The Nation (Nairobi), February 5, 2004
By: Wodera James, Nairobi
A research scientist from the Ethiopian Health and Nutrition Research Institute (EHNRI) has sparked off a furious debate by calling for the immediate revision of the insecticide-treated bed-nets (ITNs) as a malaria control strategy for Africa.
Dr Tesfaye Mengesha of EHNRI, says that the ITNs strategy is not only "wanting," but also "ineffective, redundant and harmful to both mothers and children who are most at risk from malaria and the target groups of ITN programs".
But Dr. Mengesha's stand on ITNs is in stark contrast to the views held by many scientists working in the malaria field, among them those from the Kenya Medical Research Institute (KEMRI).
Backed by comprehensive data obtained from trials on the efficacy of ITNs in reducing malaria morbidity and mortality in areas of different ecological settings, many scientists believe that currently, ITNs represent the most cost-effective malaria control strategy in the continent.
"Well designed studies carried out in malaria endemic regions of Ghana, The Gambia, Kilifi in Kenya, and Burkina Faso, have all provided sufficient evidence on the health benefits of using ITNs.
More recently, data obtained from a study conducted from 1997 to the year 2000 in an area of intense and perennial malaria transmission in western Kenya by the US-based Centers for Disease Control and Prevention (CDC) in collaboration with KEMRI demonstrated that ITNs significantly reduce childhood morbidity and mortality as well as the adverse effects of malaria during pregnancy," observes KEMRI's Dr. Simon Kariuki.
However, Mengesha, who claims to have carried out extensive research on ITNs and their usage throughout Africa, told Horizon that it is unfortunate that business concerns have been placed ahead of health and medical concerns.
But Dr Kariuki disagrees, noting that he has not seen any published research on ITNs by his Ethiopian counterpart. "Is his extensive research published?" he questions, and adds, "I did a Medline search on Dr Mengesha and I am sad to say that I did not see any work that he has published to back his claims of extensive research on ITNs."
Mengesha, on his part, reads economics in the whole ITNs saga. "They (those agitating for continued use of ITNs) are being driven by the need to make quick profits as opposed to the facts on the ground," he says.
The Ethiopian scientist argues that continued use of ITNs is not only "ineffective," but if used by pregnant women, they "compromise the health of both the mother and child by depriving them of the much needed natural immunity hence making them susceptible to deadlier strains of malaria and other diseases later in life".
Mengesha presented these views to a disapproving audience at the recent 24th Annual African Health Science Congress held in Addis Ababa, Ethiopia, towards the end of last year.
However, Kenyan researchers at the parley, including those from KEMRI, Ministry of Health and local universities, disagreed with Mengesha and strongly advocated the continued use of ITNs.
ITNs target the mosquito, especially Anopheles gambiae, the vector mainly responsible for the spread of malaria in many parts of the country and in sub-Saharan Africa. KEMRI has carried out extensive research on ITNs. The highlights of some of KEMRI's and her collaborators' findings on the health benefits of ITNs in western Kenya were reported in 21 articles included in a supplement of the April 2003 issue of the prestigious scientific journal, the American Journal of Tropical Medicine and Hygiene.
The Writer is an Information Officer with KEMRI.