91av

LAST week a pair of British researchers were hoping that flood-ravaged
Mozambique would try out their cheap and effective method of protecting disaster
victims from malaria. Instead, the Mozambique government has vetoed the plan to
spray refugees’ blankets with insecticide to kill the mosquitoes that carry
malaria, despite strong backing from aid workers in the country.

When told of Mozambique’s decision by 91av on 10 March,
Mark Rowland from the London School of Hygiene and Tropical Medicine said: “This
is very sad. It could have saved thousands of lives in Mozambique in the next
few weeks. I fear the worst. The malaria epidemic there is going to be huge
unless something is done urgently.”

Malaria is a major threat to Mozambique’s refugees as the floodwaters recede
and people return home. The pools of water now covering the landscape are
perfect breeding grounds for the Anopheles gambiae mosquitoes that
carry the deadly disease. Rowland fears a repeat of the heavy death toll from
malaria in the Tanzanian camps that sheltered the Rwandan refugees in the
mid-1990s.

In settled communities, the main weapon against malaria, apart from drugs, is
to spray insecticide in the buildings where people sleep. An alternative
developed during the 1990s has been to distribute bed nets sprayed with
insecticide. “But in emergencies such as Mozambique, people are mostly living
outdoors or in tents,” says Rowland. “There isn’t even anywhere to hang a bed
net.” And as the aid community discovered in Tanzania, bed nets are costly and
very hard to get in large numbers at short notice.

Blankets are different. “Every relief agency hands out blankets during
emergencies as a matter of routine. They are stockpiled in warehouses in huge
numbers ready for distribution. Several hundred thousand are on their way to
Mozambique,” says Rowland. “It is relatively cheap and easy to get them sprayed
as you distribute them. Even if people wash the blankets or they get rained on,
they will still provide protection for three or four months, hopefully until the
refugees are back in their homes.”

Rowland and his colleague Hugh Reyburn developed the idea while working in
Pakistani camps for refugees from Afghanistan. In trials, the incidence of
malaria among children sleeping under sprayed sheets and blankets fell by 64 per
cent. Each spraying of permethrin, which is widely used against headlice among
children in the developed world, costs 17 cents.

Nonetheless the Mozambique government has turned down an aid workers’ plan to
spray blankets distributed to flood victims. “We have decided to stick with
spraying the camps, and we hope to distribute nets when they arrive. I have 11
000 on order,” says Melanie Renshaw, the regional malaria officer for UNICEF. “I
have no doubt that spraying blankets is an extremely good idea, but it has never
been tried out in Africa before. We are not sure yet if people would accept the
sprayed blankets.” She says she hopes to carry out a trial soon among Angolan
refugees.