Dengue

International POPs Elimination Network

October 2007

A sustainable strategy for eliminating DDT from disease vector control programs and reducing malaria: the Mexican Model
Jorge F. Méndez-Galván,1,4 R. Tapia-Conyer,2,3 A. Betanzos-Reyes,4 H. Olguín-Bernal,4 G. Sánchez-Tejeda,4 J. Thirión-Icaza,4 G. Reyes-Cabrera,4 R. and O. Velázquez-Monroy.4
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“Federico Gómez” Children’s Hospital ofMexico, Ministry of Health, Mexico, 2 The CARSO Health Institute, 3 Underministry of Health Prevention and Protection (Subsecretaría de Prevención y Protección a la Salud), Ministry of Health, Mexico, 4 CENAVECE, Ministry of Health, Mexico, Ministry of Health, Mexico.

INTRODUCTION Malaria continues to be one of the most significant health problems, causing approximately 200 million cases a yearwith between one and two million deaths. World efforts have been focused on vector control through the use of insecticides, applied residually on the walls of homes or impregnated in bednets, and through early diagnosis and treatment of those infected with this illness. In response to the resistance of mosquitoes and parasites to insecticides and respectively, there is increasingly more researchon these phenomena and some important advances have been made, although these threats have not been erased.1 A different perspective asserts that one of the fundamental problems that must be resolved in order to control malaria is whether actions aimed at vector control and early diagnosis and treatment are ongoing and sufficient in nature. There are other problems that are no less important,specifically: 1) The need to update the natural history of the illness and its epidemiology, 2) The need to discuss whether such large amounts of insecticides are actually necessary to control transmission, 3) Whether it is truly necessary to return to the use of DDT, 4) Whether we can improve diagnosis and treatment of those infected with this illness, 5) To better recognize the dynamics of vectorpopulations and to use principles other than insecticide use, 6) The need to truly work together with communities, 7) Whether only these mosquitoes are controlled with malaria vector control measures, and 8) The fact that even if this illness is brought under control, the risks associated with that control remain in most situations. In addition, one of the problems analyzed most recently is that theprices of the inputs used in controlling malaria are inaccessible, and while the incidence of malaria has increased, resources have diminished while costs have risen. Together, all of this confirms that malaria is indeed a neglected disease. The scientific information produced and published since the beginning of the last century has still not been analyzed at the international level. Someexamples of relevant information include: the findings indicating that zoonotic illnesses are transmitted in concentrated sites where the animals involved have found their niches;2 and references on malaria in Panama indicating that most infections were found in the same homes and some individuals had repeated infections, leading to the conclusion that the most important types of P. vivax malaria casesto be monitored are those in which the same individuals have numerous repeated infections.3,4 Nevertheless, the information in all of these reports was disregarded when strategies for eradicating malaria were designed in the mid-1950s.5 More recently, a range of evidence on the epidemiology of malaria in different parts of the world has been published. It has been confirmed, for example, that thereare homes and families in which malaria infections are constantly present, and it is assumed that the
A sustainable strategy for eliminating DDT from disease vector control programs and reducing malaria: the Mexican Model

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International POPs Elimination Network

October 2007

transmission in these homes is more intense than in other homes.6,7,8,9,10,11,12,13,14 Along this line it...