drugs.
Avoid building up drug resistance.
Treatment
21. Transparency and Accountability Network
IMMC Components
Insecticide treated bednets
(ITN) help reduce malaria
transmission. They reduce
contact with malaria infected
mosquitoes and reduce malaria
among people using bednets.
But what about protection
outside the house?
Insecticide Treated Bednets (ITN)
Widespread bednet use requires a lot of effort and bednets are
expensive relative to local incomes. ITN is a valuable part of a total
solution, but only a part. ITN cannot achieve full success on its own.
22. Transparency and Accountability Network
IMMC Components
The Panama Canal Zone around 1904.
Most of temperate Europe ended malaria largely
by improved environment that reduced vector.
USA eliminated endemic malaria
Japan almost totally reduced malaria
Italy and lastly Sardinia reduced malaria
India had major reduction in malaria prevalence
Considerable reduction in Caribbean locations
Considerable reduction in Latin America
Australia eliminated endemic malaria
South Africa, Swaziland and Mozambique used
regional control and IRS (including use of DDT) to
reduce malaria epidemic arising after about 10
years of no DDT use.
Examples of success
Success in the early part of
the 20th
Century
Immediate post WW2 era to
around 1960
(heavy use of DDT)
Recent experience in Africa
23. Transparency and Accountability Network
IMMC
Integrated Mosquito and Malaria
Control
Questions?
For more information:
Peter Burgess
1 212 772 6918
peterbnyc@gmail.com
24. REMINDER
This slideset is A WORK-IN-PROGRESS. It will be
upgraded periodically. It is part of a series of more
than 100 slidesets. Navigation to these is available
here:
http://www.truevaluemetrics.org/DBadmin/DBtxt001.php?vv1=N1-Slidesets-p3
More about the True Value Metrics initiative is at:
http://www.truevaluemetrics.org/DBadmin/DBtxt001.php?vv1=list0100-MainNav
FEEDBACK is welcome. Please email to Peter
Burgess … peterbnyc@gmail.com … with a catchy
phrase in the subject line so that it gets attention,
and please identify the specific slideset(s) or
webpage involved.
TRUE VALUE ACCOUNTING
25. THANK YOU
Some links and contact information:
Email Peter Burgess … peterbnyc@gmail.com
Peter Burgess LinkedIn profile
https://www.linkedin.com/in/peterburgess1
Link to TrueValueMetrics.org website
http://www.truevaluemetrics.org/
Link to navigation to other resources:
http://www.truevaluemetrics.org/DBadmin/DBtxt001.php?vv1=list0100-MainNav#1
TRUE VALUE ACCOUNTING
Hinweis der Redaktion
The purpose of this presentation is to describe the various interventions that comprise a comprehensive, integrated mosquito and malaria control (IMMC) program.
Tr-Ac-Net (Peter Burgess) has collected a lot of material from peer reviewed papers about the costs of various interventions, but the information is, by good cost accounting standards, rather weak and not at all clear
The reference material is listed in a “reference” file. Many of the authors of the papers have been contacted for clarification and guidance ... and an encouraging number of authors have shown interest in the IMMC Consortium initiative.
Aerial treatment is very cost effective when the operations are used optimally. Work done is fast, and results can be significant.
But operations need to be driven by good data, good analysis and good science.
Aerial operations can do work in areas that cannot be reached easily on the ground ... marshy areas and informal shantytown areas with limited road access.
Very low volumes of insecticide are used ... ultra low volume (ULV) droplets are tiny and kill mosquitoes while they are flying. The residue may never actually reach the ground.
Other techniques such as larvaciding are effective when applied precisely where needed ... this requires good data and equipment such as GPS gear to operate with precision.
This is just an introduction.
More information is available in a variety of formats including pdf files, spreadsheet versions and presentation files.
Generally speaking this material is available free to members of the Transparency and Accountability Network (Tr-Ac-Net Inc.) a not for profit corporation incorporated in Vermont USA. Contact Tr-Ac-Net ([email_address] or www.tr-ac-net.org) about becoming a member.
The major theme of Tr-Ac-Net information is the critical value of management information, the decision making process and accounting and accountability.
Another recurrent theme is the importance of value adding activities in socio-economic progress, and the profile of the value chains so that there is reasonable equity between all the legitimate stakeholders.