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Dichlorodiphenyltrichloroethane (DDT) for Indoor Residual Spraying in Africa: How Can It Be Used for Malaria Control?

Shobha Sadasivaiah, Yeim Tozan, AND Joel G Breman^*

In 2006, the World Health Organization issued a position statement promoting the use of indoor residual spraying (IRS) with dichlorodiphenyltrichloroethane (DDT) for malaria vector control in epidemic and endemic areas. Other international organizations concurred because of the great burden of malaria and the relative ineffectiveness of current treatment and control strategies. Although the Stockholm Convention of 2001 targeted DDT as 1 of 12 persistent organic pollutants for phase-out and eventual elimination, it allowed a provision for its continued indoor use for disease vector control. Although DDT is a low-cost antimalarial tool, the possible adverse human health and environmental effects of exposure through IRS must be carefully weighed against the benefits to malaria control. This article discusses the controversy surrounding the use of DDT for IRS; its effective implementation in Africa; recommendations for deployment today, and training, monitoring, and research needs for effective and sustainable implementation. We consider the costs and cost effectiveness of IRS with DDT, alternative insecticides to DDT, and the importance of integrated vector control if toxicity, resistance, and other issues restrict its use.

Received March 9, 2007. Accepted for publication July 23, 2007.

Acknowledgments: We thank Mortezza Zaim of the WHO Pesticides Evaluation Scheme, Robert Gwadz of the National Institute of Allergy and Infectious Diseases, Yeya Touré of WHO Special Programme for Research and Training in Tropical Diseases, and the anonymous reviewers for their constructive comments on the manuscript. We acknowledge the African Network on Vector Resistance for their assistance on vector surveillance capacity in Africa. We also thank Kathleen Walker, University of Arizona; Juan Arredondo, Ministry of Health, Mexico; Gezahegn Tesfaye and Afework Hailemariam Tekle, Ministry of Health, Ethiopia; Yemi Sofola, Ministry of Health, Nigeria; John Paul Clark, United States Agency for International Development; Ellis McKenzie and David Smith, Fogarty International Center, National Institutes of Health; Pierre Guillet, Global Malaria Programme, WHO; and Robert Novak and Uriel Kitron, University of Illinois at Urbana Champaign for their guidance and feedback. The views expressed in this article do not necessarily reflect the views of those listed above.

Financial support: This work was supported by the Disease Control Priorities Project, Fogarty International Center, National Institutes of Health.

^* Address correspondence to Joel G. Breman, Fogarty International Center, National Institutes of Health, Bethesda, MD. E-mail: jbreman{at}nih.gov

The first two authors contributed equally to this manuscript.

Authors’ addresses: Shobha Sadasivaiah, Weill Cornell Medical College of Cornell University, 1300 York Avenue, New York, NY, 10021–5320, Tel: 301–496–0815, Fax: 301–496–8496, E-mail: shs2019{at}med.cornell.edu. Yeim Tozan, Earth Institute, Columbia University, B15 Hogan Hall, Mail Code 3277, 2910 Broadway, New York, NY 10025–7822 and Disease Control Priorities Project, Fogarty International Center, National Institutes of Health, Building 16, Room 202, 16 Center Drive, MSC 6705, Bethesda, MD 20892–6705, Tel: 301–496–0815, Fax: 301–496–8496, E-mail: tozany{at}mail.nih.gov. Joel G. Breman, Disease Control Priorities Project, Fogarty International Center, National Institutes of Health, Building 16, Room 214, 16 Center Drive, MSC 6705, Bethesda, MD 20892–6705, Tel: 301–496–0815, Fax: 301–496–8496, E-mail: jbreman{at}nih.gov.

Reprint requests: Joel G. Breman, Fogarty International Center, National Institutes of Health, Building 16, Room 214, 16 Center Drive, MSC 6705, Bethesda, MD 20892-6705, Tel: 301-496-0815, Fax: 301-496-8496, E-mail: jbreman{at}nih.gov.

This article has been cited by other articles:

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