Elsevier

The Lancet

Volume 356, Issue 9226, 22 July 2000, Pages 330-332
The Lancet

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DDT house spraying and re-emerging malaria

https://doi.org/10.1016/S0140-6736(00)02516-2Get rights and content

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DDT in malaria eradication

Even in the earliest field studies, DDT showed spectacular repellent, irritant, and toxic actions that worked against malaria vector mosquitoes.10 When DDT was sprayed on house walls (2 g/m2) it exerted powerful control over indoor transmission of malaria.11 As a consequence, house spraying produced excellent and rapid results in 1943 in the Mississippi Valley, USA, then in Italy, Venezuela, Guyana, India, and several other countries. Housespraying programmes functioned as national

Resistance to DDT

Resistance of Anopheles spp mosquitoes to DDT is not a major barrier to the continued use of DDT for malaria control (ie, where DDT is still effective, it should be used). Resistance slowly appeared in the 1960s in response to intensive agricultural uses of DDT, especially in cotton production. The current distribution of DDT resistance among malaria vectors covers limited regions located in West Africa (A gambiae), southwest Asia (Iran, Pakistan, India, Sri Lanka; A culicifacies), Greece (A

Environmental concerns

Claims of risks of DDT to human health and the environment have not been confirmed by replicated scientific inquiry. This is all the more remarkable given that DDT has been used for malaria control for almost 55 years. According to Curtis and Lines,17 toxicity of DDT in human beings and effects on the environment are questionable and require further investigation.

Since the early 1970s, DDT has been banned in industrialised countries and the interdiction was gradually extended to malarious

Consequences of the ban

When a malaria-endemic country stops using DDT, there is a cessation or great reduction in numbers of houses sprayed with insecticides, and this is accompanied by rapid growth of malaria burden within the country.1, 12, 17 DDT house spraying was stopped in Sri Lanka in 1961, and this was followed by a major malaria epidemic. Since then, numerous epidemics have occurred in many countries, after suspension of DDT house treatments, such as Swaziland (1984) and Madagascar (1986–88), where malaria

The future

There is no ideal solution to the problems of malaria control, and DDT house spraying has its limitations. However, DDT remains a remarkably effective tool that should still be used. There is a continuing need for operational research to improve the cost-effectiveness of this approach. It is an astonishing fact that WHO guidance for spraying houses is the same today as it was in the eradication era (2 g of DDT/m2 of wall surface every 6 months). New and improved approaches to malaria control

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      However, in some cases the threat has to be explicitly stated because there can be several of them. Measures that promote safety against the ecotoxic effects of DDT may on some occasions lead to less safety against malaria (Roberts et al., 2000; Schettler et al., 2000; Anon, 2000). Parents who keep their children indoors to make them safe against attacks from paedophiles have been accused of making them less safe against other dangers such as obesity (Gardner, 2008, p. 14).

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