Regional Program of Action and Demonstration of Sustainable Alternatives to DDT for Malaria Vector Control in Mexico

and Central America

Third Biennial International Waters Conference

Salvador, Bahia, Brazil.

20-25 June 2005

This Project conforms with the Contaminant-based Operational Program No. 10 and will help demonstrate ways of overcoming barriers to the adoption of best practices that limit contamination of the international waters environment.

The proposed activities are also consistent with several provisions with the adopted Stockholm Convention on POPs. DDT is one of the POPs in the Stockholm Convention.

Focal Areas

While Malaria is Increasing in The AmericasWhile Malaria is Increasing in The AmericasPP. . VivaxVivax y y PP. . FalciparumFalciparum

1959 - 19991959 - 1999

PAHO/WHO

Year

Num

ber

of c

ases

(th

ousa

nd)

0

50

100

150

200

250

300

58 60 62 64 66 58 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98

US$

mill

ions

Year

PAHO/WHO

Financing in Malaria Campaigns Financing in Malaria Campaigns iin The n The Americas is Decreasing Americas is Decreasing

1958 - 19991958 - 1999

DDT in the Environment, Including International Waters and Human

Bodies.

Facts on the Course of DDT

• DDT was Used for Public Health Malaria and other Vector Born Disease Control.

• Central America and Mexico Stopped DDT Use in the 1990’s and 2000.

• DDT is Still found in the Environment and Human Bodies.

Dispersion of DDT in Mexico

Levels of DDT found on sediments in the Lagoons of Zempoala, Morelos and its comparison with DDT used for malaria control in Mexico

Decades

DD

T a

pplie

d (t

)

Year

DDT used in Mexico

Impact in BiotaConcentration of DDT (ng/g) in species of the food chain in

“La Cigüeña”, Chiapas (2002)

Crabs = 23.84Fish = 24.08

Birds = 232.50

Sediment = 138.37

Impact in the EnvironmentTotal DDT (µg/kg) in superficial soil in malaria communities

in 2002

La Cigüeña

La Ventanilla

Lacandona

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000T

otal

DD

TA

vera

ge (

µg/

kg)

Ventanilla Cigüeña Lacandona

Total DDT interiorTotal DDT exterior

Impact in HumansDDT blood concentration in children (µg/L)

0

10

20

30

40

50

60

70

80

2000 2001 2002 2003 2004

Years

DDT in blood in children "La Cigüeña", Chiapas

DDD (µg/L)DDE (µg/L)DDT (µg/L)

Mea

n co

ncen

trat

ion

(µg

/L)

Impact in HumansDDT, DDE and DDEms levels in breast milk of 30 Mexican

mothers (ng/g lipid)

SubstanceSweden

1992Mexico

2004

DDT 22 366

DDE 227 1683

DDEms 0.4 3.4

Participating countries

Belize, Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama

Implementing agency

•United Nations Environment Programme

Executing agency

•Pan American Health Organization (PAHO)•National Governments

Funding Partners

•Global Environment Facility•National Governments•PAHO•CEC Total

7.1655.8650.6540.200

US$ 13.884

Duration Three years: August 2003- July 2006

UNEP/ GEF/ PAHO Project to Demonstrate DDT Alternatives for Malaria Control.

Overall Objective

• To demonstrate that methods for malaria vector control without DDT or other persistent pesticides are replicable, cost-effective and sustainable thus preventing the reintroduction of DDT in the Region.

• Elimination of DDT stockpiles• Implementation of demonstration projects on alternatives

to DDT for Malaria Control and dissemination• Strengthening of national institutional capacity to control

malaria without DDT• Coordination and management

Components

Inventory of DDT and Other POPs

Country DDTOtherPOPs

Belize 13.000 0.008

Costa Rica 8.621 0.122

El Salvador 4.672 46.252

Guatemala 15.058

Honduras 3.539 12.490

Mexico 87.000

Nicaragua 0.003 5.647

Panama 4.545

Total 136.438 64.519

Implementation Strategy

• To integrate epidemiology with socio-economic issues, entomology, public health, environment, water and provision of health care.

– Epidemiological stratification with risk approach

– Elimination of the persistent parasite

– Ecological larvae control with social participation

– Control of the adult mosquito with inexpensive techniques and low environmental impact

– Sustained sanitation educational program aimed at the community

1. Community participation can provide mosquito

control management by regulating or modifying the

breeding sites in water bodies and areas surrounding

houses.

2. Hygiene seems to play a great roll in malaria

transmission. Good sanitation and familiar hygiene

can reduce mosquito attraction.

3. If malaria concentrates in only a few households,

then suitable drug treatment can reduce infection

sources and the risk for the community.

Model for Malaria ControlModel for Malaria Control

The breeding sites are influenced by the presence of water in streams and rivers.

The breeding sites are characterized by the presence of low flux of streams and green algae.

Aquatic Habitat of Larval StagesAquatic Habitat of Larval Stages

Technical Manual on Demonstration Activities

Guide for the implementation and demonstration of sustainable alternatives for the integrated control of malaria in Mexico and Central America

http://shp.paho.org/sde/ddtgef/default.aspx

Collection, Discussion and Dissemination of Information

Geographic Information System Models used in the Project

The SIGEpi perspective has the purpose of standardizing, integrating, compiling and facilitate the interchange of digital cartographic infrastructure ( data, methods and software) as a foundation for

analyzing geographically the data about malaria vector control and DDT residuals.

Tropical rainforest distribution (red) CONABIO map Mex. 1999 and CIESIN

satellite image, 1995

Areas below 800 meters above average sea level. Digital Elevation Model (DEM),

USGS, 2001.

API by first sub-national level in Mesoamerica (Central America Basic Indicators 2001) and Mexico Rates x 1000 inhabitants by second

administrative level (SUAVE, Mex, 2001)

Costa Rica’ s GIS Local Scale Observation Level for Malaria

Control

Mosquito breeding sites and surrounding positive houses to malaria

Progress in the GPS dwellings survey in localities along the border corridor between Costa Rica and Panama

Paper map

The same map in vector and raster digital format in SIGEpi

GPS demonstration

Panama

Costa Rica

From Sketch to Digital Maps in Panama Showing Malaria

Houses (red houses)

Calculating the number of preventive treatments in

the 200 meters surroundings

Steering Committee8 Ministers of HealthPAHOUNEPCECCCADObservers: World Bank, UNDP, NGOs, other cooperation agencies

Regional Operational Committee

1 Regional Coordinator8 Focal Points (Health)8 National CoordinatorsRepresentatives from NGOs and the Civil Society

9 Working Groups Demonstration Projects

National CoordinatorFocal PointEnvironment RepresentativeAgriculture representative

National CommitteeNational Focal Point (Health)National CoordinatorEnvironment RepresentativeAgriculture RepresentativeCustoms or Immigration Representative

UNEP/GEFImplementing/Donor Agencies

PAHOExecuting Agency

CECCooperation Agency

Advisory Committee

Universities, Research InstitutionsCivil Society, Organizations and NGOs with activities related to the project

Advisory Committee

One representative from each governmental unitRepresentatives from NGOs and the Civil Society

Organizational Chart