Meant to Keep Mosquitos Out, Nets Are Used to Haul Fish In
nytimes.com
nytimes.com
Actually Flu and Malaria kill roughly about the same number of people globally each year. Imagine if African billionaires showed up on our shores one day and started handing out respirators and face masks to Americans. "Just everyone wear these all winter and you won't catch the flu! So many lives would be saved!" We might use them to go fishing as well.
My wife got malaria all the time in Nigeria, it was like a really bad cold or a flu in America. You get over it and move on. Only if your immune system is already compromised in some other way like old age or whatever malaria isn't really that big a deal among those who were strong and healthy before getting it. Instead of trying to stop malaria, focus on how they can get food. If they're well fed and strong/healthy, the malaria won't kill 'em just like it didn't kill my wife or any of her 5 siblings, or her university classmates, or my parents, or their siblings, etc. Now, there are those in Africa who don't have plenty to eat and/or have stressful daily lives that prevent getting a couple of days of rest. That is what allows malaria to kill so many. Just like the flu in America would kill a whole lot more often if there was a lack of food or inability to get consecutive days of rest.
One also has to remember the epidemic flu viruses that killed millions in the west in past centuries, yet now we barely care enough to get flu shots.
However, for people with limited access to medical care (too remote or too impoverished), preventing Malaria altogether is the best bet, hence mosquito nets.
Anyhow, health and other factors matter more than mosquito nets... Malaria isn't too different than the flu, and the flu has killed millions in the past.
In the US, 3,000-49,000 people die each year from the flu.[2]
Clearly, the scales are not comparable.
[1] http://www.who.int/malaria/media/world_malaria_report_2013/e...
vs.
> in the US
Speaking of incomparable scales...
627,000 malaria deaths * 90% in sub-Saharan Africa[1] = 564,000 malaria deaths in sub-Saharan Africa.
564,000 deaths / population of Africa (~815 million) = 69.2 African malaria deaths per 100,000 people.
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About 32,743 U.S. flu deaths per year, recently.[2]
32,742 deaths / population of U.S. (~316 million) = 10.4 U.S. flu deaths per 100,000 people.
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It looks like, by these numbers, that malaria in Africa is about 6.7 times as deadly as the flu in America.
[1] http://www.who.int/malaria/media/world_malaria_report_2013/e...
[2] http://www.npr.org/blogs/health/2010/08/26/129456941/annual-...
The flu? That's a completely different story..
Malaria is believed to kill on the order of a half million or more a year. There are other infectious diseases that kill millions of people - such as the many illnesses that cause diarrhea - and these are also prevalent in Africa, and related to health care.
Ultimately improving health care has cumulative effects. A society that does not need to worry about malaria (or influenza, for that matter) can begin to work on other issues. When so many children die every year from a random illness, adults cannot plan families, governments cannot address other issues.
It's vital that malaria be cured because it is necessary to solve many other issues. Improving health care, period, would reduce the population growth rate and allow more resources to be dedicated to education, infrastructure, and yes, further improving health care.
It's only in places like the United States, where the leading causes of death are from ourselves (car crashes), from disease associated with old age (cancer, heart disease), and our mistakes (medical mistakes), that we can be a society that looks so far forward.
It's difficult for someone in the 21st to realize that our treatment of influenza and other diseases has prepared us to be a super power. Diseases just don't kill people very often in the US, and allowing young children and their parents to not worry has drastically changed our society.
[1] http://www.huffingtonpost.ca/lawrence-solomon/death-by-influ...
People in Europe don't die of malaria. It just doesn't happen. People in Europe do die of influenza, and that is a global problem, but this is a localized disease that kills a half million people a year. Now, this might be just a case of me coincidentally finding stats to back up my argument, but I searched for "malaria deaths africa" and found this graphic:
http://www.rbm.who.int/gmap/3-2.html
It looks like Sub-Saharan Africa has about 71% of the worldwide cases and 86% of the worldwide deaths. Concentrated in a population of comparable to the US or the EU - not the world. If these statistics are accurate, the death rate is so much higher it's not comparable to influenza. The top 4 countries, Nigeria, DRC, Uganda and Ethiopia have a higher population than the US, but they also apparently account for half of the malaria deaths.
So it's not like the flu, for the countries with prevalent malaria, it's many, many times worse.
http://www.who.int/mediacentre/factsheets/fs211/en/
Malaria kills about 650,000 people each year. The low estimate is 473,000 and the high estimate is 789,000
So, if by "roughly the same" you mean "more" then yes, they are roughly the same.
And people do take flu immunisation if they are in a vulnerable group.
Couldn't giving them out for free increase coverage even if the average usage is lower?
The symptom is that people are misusing nets. The problem is that they have no sustainable food system.
You've hit on the fundamental challenge of complex systems — it's the interactions between components that determines the behavior, not the components themselves. I would strongly recommend the video I linked elsewhere in this thread, if only as a "crash course" in systems thinking.
Agreed, that doesn't qualify as a sustainable food system.
No argument there. They need their own sustainable food system.
We all do, if humanity is to continue (which is all "sustainable" means — able to continue).
How could humanity possibly continue without a sustainable food system? Am I missing something? This seems pretty uncontroversial.
The problem is picking the right problem. There are big problems, like hunger. No matter how many resources you have, you're never going to make a dent in world hunger.
There are smaller problems, like dam building. One could, conceivably, build all the dams in the world that need to be built. But just like the big problems, there's never going to be any shortage of these smaller problems to solve, and each effort needs to be managed and championed.
So you can't just solve all of them. You have to pick one at a time and throw everything you have at it. The problem is not resources, but ideas. We need really good ideas for how best to go about making the world a better place. A good idea needs to be simple, because it has to be scaled.
HN is a forum where one good idea could inspire someone to make a Kickstarter campaign, that could attract the attention of someone like Bill Gates, and could improve the lives of potentially millions of people. I wish more people took that seriously.
Malaria nets have their problems. But they've also helped eradicate malaria in many places. People look at stories like this and they think, "aww that was a stupid idea anyway! Silly billionaires." It's not a stupid idea. It's a great one that we need more of.
You seem to be viewing the less-industrialized world as a philanthropic playground for the rich. Naomi Klein's comments about Richard Branson's climate prize seem especially pertinent here. https://www.youtube.com/watch?v=Jdaxehd0cF0#t=2m44s
So, you have nothing to bring to the discussion other than some silly moralizing.
If Richard Branson could fix global warming while keeping a silly grin on his face, tossing around a beach ball, would you pat him on the back like he's expecting you to do and tell him how great he is, or would you rather he just sit down and shut his stupid face because obviously global warming won't respond to such a simplistic approach? Even if it does?
>>>The basic problem is this. There are a great deal of resources that can be brought to bear on solving problems in the world. There are lots of philanthropists in the world, with lots of money.
Yes, those things are true. There are also people over there, and their participation matters at least as much as (and I would argue much more than) that of the wealthy elite.
In the case of the "carbon-sucking gizmo", the cure is worse than the disease. Even Branson-level cash can't change thermodynamics and evolution.
The Virgin Challenge finalists are conspicuously absent in their energy and land use analyses. I expect they suffer from the same problems as previous CCS "solutions" — energetically they can't compete with simply shutting down a coal plant, and in land use they can't compete with reseeding farmland to forest. So when you understand why those simpler methods aren't done, you'll understand the finalist's actual scaling problem.
It all washes out in the lifecycle analysis. Anything else is feel-good.
"It is often argued that cost-sharing—charging a subsidized, positive price—for a health product is necessary to avoid wasting resources on those who will not use or do not need the product. We explore this argument through a field experiment in Kenya, in which we randomized the price at which prenatal clinics could sell long-lasting antimalarial insecticide-treated bed nets (ITNs) to pregnant women. We find no evidence that cost-sharing reduces wastage on those who will not use the product: women who received free ITNs are not less likely to use them than those who paid subsidized positive prices. We also find no evidence that costsharing induces selection of women who need the net more: those who pay higher prices appear no sicker than the average prenatal client in the area in terms of measured anemia (an important indicator of malaria). Cost-sharing does, however, considerably dampen demand. We find that uptake drops by sixty percentage points when the price of ITNs increases from zero to $0.60 (i.e., from 100% to 90% subsidy), a price still $0.15 below the price at which ITNs are currently sold to pregnant women in Kenya. We combine our estimates in a cost-effectiveness analysis of the impact of ITN prices on child mortality that incorporates both private and social returns to ITN usage. Overall, our results suggest that free distribution of ITNs could save many more lives than cost-sharing programs have achieved so far, and, given the large positive externality associated with widespread usage of ITNs, would likely do so at a lesser cost per life saved."
Jessica Cohen & Pascaline Dupas, "Free Distribution or Cost-Sharing? Evidence from a Randomized Malaria Prevention Experiment", 2010 http://www.stanford.edu/~pdupas/CohenDupas.pdf
"The third finding from recent pricing studies is that people need not have paid for something to value it. Households are as likely to use their bednet when they get it for free as when they have to pay for it (4, 7–9). People are as likely to use their water filter if they paid a lower price for it (2). This is surprising for two reasons. First, standard economic theory suggests that charging nontrivial user fees should help target products to those who need them the most—and thus those most likely to put them to appropriate use. But this reasoning breaks down when people face credit constraints and their ability to pay is lower than their willingness to pay. When those who could use a product the most are too poor to pay cash for it, higher prices screen out the poor, not just those with lower health returns from using the product (9). Second, it is often thought that the act of paying itself makes people value a product or service more; the feeling of “guilt” from having spent money on something that is left unused would make people more diligent users. However, experimental studies designed to test the importance of this psychological phenomenon suggest that this consideration is not important when it comes to essential health (2, 7, 10). The cost of poor health seems a good enough incentive to put products to good use."
Pascaline Dupas, "Getting essential health products to their end users: Subsidize, but how much?" Science 345:1279-1281, 2014. http://www.sciencemag.org/content/345/6202/1279.full.pdf?key...
One solution is to look for another solution. Like a genetically modified mosquito that is inhospitable to malaria and outcompetes regular mosquito.
Other is to try stabilizing the region.
I understand why the nets were treated with insecticide, but it seems a bit foolhardy to have done so when there was a possibility the nets might not be used for their intended purpose. Although I suspect no one involved considered such a possibility, or if they did that it wouldn't be nearly as wide spread.
I think this represents one of the major problems with our current means of providing foreign aid. Although well-meaning, providing mosquito nets to people in effort to protect them from a disease that is likely to kill them versus starving to death (which definitely will kill them), the people are going to address their immediate concerns first. I don't know what the solution is, but it seems that just attacking one particular problem at a time isn't working. I agree with other comments here that eliminating malaria probably means dealing with food stability and access to clean water first and foremost, then addressing malaria (in parallel, possibly). I respect the organizations that are trying to help, but the solutions don't come easily.
But then you also have the other problem that these are impoverished, sometimes war-torn areas that have threats even beyond the scope of access to food and water...
Overfishing and the extinction of both fishes and the professional fishers is a big problem for all the community.
So what happens to the mosquitoes when the fish population drops?
A summary of the background facts are
- Malaria is a big problem. - Mosquito nets prevent malaria - It's hard to get people to use mosquito nets.
I think the key takeaways from the article are that (1) the proponents of mosquito nets aren't convinced that the scale of this problem is big enough to offset the overall positive effect of free mosquito nets. But (2) critics of mosquito nets suspect that proponents have too much psychologically (and financially?) invested in the mosquito net solution to consider alternatives. E.g. this interesting quote:
>Dr. Lehman, the American physician on Lake Tanganyika, wonders if there might be better malaria solutions for waterside communities. Specially treated wall coverings? Custom-fit window screens? “Why is this question not being asked?” she said, a bit exasperated. “Is it that we don’t really want to know the answer?”
Of course the problems first has to be acknowledged.
Of interest, people also use malaria nets for gardening. They are used as a means to keeps bugs out of crops.
The more complicated issue is whether people are using the nets properly. It takes discipline to correctly put the net over your body the entire night and sleep under it.
I'm interested to know what language this label was written in. Bemba? Nyanja? Moreover, where did the manufacturers intend for Zambians to wash the nets?
How dare our charity be used for practicalities! We must over-engineer harder! Only our brilliance can save poor, poor Africa!
Same nonsense I've been reading about since the 1800s. The Africans figured out how to deal with public health a long, long time ago: spread your villages and use air and time to isolate outbreaks. This has worked for longer than human history has been recorded. And this technique has survived countless imperial collapses as well.
We simply wish to mold Africa into an urban scheme because we don't know how to bring "progress" without packing millions of people into city blocks. That causes disease spreading, which puts diminishing returns on the urban scheme. There's one city in Africa who loses about 1% GDP from city-based malaria alone.
If you want to over architect something, the net isn't the problem. Learn to engage in feel-good progressivism without the dependency of industrial organization models. Billions of dollars to whoever figures it out first.
Africa is not a monolithic problem with identical inputs and outputs everywhere. Assistance from first-world countries does actually make a difference, and comes in many, many forms, from medical care to microloans to security assistance and psychological trauma support.
Knowing Maslow's hierarchy of needs, it's Physiological needs (food) vs Safety needs (Malaria protection). And the former are more basic, so expecting anything else shows little foresight (easy to say in hindsight, I know).
Obviously malaria has its own transmission dynamic that doesn't directly apply here, but for infectious disease generally (eg. ebola) African safety needs are an important part of our own safety.
As per my comment on another post I do not fall into your idea of "we". I've spent all of my life in Africa. Much of it under mosquito nets.
Much like other posters here you're approaching this from an academic point of view (maslow etc). The truth is very different. Eg did you know that DDT is still (officially) being used to combat malaria? As in they spray that stuff on houses (it's compulsory for some areas). Enjoy the birthdefects. Another poster here reckoned my pessimism is unwarranted. What does it take for it to be warranted?
Africa... One step forward two steps back.
http://www.who.int/gho/malaria/epidemic/deaths/en/
The ecology of a country is a very complex system and becomes even more complex if you throw humans into it. So any significant aid is bound to have unintended side effects. Thus, any aid must be accompanied by close monitoring and modified when necessary. This particular problem, for example, can be easily solved by making nets weaker so they break during fishing.
But one should not take any side effect as an excuse to stop aid. Unless of course one is looking for any excuse to stop aid.
No? I bet I've spent more years in Africa than you have (my entire life). Also spent thousands of nights under mosquito nets. Ever seen someone fish with a mosquito net? I have.
"ecology of a country"? Spare me the armchair commander BS.
"Western" people mostly miss the plot. Eg vaccination. Massive freaking supply chain operation to get the stuff to Africa (great success) ... Mobile LPG powered refrigeration etc. High Five. Local witchdoctor says these things are evil - entire shipping of mission critical vaccines expire on site. (true story)
One step forward two steps back. ..
Africa is not a monolith: it's 54-countries strong with a multitude of cultures (I'd bet you'd be hard-pressed to find a "local witch doctor" in Tunis).
You are entitled to your opinion, just because you live there doesn't automatically make you an expert. I too have spent my entire life in (southern) Africa.