Malaria Treatment & Prevention

I sincerely hope that Dr. Shah does not intend on ending malaria as "a
major public health program". While that was surely a misquote, or
mis-statement of Dr. Shah, it reflects as fear of mine as a public
health worker for the past 30 years. History shows that soon as
children stop dying, the money will go elsewhere, and malaria will
return. We do have improved tools now that can make the difference,
but they are expensive, and have to be used continually. Nets only
last a few years and they need to be replaced (although some
apparently last longer than others, I have been waiting five years for
CDC or WHO do do meaningful studies). IRS has do be done every year
and is expensive. I have been told that a malaria vaccine is just a
few years away for the past 25 years.

As Dr. Shah alluded, both the malaria parasite and vectors are very
adaptable, and it is only a matter of time until the pesticides and
medicines which are now effective will become useless. Zambia
Anopheles have developed resistance to both DDT and permethrins.
More expensive pesticides are available, but as the parasite develops
more resistance ...

I sincerely hope that Dr. Shah does not intend on ending malaria as "a
major public health program". While that was surely a misquote, or
mis-statement of Dr. Shah, it reflects as fear of mine as a public
health worker for the past 30 years. History shows that soon as
children stop dying, the money will go elsewhere, and malaria will
return. We do have improved tools now that can make the difference,
but they are expensive, and have to be used continually. Nets only
last a few years and they need to be replaced (although some
apparently last longer than others, I have been waiting five years for
CDC or WHO do do meaningful studies). IRS has do be done every year
and is expensive. I have been told that a malaria vaccine is just a
few years away for the past 25 years.

As Dr. Shah alluded, both the malaria parasite and vectors are very
adaptable, and it is only a matter of time until the pesticides and
medicines which are now effective will become useless. Zambia
Anopheles have developed resistance to both DDT and permethrins.
More expensive pesticides are available, but as the parasite develops
more resistance to Artemisinin (as in Cambodia), I don't know what we
will be able to do.

I worked in South America in the 1970s, and malaria was controlled.
Children stopped dying. Money went elsewhere. Malaria returned.

Sri Lanka controlled malaria. Children stopped dying. Money went
elsewhere. Malaria returned.

Zanzibar controlled malaria in the 1930s, 1960s and 1980s. Children
stopped dying. Money went elsewhere. Malaria returned.

Zanzibar controlled malaria in the 1960s, Children stopped dying. The
money went elsewhere. Malaria returned.

The point of this is that we have a limited window of opportunity now.
Maybe only about five years. PMI, along with GFATM, UNICEF RBM and
others have shown recently in Zanzibar and other places, that malaria
can be controlled, and beaten with existing tools. But it has to be a
strong, and long campaign to control it universally. That means
eradication, or having cheap, effective control measures available in
countries where malaria is a problem for a long time. Tanzania was
producing cheap, effective ITNs and ACTs in country, but, instead of
promoting this as an example of what should be done, the international
malaria community has tried to shut them down! We have to take the
long view of malaria.

Best, Charles Llewellyn (Retired USAID Health Officer working with
PMI in Tanzania 2005 to 2010)

--
Charles Llewellyn
114 Marsh Street
Beaufort, NC 28516

Cell 919 599-2147

Dear Charles,

Thanks for sharing your experience and comments. You're right though that was a mistype. He wants to eliminate malaria as a public health PROBLEM.

best
sarah

I share the same concerns as Charles regarding the shifting focus on
whatever is the current hot topic. We have seen major advances in the war
on HIV and AIDS. And with those advances funding has been withdrawn and we
are about to see the effects of those decisions.

I'm concerned with what we can realistically do on the ground at the village
level to keep the war on malaria going strong.

--
Michelle Kiprop, RN MSN
Family Nurse Practitioner
Empowering Lives International
P.O. Box 6367
Eldoret, 30100 KENYA
+254.711.174720