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      DDT reintroduction for malaria control: the cost-benefit debate for public health Translated title: Reintrodução do DDT para combate à malária: uma discussão de custo-benefício para a saúde pública

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          Abstract

          DDT is a persistent insecticide that was widely used in the world from the 1940s until the 70s, when it was banned in the United States and other countries. Most of its toxic effects are not observed in the acute forms, but particularly after chronic exposure. These long-term issues include reproductive effects, varying according to the time of life in which the individuals were exposed. The aims of the current study were to review the principal toxicological effects of DDT on reproduction, stratifying by physiological periods of exposure, and based on the magnitude of these effects, to discuss the cost-benefit relationship of reintroducing DDT with the specifically defined vector control criteria.

          Translated abstract

          O DDT é um inseticida persistente que foi amplamente utilizado no mundo a partir da década de 40 até a de 70, quando foi banido nos Estados Unidos e outros países. A maioria dos efeitos de sua toxicidade não é observável em formas agudas, mas especialmente após exposições crônicas. Dentre estes aspectos em longo prazo estão os efeitos reprodutivos, que variam de acordo com o a época da vida em que as pessoas foram expostas. Os objetivos deste estudo são: revisar os principais efeitos toxicológicos do DDT na reprodução, estratificando de acordo com os períodos fisiológicos de exposição; e a partir da magnitude destes efeitos discutir o custo-benefício da volta da utilização do DDT com critérios definidos de eliminação de vetores da malária.

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          Identifying critical windows of exposure for children's health.

          Several authors have considered the importance of exposure timing and how this affects the outcomes observed, but no one has systematically compiled preconceptional, prenatal, and postnatal developmental exposures and subsequent outcomes. Efforts were undertaken to examine the information available and to evaluate implications for risk assessment for several areas: a) respiratory and immune systems, b) reproductive system, c) nervous system, d) cardiovascular system, endocrine system, and general growth, and e) cancer. Major conclusions from a workshop on "Critical Windows of Exposure for Children's Health" included a) broad windows of sensitivity can be identified for many systems but detailed information is limited; b) cross-species comparisons of dose to target tissue and better data on the exposure-dose-outcome continuum are needed; c) increased interaction among scientific disciplines can further understanding by using laboratory animal results in designing epidemiological studies and human data to suggest specific laboratory studies on mechanisms and agent-target interactions; and d) thus far, only limited attention has been given to peripubertal/adolescent exposures, adult consequences of developmental exposures, and genome-environment interactions. More specific information on developmental windows will improve risk assessment by identifying the most sensitive window(s) for evaluation of dose-response relationships and exposure, evaluation of biological plausibility of research findings in humans, and comparison of data across species. In public health and risk management, information on critical windows may help identify especially susceptible subgroups for specific interventions. Images Figure 3
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            A steep decline of malaria morbidity and mortality trends in Eritrea between 2000 and 2004: the effect of combination of control methods

            Background Malaria is a huge public health problem in Africa that is responsible for more than one million deaths annually. In line with the Roll Back Malaria initiative and the Abuja Declaration, Eritrea and other African countries have intensified their fight against malaria. This study examines the impact of Eritrea's Roll Back Malaria Programme: 2000–2004 and the effects and possible interactions between the public health interventions in use. Methods This study employed cross-sectional survey to collect data from households, community and health facilities on coverage and usage of Insecticide-Treated Nets (ITNs), Indoor Residual Spraying (IRS), larvicidal activities and malaria case management. Comparative data was obtained from a similar survey carried out in 2001. Data from the Health Management Information System (HMIS) and reports of the annual assessments by the National Malaria Control Programme was used to assess impact. Time series model (ARIMA) was used to assess association. Results In the period 2000–2004, approximately 874,000 ITNs were distributed and 13,109 health workers and community health agents were trained on malaria case management. In 2004, approximately 81% households owned at least one net, of which 73% were ITNs and 58.6% of children 0–5 years slept under a net. The proportion of malaria cases managed by community health agents rose from 50% in 1999 to 78% in 2004. IRS coverage increased with the combined amount of DDT and Malathion used rising from 6,444 kg, in 2000 to 43,491 kg, in 2004, increasing the population protected from 117,017 to 259,420. Drug resistance necessitated regimen change to chloroquine plus sulfadoxine-pyrimethamine. During the period, there was a steep decline in malaria morbidity and case fatality by 84% and 40% respectively. Malaria morbidity was strongly correlated to the numbers of ITNs distributed (β = -0.125, p < 0.005) and the amount (kg) of DDT and Malathion used for IRS (β = -2.352, p < 0.05). The correlation between malaria case fatality and ITNs, IRS, population protected and annual rainfall was not statistically significant. Conclusion Eritrea has within 5 years attained key Roll Back Malaria targets. ITNs and IRS contributed most to reducing malaria morbidity.
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              Entomopathogenic fungi for mosquito control: A review

              Fungal diseases in insects are common and widespread and can decimate their populations in spectacular epizootics. Virtually all insect orders are susceptible to fungal diseases, including Dipterans. Fungal pathogens such as Lagenidium, Coelomomyces and Culicinomyces are known to affect mosquito populations, and have been studied extensively. There are, however, many other fungi that infect and kill mosquitoes at the larval and/or adult stage. The discovery, in 1977, of the selective mosquito-pathogenic bacterium Bacillus thuringiensis Berliner israelensis (Bti) curtailed widespread interest in the search for other suitable biological control agents. In recent years interest in mosquito-killing fungi is reviving, mainly due to continuous and increasing levels of insecticide resistance and increasing global risk of mosquito-borne diseases. This review presents an update of published data on mosquito-pathogenic fungi and mosquito-pathogen interactions, covering 13 different fungal genera. Notwithstanding the potential of many fungi as mosquito control agents, only a handful have been commercialized and are marketed for use in abatement programs. We argue that entomopathogenic fungi, both new and existing ones with renewed/improved efficacies may contribute to an expansion of the limited arsenal of effective mosquito control tools, and that they may contribute in a significant and sustainable manner to the control of vector-borne diseases such as malaria, dengue and filariasis.
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                Author and article information

                Journal
                csp
                Cadernos de Saúde Pública
                Cad. Saúde Pública
                Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz (Rio de Janeiro, RJ, Brazil )
                0102-311X
                1678-4464
                December 2007
                : 23
                : 12
                : 2835-2844
                Affiliations
                [02] Rio de Janeiro orgnameUniversidade do Estado do Rio de Janeiro orgdiv1Núcleo de Estudos da Saúde do Adolescente Brazil
                [03] Rio de Janeiro orgnameFundação Oswaldo Cruz orgdiv1Escola Nacional de Saúde Pública Sergio Arouca Brasil
                [01] Rio de Janeiro Rio de Janeiro orgnameUniversidade Federal do Rio de Janeiro orgdiv1Instituto de Estudos em Saúde Coletiva Brazil
                Article
                S0102-311X2007001200004 S0102-311X(07)02301204
                10.1590/S0102-311X2007001200004
                09b3ce5b-774a-4ea6-97d9-5467a621ce76

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 83, Pages: 10
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                SciELO Public Health

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                Categories
                Review

                Exposição a Praguicidas,DDT,Malária,Pesticide Exposure,Malaria

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