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Column: For sustainable control of malaria in Sudan: No more broken water pipes and water containers!

January 29, 2014 - 17:10 -- Bart G.J. Knols
Do you know what LBWPs means?! 
It is a common terminology between entomologists, health officers and other people working in mosquito control in Sudan and it means “Leakages of Broken Water Pipes”. I live in Omdurman City in Sudan and broken pipes were a common fact of life as I grew up. For writing this column, I decided to count the number of broken water pipes along the 20 km distance I commute to work; there were two. One was a large pipe alongside the main road and the other was inside my neighbourhood. This scenario reaches its peak in the winter, nowadays probably as a result of a decrease in demand for tap water and high water pressure inside pipes. Most visibly, broken pipes can represent breeding sites for mosquitoes...

Permanent piped water supply is now significantly better than in previous years in my city but I store water in my home for domestic use because piped water supply is unreliable especially during the summertime. It is winter nowadays but there is always fear that the combination of scorching hot days and bone-dry taps can occur anytime; so my water storage containers always remain full. Personally, I do not have clay pots (used for preservation of drinking water) in my house, but like most Sudanese, I enjoy drinking from them. However, as an entomologist I am also aware of how easily water-filled containers can turn into mosquito larval habitats.
Larval source management and LBWPs experience in Khartoum
As in many countries pipe-breaks result for a variety of reasons including soil expansion and contraction, construction work, poor installation, but in my experience is often related to urban expansion outpacing infrastructure development and heavy vehicle movements. 
Leakages of Broken Water Pipes (LBWPs) are becoming a major resource for the main malaria vector and this is spreading in all urban areas in Khartoum, northern and central States [1,2]. It plays a role in supporting the permanent presence of the malaria vector throughout the year. The significant decline in malaria control in the Khartoum State where I live was due to the successful Khartoum Malaria Free Initiative (KMFI), as part of Roll Back Malaria programme, which included successful larval source management (LSM) as an essential component of malaria prevention. Because LBWPs represent one of the major larval breeding sites for malaria vectors, KMFI collaborated with the Public Works Department (PWD) to repair broken water pipes; KMFI is responsible for surveillance, reporting and transportation and the PWD provides engineers and equipment [2]. 
It is my impression that as we make progress in larval source management in Khartoum State the role played by small LBWPs is becoming a proportionally larger problem for the sustainability of LSM for various reasons; some of LBWPs occupied by malaria vectors are very small in size, on no-mans land, and occur in relatively high frequencies with the result that the cost for searching and reporting small LBWPs can sometimes be a difficult task for health workers (see video). This also applies to water containers inside houses which are numerous and difficult to trace, requiring labour-intensive house inspections.
Could sustainable LSM be achieved without community participation?
In addition to the obvious solutions for sustainability through more resources for PWDs and improved coordination with KMFI and other sectors involved (which are already energetic) but, under such circumstances, I think for the sustainability of LSM it is important to stage large-scale community campaigns, especially during the time when mosquito densities peak. Such campaigns, both in urban and rural areas can help to decrease the burden of such difficult tasks done by health observers and result in valuable output in terms of malaria control. 
Reporting and /or treating of LBWPs and water containers by community members, through affordable rational choice of larvicides (or other choices) and by using citizen reporting tools, can have effective results that might support the sustainability of the tremendous efforts done by health observers. 
While there is noticeable progress in malaria control, especially in Khartoum State and all over Sudan in general, I wonder about similar challenges and observations in other African countries that could be usefully shared as comments below. For instance:
Do other malaria-endemic countries face similar challenges?
What solutions have been tried to resolve this problem (if present)? 
Can large-scale community campaigns that involve Larval Source Management and management of water containers be successful? Or add value in the fight against other mosquito-borne diseases?
Dr. Rasha Siddig Azrag
Assistant Professor
Department of Zoology, Faculty of Science, 
Khartoum, Sudan.
Supported by Dr. Guy Reeves
Post Doc., Max Planck Institute for Evolutionary Biology,
Plön, Germany.
Cited references:
1. Y.E. Himeidan1 and E.El-A. Rayah (2008). Role of some environmental factors on the breeding activity of Anopheles arabiensis in New Halfa town, eastern Sudan. East Mediterr. Health J. 14(2):252-9.
2. WHO (2013). Larval source management: a supplementary measure for malaria vector control: an operational manual.
The views expressed in this article are the authors alone and not intended to reflect those of their organizations.

 Rasha is a medical entomologist working in the department of Zoology/ University of Khartoum, Sudan and used to teach basic entomology courses to undergraduate students and molecular entomology to master students in the Medical Entomology and Vector Control program. She has experience from working in different vector control programmes, from basic classic control methods to the use of genetic methods. 
Guy is a research scientist at the Max Planck Institute for Evolutionary Biology in Plön, Germany. Part of his research involves the exploration of genetic methods to control vectored diseases.

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Submitted by Anton Alexander (not verified) on

I am surprised not to find any comments in response to the questions posed. The problems explained were successfully addressed in Palestine a number of years ago, and rather than explain each aspect separately, perhaps it may be more convenient to choose the topics yourself from the website . Education was the key, and as an example of a problem encountered in Palestine, see the 8th page of that may have dealt with an issue raised in your film.
Remember the method of malaria elimination employed in Palestine 90 years ago worked.