The politics of malaria control in Nigeria is not really enjoying Environmental health professional touch / approach as its done in civilized countries of the world where the war against malaria is (as a result) being won relatively to a large extent, but rather, the malaria fight in Nigeria is currently seen to suffer manipulations in favour of chemotherapy and Chemoprophylaxis thereby relegating non-drug techniques that Environmental Health actually, professionally provides.
That solely contributes to the reasons why malaria remains endemic in Nigeria despite all the billions of Naira pumped into the fight.
Also, another big contributory factor is the usurpation of managerial functions of preventive and Environmental health by medical doctors (for percuniary gains) from the trained Environmental Health Officers who are better trained and certified to manage the services.
There must be clear cut boundary between preventive health practitioners and curative health practitioners in Nigeria for malaria war to be won.
- EHSadvisor
We shall concentrate our discuss on Environmental health approach that could actually change the status quo and turn the tide against mosquitoes and malaria. You need to learn how you can make the environment unfavourable for mosquito breeding and how to kill the mosquito larvae in water collections as you will know more about the distinguishing characteristics of Anopheline larvae.
Environmental Health Management for vector control refers to the planning, organisation, carrying out and monitoring of activities for the modification and/or manipulation of environmental factors, with the aim of preventing or minimising vector breeding and reducing human-vector-parasite contact.
If such measures result in long-lasting or permanent changes in land, water or vegetation, they are often referred to as Environmental modification.
When such measures have a temporary effect and need to be repeated, they are known as Environmental manipulation.
Let us now focus on some simple and effective environmental manipulation tools, which can be planned and implemented at the village level by mobilising the community and under your direct supervision. Some environmental modification methods could involve very complicated engineering designs of natural and man-made water systems to make them unfavourable for vector breeding.
The first step in planning Environmental management activities is to identify the water collections where the potential vectors of malaria are breeding. You might plan to remove or destroy all potential breeding sites, whether they are sheltering mosquito larvae or not. However, this could be unrealistic if there are too many sites and your human and material resources are limited. Then you have to be selective and prioritise water collections according to the following criteria:
A) Water collections with anopheline mosquitoes only, and/or anopheline and other mosquito larvae should be removed.
B) All temporary rain water collections should be destroyed.
C) All water collections with other mosquito larvae have to be addressed.
D) Any standing water that is not used by people or their animals should be removed.
We will also enable you know more on how to identify areas that are vector breeding habitats in the community, and how to organise and coordinate community participation in larval control measures.
It is worthy of emphasis here again while also letting our government and political leaders know that cleaning and modifying the environment can make it hard for mosquitoes to complete their life cycle and be then develop to transmit malaria.
Larval control is one of the most important malaria prevention measures that can be planned and implemented at the community level.
Larval control is any method that helps prevent vector breeding or kills the mosquito at its larval stage.
There are other malaria prevention or vector control measures that are also very important and you need know more about. -EHSadvisor's blog
Some key points to know in malaria control and transmission:
1) Malaria is transmitted by a mosquito vector known as the female anopheles mosquito.
Not all mosquito types transmit malaria. The female anopheles mosquito lays its eggs in water collections and the life cycle in water takes about 10 days to complete.
The implications of these facts are that:
i. No mosquitoes means no malaria transmission.
ii. Making water collections unfavourable for mosquito breeding means few or no mosquitoes in the community.
iii. Killing the mosquito larvae in the water collections before they become adults and fly away, means fewer or no mosquitoes in the community.
If we could mobilize and synergize all our
Environmental Health resources to focus on achieving the above goals in our daily routine jobs would definitely mean very small or no malaria transmission.
This above malaria control method is called INTERRUPTION OF PATHWAY OF TRANSMISSION
in environmental health professional lingua. And it can be achieved by massively mobilizing Environmental Health professionals to that effect.
2.) There are measures that rely on using insect-killing insecticides against the adult (flying) mosquitoes by spraying insecticides with active knockdown effect indoors, against the adult mosquitoes and and also using insecticide-treated bed nets (ITNs) to achieve same.
ITS THE USE OF INSECTICIDAL CHEMICAL FORMULATIONS TO KILL MOSQUITOES AND BY EXTENSION, MALARIA.
This method is effective against adult and larval stage of the mosquitoes when professionally done. It is very good for indoors other impregnated materials as its kills broad spectrum
Also, its application in breeding sites and
have recorded very encouraging report. Eg DDT
Moreover, they kill all insects in its scope of application including those not of public health importance.
Larval control for malaria prevention
It must be also pointed out that malaria prevention with target on larval control is better and very strategic in winning the malaria war for the following reasons:
a.) Larval control is the first line of defense in malaria prevention and presents your first chance of breaking the malaria transmission cycle.
b.) The mosquito larvae are not flying insects; it is easy to find the water collections where they are developing to become the adult mosquitoes that will start biting people and transmitting malaria.
c.) Many of the larval control measures are inexpensive; they can be implemented by educating, mobilising and coordinating even community members to help by cleaning their environment. Compared to other measures, the chemical methods of larval control are also not very expensive and are simple enough to be applied even by volunteer health workers in the community after simple guides..
It must be pointed out that mosquito species differ in their preferences for breeding habitats. The species that mainly transmit malaria in Ethiopia (Anopheles arabiensis) breed in clean and muddy water collections that are either man-made or naturally-occurring near houses; they do not breed in polluted water like in poor sanitation systems. Once the breeding sites are known, appropriate control measures may be simple and inexpensive.
Most breeding sites in and near houses are easy to identify and simple methods are available to eliminate them. Community members can and should join hands with Environmental health officers in their job by taking mass action against any known/identified breeding sites of mosquitoes observed in or near their premises.
Larval control may be the only effective approach when mosquitoes bite outdoors and do not enter houses to feed or rest, or when the mosquitoes are not susceptible to the available insecticides.
Insecticide resistance of malaria vectors is particularly important in the Ethiopian situation. An important additional advantage of larval control is that some of the measures provide long-lasting protection.
LARVICIDING:
Larviciding is a technical term used to refer to the use of chemicals or biological agents or toxins to kill (mosquito) larvae. Water collection that cannot be managed properly by Environmental control measures can be better dealt with by larvicides. Like Environmental control measures, the success of larvicides will depend on the identification of mosquito breeding sites and their distribution in the area, followed by sustained weekly spraying of chemicals. Larvicides should be applied in conjunction with other Environmental control measures (Integrated pest management).
Applying larvicide into water collections that act as vector breeding sites. (Photo: Dr Yemane Ye-ebiyo Yihdego)
A chemical called Temephos (sold under the trade name Abate) has been the most widely used mosquito larvicide worldwide and in Ethiopia. Temephos is highly active against the nervous system of mosquito larvae and other aquatic insects, and a relatively low dosage can kill them before they reach the adult stage. Its toxicity (ability to poison) fish, birds, humans and other mammals is very low. Its low toxicity to non-target organisms and low effective dosage make Temephos the most appropriate larvicide in many situations. It is recommended for the control of mosquito larvae in drinking-water and in areas where fish, birds and mammals may come into contact with it.
According to the current Ethiopian national strategy for vector control, health posts will be supplied with spray pumps and Temephos, and you are expected to mobilise the community to undertake larviciding when necessary. Unlike indoor residual spraying.
Larviciding requires little technical skill and therefore you can train community members to spray Temephos into breeding sites under your supervision and technical support.
Before commencing larvicding technique, ensure the following:
a) You have to first estimate (in square metres) the size of the breeding sites that shows positive for Anopheles larvae, that in your professional opinion cannot be dealt with effectively by environmental management method.
b) Use a disposable syringe to measure 8 ml of Temephos (Abate) and mix it into 8 litres (one spray pump) of water.
c) One spray pump should cover an area of water of 320 square metres.
d) Pump by hand 60 times to produce the necessary level of air pressure in the sprayer.
e) Use trained community volunteers to spray the chemical onto the water in the breeding site.
d) Keep good records of the accomplished activities.
To ensure effective prevention and control of malaria in the target area, it is important that all temporary or permanent vector breeding sites are identified and dealt with through active participation of community members.
NOTE: This malaria control strategy becomes effective only when the mosquitoes are systematically interrupted from breeding and/or their population is substantially decreased.
In summary, methods to control mosquito larvae involve the following:
i) Eliminating or changing the breeding place to make it unsuitable for development of larvae.
ii) Making the breeding place inaccessible to adult mosquitoes.
iii) Larval control is also possible without changing breeding sites by applying chemical larvicides.
iv) The control of breeding places must be carried out around human settlements in an area with a radius greater than the flight range of the target mosquito species. For many species this is about 1.5–2 km.
v) All control measures that are not permanently effective have to be maintained throughout the period of the mosquito breeding season.
vi) The effort and expense needed to obtain effective larval control may vary with the size of the settlement and the type and number of breeding sites.
vii) In areas where malaria is a risk, you have to organise and educate the community to undertake environmental management activities such as draining, filling of communal mosquito breeding sites, irrigation canal water management, and chemical larviciding, etc.
viii) These activities have to be well planned and performed under your keen professional supervision and assisted by volunteer community workers.
In addition to the above efforts, do ensure that community level social and traditional structures such as CDCs, women’s associations, youth associations, cooperatives, health committees, schools, religious and community leaders, will all play a major role in social mobilisation as well as empowerment of the community to implement community based activities.
If the aforementioned procedures are carefully followed by qualified environmental health practitioner, there will be no breeding sites for mosquitoes and malaria will be defeated in Nigeria.
Always visit our blog for more to come soon....
-EHSadvisor's blog
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