Sorry about the rather long heading for this post. But I wanted the heading to say more than being just a heading for this post. A news item in Yahoo Health News prompted me to write about this issue.

The news item was about a recent study published in The Cochrane Library which reviewed field studies done to evaluate the effectiveness of electronic mosquito repellents. The review concluded that electronic mosquito repellents are not effective! Here is the summary of the results of the review study.

Malaria is the number one killer of children under 5 years old in PNG. Malaria is also a high risk factor in pregnancy. And each year the National Department of Health of Papua New Guinea spends a lot of money to buy anti-malarial drugs. But we all know the common saying – prevention is better than cure!

My question is: are we doing enough to prevent malaria in PNG?

The current policy on the  prevention of malaria I think is only focused on distributing betnets. But I think we should more than that.

In the 60s and 70s and maybe through to early 80s, there used to be indoor spraying of DDT. DDT was very effective in killing adult mosquitoes but due to environmental concerns it was stopped by WHO. Mosquitoes were also becoming resistant to DDT. But since than, despite advancement in technology and research capabilities, there has not been any insecticide produced commercially at a large scale to combat mosquito transmitted diseases. There are some out there in the market but I think they are not as effective as DDT.

A friend who recently completed his MPH in  international health from the National Institute of Public Health, Tokyo, told me that DDT has been re-introduced by WHO for use but I have not sighted any article on that yet.

Many may argue that given our environment, climate and other factors, distributing bednets is the most cost-effective way. And I agree with that. But I also think this should be done aggressively and at regular intervals.  Not on an ad-hoc basis as it is now. I think every individual in every village should have a treated bednet. And not only that but there should be follow ups every 6 months or so for re-treatment of the bednets while issuing new ones to those who do missed out on the first time.

I am currently studying the toxicity of coconut oil on mosquito larvae. Although, I am not yet convinced that larviciding may be an option for controlling malaria in PNG in the villages, it may be useful in urban and peri-urban areas to control urban malaria.

Then there are the numerous mosquito coil repellents.

I have seen numerous brands in the supermarkets in PNG. Someone need to test the effectiveness of those coils too in PNG. Otherwise it may turn out like the electronic mosquito repellents. Being effective in the laboratory does not necessarily mean it will be effective when used in our homes.

Furthermore, I have also sighted research articles published in journals about these mosquito coils causing cells in the nose and throat to take abnormal shapes due to chronic inhalation of the smoke from these coils. These repellent coils need to be burn to release the insecticide or repellent as smoke. So if we are using them in our homes, it may work on mosquitoes but we are also inhaling the chemicals. Little is known about the side-effects of chronic inhalation of these chemicals.

I think we are not doing enough to reduce the burden of malaria in PNG. Treating with drugs is only curative. We should do more to prevent the number of deaths from malaria. When there is drug shortage in the country, the health workers make a lot of noise in the news media. The issue of intermittent supply of drugs in PNG hospitals is another problem on its own so will not talk much about it here. But only to say, we should put the same effort and energy in PREVENTING MALARIA in the villages as we are doing to make drugs available in the hospitals.