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

““The Convention reconizes three important facts:The Convention reconizes three important facts:

1.1. ... To mantain thier reliance on the use of DDT for ... To mantain thier reliance on the use of DDT for indoor residual spraying to control insect vectors, indoor residual spraying to control insect vectors, particularly malaria vectorsparticularly malaria vectors, ..., ...

2.2. A need to acelerate research and development of A need to acelerate research and development of safe, effective and affordable alternatives to safe, effective and affordable alternatives to DDT, ....DDT, ....

3.3. A longer-term goal of reducing the over-reliance of A longer-term goal of reducing the over-reliance of vector control programmes on pesticides in vector control programmes on pesticides in general, to protect both the ecosystem and human general, to protect both the ecosystem and human from negative impacts of POP pesticides.”from negative impacts of POP pesticides.”

WHO on DDT use in disease vector control under WHO on DDT use in disease vector control under the Stockholm Convention on POP’s (May-2004)the Stockholm Convention on POP’s (May-2004)

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, Mexico (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

Mexico, 2002

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

La Cigüeña

La Ventanilla

Lacandona

Impact in HumansDDT blood concentration in children, Mexico (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)

Me

an

co

nc

en

tra

tio

n (

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 Participating countriescountries

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

Implementing Implementing agencyagency

•United Nations Environment Programme

Executing Executing agencyagency

•Pan American Health Organization (PAHO)•National Governments

Funding Funding PartnersPartners

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

7.1655.8650.6540.200

US$ 13.884

DurationDuration Three years: August 2003- July 2006

General Information

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.

1. Implementation of demonstration projects and dissemination

2. Strengthening of national institutional capacity to control malaria without DDT

3. Elimination of DDT stockpiles4. Coordination and management

Components

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 adopted Stockholm Convention on Pops.

Focal Areas

Implementation Strategy

• To integrate epidemiology with social sciences, entomology, public health, environment 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

Demonstration projects

• Demonstration projects in sites selected

• Baseline assessment concluded

• Community participation attained

Technical Manual

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

Dissemination

The Regional Perspective of Malaria in Mexico and Central America in the Context

of Epidemiological Stratification

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)

GIS-DDT-GEF Demonstration areas in Central America, GPS survey progress

and instrumentation of the SIGEpi Model up to May 2005

Tropical broad leaf rain forest

Municipalities with malaria transmission in 2004Municipalities with malaria transmission in 1960

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

Malaria Stratification and Levels of Analysis in the GIS DDT Model for

Honduras, May 2005API, municipal level 2002 API, locality level 2005

Cases, intra-locality level cases 2005… in SIGEpi

• Identification of malaria houses per week• Detection of houses on transmission risk

•100 meters proximity• close to a mosquito breeding site

• Intervention programming of community actions and focal control and preventive treatments

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

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

Malaria Malaria cases and house spraying cases and house sprayingMMééxico 1959 - 2004xico 1959 - 2004Cases Houses

ERADICATIÓNERADICATIÓN

Y e a r

DDT

CONTROLCONTROL

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

59 61 63 65 67 69 71 73 75 77 79 81 83 85 87 89 91 93 95 97 99 01 03

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Houses

Cases

Piretroids