Background Under-five mortality rate 123/1000 live births SA 1.1 - PDF document

Out line • Back Ground and Introduction • DDT Assessment at Global level Overview of DDT Use In Ethiopia • Comparison of DDT with Other Insecticides • Ethiopian Experience in Using DDT: Information Dissemination Work Shop • Challenges and The way forward On the status of DDT use, Seife Bashaye, April 2009 Cont.. Background • Under-five mortality rate 123/1000 live births • SA 1.1 million Km 2 • Neonatal mortality rate 39/1000 live births • Population estimated73,845,035 (2007 census) • 84 % Rural • Infant Mortality 77/1000live births • There are 9 regional states and 2 city administrative • Maternal Mortality Ratio live births4 councils • Total fertility rate 5,4 • 736 woredas (districts) and 15,000 kebeles • 2007 – DPT1 – HepB – Hib coverage72.6% * 2HEW for each kebele • 2007 – TT2+ for Pregnant women 62.2% * Cont.. Introduction • DDT  Was in use in Developed Countries (para,Para ’ Dichlorodipheniltrichloroethane) is  USA (Until 1972), United Kingdom (until 1984), Germany a persistent Organochlorine compound which (until 1974) Canada (until 1989) Sweden and Norway was widely used as insecticide in agriculture in (until 1970) were some of them  The Stockholm convention which entered in to force in different countries including Ethiopia. May 2004 , had a goal of reducing and ultimately eliminating the use of DDT • synthesized in 1974 where it’s insecticidal properties have been clearly identified in1939. 32

DDT Assessments at Global Level Cont Contemplation in Withdrawal from DDT were • WHO, International Program on Chemical safety (IPCS), largely related to Environmental Concerns United Nations Environmental Program, International Labor Organization (ILO), the initiatives by FAO, and others involved • transportation of DDT far from origin of use in the issue via biotic and a biotic factors and its • But the continued need for DDT in diseases accumulation in the fat tissues of animals, vector control as indoor Residual spray oceans, lakes rivers and air sustained • its toxicity to aquatic life mainly the fish including the amphibians DDT Ass Cont DDT ASS Cont..  For instance in USA alone DDT reached up to • The other factor is its Persistence in the 36,000 metric tones/year by mid 50s. A total environment related to its half life in of 613,000 mt tones had been in use there in different media, soil and water. (up to 15 the USA years in soil)  DDT as in IRS no justification on adverse effect • Some peoples link it to egg shell thinning in has been identified that can Change The birds (controversial). WHO Position not to use it. • These Environmental concern was realized mainly when DDT was released in to open environment linked to agriculture. cont Some Explicit Documents • The IPCS global Assessment conducted in 2000 • International Program on Chemical Safety reported that the biological plausibility of (IPCS) assessments conducted as early as 1995 possible problems to certain human functions like reproductive systems. showed that 12 Persistent Organic Pollutants) • The assessment conducted by WHO was the POPs were identified most recent which considered a number of evaluations undertaken by Joint Meeting on • a number of health related concerns like Pesticides Residues (JMPR) in 2000 impaired reproduction, endocrine dysfunction • concluded that DDT and its metabolites show and immuno- suppression raised wide range of long term health effects in laboratory animals 33

Cont.. Cont..  All studies that were reviewed showed that • despite the range of effects in animals, no correlation between exposure to DDT and still births, miscarriage or premature rupture epidemiological studies in Humans did not of fetal membrane support hypothesis that DDT or its  An over all outcome from the review of JMPR metabolites increased rates of pancreatic meeting in 2000 agreed the provisional cancer, multiple myeloma, breast cancer, Tolerable Daily intake (PTDI) to 0.01mg/kg bw uterine cancer or prostate and testicular based on toxicity in rats cancer. Cont.. Cont. • This assessment documented the • JMPR further concluded that the available reproductive ,developmental and other data on humans did not show causal effects on animals excluding humans. relationships for carcinogenicity in any organ • WHO, based on these assessment findings, system or significant adverse effects after came to the conclusion that there is no reason repeated exposure to concentrations up to to change the use of DDT for Vector Control. 0.25 mg/kg bw per day. • Different reviews made by WHO in different • The Joint WHO /FAO International DDT risk forums conducted in different countries, i assessment was the other source Cont.. Cont.. • Recommended that DDT can be used in • Different reviews made by WHO in different malaria endemic Countries in addition to the forums conducted in different countries, epidemic affected ones, which was not the • Consultative meeting Resolution regarding tradition before 2006. The most “PRO DDT” health effects on DDT delivered in Congo Brazzaville in 2006, 34

Conditions Comparison of DDT with Other Insecticides  It is effective( Bio assay and susceptibility tests should be done regularly ( Challenge) • DDT so far is the first line insecticide used for IRS,  For Indoor Spraying (another Challenge because it is the cheapest, relatively safe, and effective under close monitoring & long residual effect – greater in Ethiopia) than 6 months  The material is used to the specifications issued by WHO(WHOPES) • DDT may be used for vector control provided  The necessary safety precautions are taken in its use that all the following conditions are met. and disposal Cont.. Cont.. Recommended dosage of Duration of effective action Estimated cost per house per WHO toxicity rating [6] active ingredients (gm/m 2 ) 41 (months) 6months (US$) [5] Insecticide Class DDT Organochlorine 1-2 >6 1.6 II • Key: Ia=Extremely hazardous; I b=Highly hazardous; II=Moderately hazardous; III=Slightly hazardous; U=unlikely to be hazardous; Source World Health 2 3-6 14.80 II Fenitrothion Organophosphate organization, The Who Recommended Classification of pesticides by Hazard, 2005 Malathion Organophosphate 2 2-3 8.20 III • Pirimiphos-methyl Organophosphate 1-2 2-3 III Propoxur Carbamate 1-2 3-6 18.80 II Bediocarp Carbamate 0.1-0.4 2-6 13.80 II Alphacypermethrine Pyrethroid 0.02-0.03 4-6 II Cyfluthrin Pyrethroid 0.02-0.05 3-6 II Deltamethrine Pyrethroid 0.02-0.025 3-6 1.60 II Etofenprox Pyrethroid 0.1-0.3 3-6 U Lambdacyhalothrin Pyrethroid 0.02-0.03 3-6 8.60 III Bifenthrine Pyrethroid 0.025-0.05 3-6 II Cont… Ethiopian Experience in Using DDT: • Major epidemics occur every 5 - 8 years, but focal epidemics occur every year, before three years. • Two parasite species – Plasmodium falciparum (60%) – P. vivax (40%) • Main malaria vector – Anopheles arabiansis – Anopheles pharoensis 35

Cont Cont.. • Malaria is a major public health problem in – Depends on topography and climate Ethiopia – 75% of the land mass malarious – Every year it was the leading cause of out patient consultations, admissions and death – > 52 million 68% of the population at risk – Recently, however, the rapid scale up of – 400,000-500,000 microscopically confirmed interventions has brought about significant decline in malaria burden cases/year In 2006/7 it become 6 th cause of outpatient • – 4 - 5 million clinical cases/year consultations • No malaria epidemic report Main Strategies Con..Malaria Epidemic • Early Diagnosis and prompt Treatment • Selective Vector Control( IRS, ITNs, – M alaria epidemics first documented in 1930, Environmental control including abates) – 1953 -1955 : About 7000 malaria deaths reported from epidemic affected places in Gonder area near Lake • Early Detection and prompt Containment of Tana, Epidemics – In 1953 which further continued to hit Bahir Dar area , Supportive( Surveillance, H.ED, Training, south of L. Tana, Operational R..) – 1958 (June – December) massive epidemic in the Dembia Plains with 3 million cases & about 150,000 deaths (100,000 square miles area of altitude range of ( Goal:To eliminate Malaria by 2020 ) 1600-2150 m affected), – 1987/88, 1994/95, 1997/98, 2003, 2005 DDT Exp . Cont.. – Indoor residual spraying has been • DDT is the first line insecticide used for implemented in Ethiopia for more IRS, (cheap, effective & long residual effect than 4 and half decades. Mainly as – up to 6 months), epidemic control • Indoor residual spraying is applied in epidemic prone areas on selective basis - – The insecticide used is DDT 75% once or twice a year – Every year 20% – 40% of spray able localities covered 36