USAID and Malaria
USAID activities for malaria control are based on a combination of internationally accepted priority interventions and country-level assessments for achieving the greatest public health impact, most importantly, the reduction of child mortality (deaths).
USAID backs a comprehensive approach to prevent and treat malaria. This includes:
- Spraying with insecticides (“indoor residual spraying,” or IRS) in communities: IRS is the organized, timely spraying of an insecticide on the inside walls of houses or dwellings. It is designed to interrupt malaria transmission by killing adult female mosquitoes when they enter houses and rest on the walls after feeding, but before they can transmit the infection to another person. IRS has been used for decades and has helped eliminate malaria from many areas of the world, particularly where the mosquitoes are indoor-resting and where malaria is seasonally transmitted. USAID and the President's Malaria Initiative (PMI) activities include conducting environmental assessments, training spray teams, procuring insecticide and equipment, and developing and evaluating spraying activities.
- Insecticide-treated mosquito nets (ITNs): Bednets treated with insecticide have been proved highly effective in killing mosquitoes. In addition, the netting acts as a protective barrier. Consistently sleeping under an ITN can decrease severe malaria by 45 percent, reduce premature births by 42 percent, and cut all-cause child mortality by 17 to 63 percent. PMI is expanding access to free and highly subsidized nets while also creating commercial markets in African countries.
- Lifesaving drugs: Artemisinin-based combination therapies (ACTs) are the most effective and rapidly acting drugs currently available for treating malaria. PMI activities include purchasing ACT drugs; setting up management and logistics systems for their distribution through the public and private sectors; and training health care workers and community caregivers in their use.
- Intermittent preventive treatment for pregnant women (IPTp): Each year, more than 30 million African women living in malaria-endemic areas become pregnant and are at risk for malaria. IPTp involves the administration of at least two doses of sulfadoxine-pyrimethamine (SP) to a pregnant woman through antenatal care services. The treatment helps to protect pregnant women against maternal anemia and low birthweight, which contributes to between 100,000 and 200,000 infant deaths annually in Africa. PMI activities include purchasing SP, training health care workers in administering the drug, and providing information about IPTp to pregnant women.
USAID and DDT
USAID supports indoor residual spraying (IRS) with DDT as an effective malaria prevention strategy in tropical Africa in those specific situations where it is judged to be the best insecticide for IRS both epidemiologically and entomologically and based on host-country policy. Its use for IRS to prevent malaria is an allowable exception under the Stockholm Convention – also known as. the Persistent Organic Pollutants Treaty or POPs Treaty – when used in accordance with WHO guidelines and when safe, effective, and affordable alternatives are not available. For a variety of reasons, some countries do not conduct IRS or have not registered DDT for use in their malaria control programs. The reasons may include the epidemiological situation of the country, the organizational capacity of the program, or in some cases, concerns related to their agricultural export market. The Stockholm Convention aims to eventually end the use of all POPs, including DDT.
The determination of which of the WHO-approved insecticides to use for USAID’s IRS programs is made in coordination with the host-country malaria control program, with the primary objective of preventing as many malaria infections and deaths as possible. That determination is based on cost-effectiveness; on entomological factors; on local building materials; and on host-country policy. USAID adheres to strict environmental guidelines, approval processes, and procedures for the use of DDT and all other WHO-approved insecticides in its malaria control programs. As part of our environmental assessments and safer use action plans, we help countries build capacity for safe and judicious use of all chemicals used in their malaria control programs, including DDT
The fact is that DDT is more effective and less expensive than many other insecticides in many situations; as a result, it is a very competitive choice for IRS programs. DDT specifically has an advantage over other insecticides when long persistence is needed on porous surfaces, such as unpainted mud walls, which are found in many African communities, particularly in rural or semi-urban areas.
USAID has never had a “policy” as such either “for” or “against” DDT for IRS. The real change in the past two years has been a new interest and emphasis on the use of IRS in general, – with DDT or any other insecticide – as an effective malaria prevention strategy in tropical Africa. (Recent successful applications of IRS, particularly in the southern Africa region, have also contributed to the keen interest among donors and among African malaria control programs.) For example, in fiscalyYear 2005, USAID supported less than $1 million of IRS in Africa, with programs utilizing insecticides purchased by the host government or another donor. For fiscal year 2007, in the PMI and in other bilateral programs, USAID will support over $20 million in IRS programs in Africa, including the direct purchase of insecticides. This dramatic increase in the scale of our IRS programs overall is the greatest factor in DDT’s recent prominence in USAID programs.
USAID Issue Briefs
President's Malaria Initiative (PMI)
- PMI Website
- PMI Fact Sheet
- President's Malaria Initiative (PMI) E-Newsletter
This e-newsletter provides readers with the latest PMI news, country-specific activities, plus Q&A with Admiral R. Timothy Ziemer, U.S. Malaria Coordinator.
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