As Uganda looks to eliminate malaria, the country is engaged in a debate over the use of chemicals such as DDT in some of the world's most malarial regions.
In the district of Apac in northern Uganda, the risk of malaria is higher than anywhere else in the world. A mosquito in this area is more likely to carry the disease than in any other place on the planet. And neighboring districts are not far behind.
Malaria is the number-one killer of children under the age of five years old in Africa, and fighting it in these areas has been such a challenge that Uganda has turned to a controversial tool: the pesticide DDT.
The chemical was used widely in the United States and Europe during the first half of the 20th century and is credited with eradicating malaria in those regions. DDT has since been banned in both places, however, following the emergence of studies linking it to a number of health issues including diabetes and cancer.
However, as Ugandan health official Dr. Myers Lugemwa explains, DDT was the only practical solution for northern Uganda.
"Every mosquito there - or almost - is [malarially] effective," said Lugemwa. "We used DDT in that area and after just a few weeks we realized the reduction in malaria cases. Overall in Apac, the malaria instances reduced by 40 percent. In the neighboring district, it reduced by 50 percent."
The spraying of DDT in northern Uganda began in 2008, targeting Apac and the neighboring Oyam district. Officials spray the walls of people’s houses - referred to as Indoor Residual Spraying or IRS - to reduce the risk of infection during sleep.
According to Lugemwa, the initial spraying saw one species of malarial mosquito disappear from the region. But not all the residents of Apac and Oyam are happy with the results. Apac and Oyam are in a region that has, over the past decade, generated interest from distributors of organic produce. With little resources or development, farmers were raising crops naturally, which were then bought for export to Europe at premium prices.
Bosco Acope is a farmer in the village of Acobatek in the Apac district. Before the indoor spraying program began, Acope was growing soy, sesame, maize and cotton. His sesame and cotton crops were being bought by organic distributors for 20 percent more than the market price, providing him with the funds to send all of his 11 children to school. But in 2008, Acope’s house and neighborhood were sprayed with DDT, and the organic companies would no longer buy his crops. The companies pulled out of the sprayed areas, forcing Acope to pull three of his children out of school.
More than 15,000 small farmers were forced to give up their organic profits. Many simply had no choice. The Indoor Residual Spraying program is optional for every household, but once one house is sprayed, the surrounding homes can be exposed to the chemical. And many farmers reported simply being pressured into the procedure by health officials trying to fill their quotas.
Apac resident Lillian Richard said she was not given an option to refuse the spraying. Richard told VOA that in 2008, several sprayers came to her house while her husband was away and began to remove her belongings. She said they did not tell her what was being sprayed on her walls and ordered her not to enter the house for two hours after they had finished. Richard said she was told that if she refused the spray, her children would not be treated for malaria at the local health centers.
In protest of the program, which is sponsored by the United States Agency for International Development, organic farmers in the Oyam and Apac districts joined with the Uganda Network on Toxic Free Malaria Control in a lawsuit against the government. UNETMAC has criticized the government’s approach, saying chemical spraying was chosen because it is cheaper than providing sufficient amounts of anti-malarial medicine.
The national field coordinator for the IRS program, Richard Onen, has dismissed the farmers’ claims, denying that residents are under any pressure to have their homes sprayed. He also said it was a misconception that the program was not popular.
"The opinion changed. Only that we had those forces from the organic farmers, who were portraying the wrong image," said Onen. "But through sensitization, the community came to appreciate. In fact, the community was saying, ‘Let’s reintroduce DDT’ because they saw DDT was effective."
Onen is employed by Abt Associates, which is contracted by USAID to conduct the spraying. The coordinator confirmed that the group did have a spray-quota of 85 percent set by USAID and revealed that Abt had received bonuses for surpassing that target.
At the nearby Bala Health Center III, health officials are seeing the positive effects of the IRS program. According to the center’s figures, there has been a nearly 25 percent reduction in malaria cases from the peak month of August in 2009 to the same month in 2010. Bala nursing officer Kale Sam said the effects of the spraying are apparent.
"People who have taken the spray are no longer reporting any cases of illness with malaria," said Sam. "Most of the cases we are receiving here, they are those ones from houses which were not sprayed."
The UNETMAC lawsuit legally halted the spraying of DDT in Oyam and Apac. But the IRS program had already transitioned to other chemicals as local mosquitos began to develop a tolerance to DDT. In 2010, the courts ruled against UNETMAC and the organic farmers.
According to Dr. Charles Lugemwa, the program could potentially readopt the less-expensive DDT as the mosquito resistance subsides. With the documented effectiveness of DDT in the highly vulnerable Oyam and Apac districts, it appears the concerns of the organic farmers may be trumped by the fight against malaria.