Facts on DDT use in Ethiopia    

DDT is being phased out internationally under the Stockholm Convention on Persistent Organic Pollutants (POPs). It is no longer permitted for use in agriculture, but several countries still rely on DDT for the control of mosquito vectors of malaria. Hadera Gebre Medhin reports on a fact-finding survey in Ethiopia to see whether DDT is being used according to World Health Organisation guidelines. 

The researcher found DDT on sale in ordinary shops in three areas visited. The unauthorised packaging carried no labels, instruction or warnings. Photo: Safe Environment Group

DDT is used in many developing countries as one of the cheapest effective methods of controlling insect vectors of disease, especially malaria. Under the POPs convention, time has been allowed to develop affordable alternatives before a complete phase out of this pesticide. The Ethiopian government decided to continue its use of DDT because of the high level of sickness and fatalities from malaria that affect the majority of the population and argues that it is crucial to prevent deaths from malaria when there is a readily available means of control. 
    The responsibility for malaria prevention and control in Ethiopia is shared between the Federal Ministry of Health, responsible for policy, technical support, provision of medical drugs, insecticides and equipment, and the regional health bureaux which have undertaken actual malaria control operations since 1993. The main malaria vector control strategies used by the Ministry of Health are indoor residual spraying (IRS) with insecticides, environmental sanitation, anti-larval chemical control, and recently, the use of insecticide-treated mosquito bed nets.
    A small case study by the Safe Environment Group (SEG) with PAN UK in 2001 identified problems of misuse of DDT by peasant farmers, who used it for treating crops as well as for home remedies for household pests. Farmers recounted several cases of acute and fatal poisonings of family members who had applied mixtures of concentrated DDT, often with malathion, to combat head lice or even attempt to cure open wounds¹. 
    Subsequently SEG undertook a study of DDT usage in collaboration with the Ethiopian Environmental Protection Authority (EPA) to identify sources of DDT, quantities used and distribution to examine safety of handling and to investigate the potential health and environmental impacts. 
    Field research was conducted in 2002, covering in detail five regional states and Dire Dawa city state/administrative council area and a partial survey of two additional states. Researchers approached over 40 institutions including federal government offices, international agencies, regional and zonal health and agricultural bureaux, one NGO, one state farm, hotels and peasant associations. Interviews with key informants provided information on DDT usage and malaria control operations, in addition to formal documentation. Six study sites throughout the country were selected for detailed discussion with farmer groups, in which a total of 80 peasant farmers offered their experiences and practices with DDT. All study sites were targeted by the health services for one or two rounds of IRS operations every year. 
    Stores in five cities were visited to observe chemicals, equipment and safety devices. Shops and open markets were surveyed too, since informal retail of repackaged pesticide products is a feature of urban and rural areas and DDT is reputed to be sold via these channels.

Insecticide usage and other methods
During the six years’ documentation studied (1996/97-2001/02), the federal malaria control programme imported or purchased 2,701 tonnes of insecticides, and distributed 2,418 tonnes to regions and other institutions. The five regions and one city administrative council covered in the study used a total of 1,888 tonnes of insecticides over this period, of which DDT accounted for 90% by weight. The spray regimes protected over 33 million people against malaria. 
    Until recently DDT was purchased and imported from China by the Ministry of Health, in the form of 75% and 100% concentration wettable powder (WP). The Adami Tulu Pesticide Processing Plant, in Oromia, has been operating since 1992 in the formulation of several pesticides, including DDT. The plant imports technical grade material and has been supplying formulated DDT to the Ministry of Health since 2001, processing 360 tonnes a year, under a flexible ten-year agreement with the federal government. Production capacity depends on requests from the regions and the budget available.
    The Ministry of Health centrally purchases and distributes vector control insecticides to the regional bureaux. In addition to DDT, 344 tonnes of malathion 50% WP were distributed over six years, mainly for areas where DDT resistance has been recorded², and 740l tonnes of temephos for control of mosquito larvae in key breeding sites. 
    As part of WHO’s Roll Back Malaria campaign, which aims to reduce the malaria burden by half by 2010, there are also some household and community-level interventions, including training, education and environmental management. UNICEF distributed almost 700,000 insecticide-treated bed nets in 2002 to protect an estimated 11 million people. Some hotels routinely apply pesticides, while some have installed bed nets and at least one had sprayed DDT within the last two years. 

DDT handling and record-keeping
SEG observed that the majority of the spray team staff loading and unloading DDT in and around malaria control stores were highly exposed and had inadequate personal protective equipment and facilities. In Gambella state, for example, only overalls, straw hats and a piece of cloth to cover the nose and mouth were provided to workers. In most regions surveyed, temporary spray men, guards, and store keepers are involved in measuring and handling DDT in stores, as well as mixing at each spray locality, and they are also highly exposed. DDT stores were observed without washing facilities, first aid kits or fire extinguishers. Some stores were totally inadequate for pesticide storage or were poorly managed.
    Under the recent decentralisation, malaria sector offices have been re-assigned to district level and this has sometimes caused disruption to record-keeping and continuity of trained personnel. In Oromia, for example, the quality and quantity of health service information on control operations was incomplete and inadequate for proper analysis. SEG found that in some cases actual dosage of DDT sprayed on interior walls was higher than the recommended 2g/m2 because sprayer nozzles were worn out.

‘Leakage’ from vector control operations 
WHO and federal health officials were of the opinion that DDT diversion from the malaria programme was negligible, while others at regional level recounted serious losses, including organised theft. In a number of sites, those with access to DDT (spray men, guards and others) had been caught stealing DDT for private sale. Stores in Gambella town had been broken into and looted several times, most recently in 2002 during the spraying period, when 40kg of DDT disappeared. Regional authorities and malaria experts claim to have instituted a system to prevent DDT leakage, and have recovered some stolen DDT. The malaria control services in some areas have started to prepare and mix DDT in the presence of malaria committees, community leaders, technicians, or even employed militia.
    The ‘leakage’ of DDT appears to come from old stockpiles in state and commercial farms, Ministry of Agriculture stores and the Desert Locust Control Organisation East Africa (DLCO-EA) stores, and currently through the malaria control spray programmes³. Liberalisation of pesticide supply has created many opportunities for dealers, mostly people without adequate knowledge or training, and even farmers are selling insecticides freely in rural markets. DDT was found repacked in small plastic bags on sale in ordinary shops in three areas. Samples of insecticides identified as DDT were freely bought in an open market and in shops in Awassa, Adua and Bahir Dar. In several areas, farmers confirmed that they often use DDT on their crops. In the Southern region farmers described how they usually prepare a mixture of DDT and malathion to treat maize and sorghum against storage pests and also on the narcotic shrub qat. Dire Dawa farmers recounted how they used to chew qat that had been sprayed with DDT until recently when they discovered an association with gastro-intestinal irritation and ulcers.

Children playing on top of a site of buried obsolete pesticides alongside an abandoned airstrip in Axum, Ethiopia, 2003. The contents of the buried drums were unknown. Photo: Stephanie Williamson

Recommendations
Many people in Ethiopia are concerned about DDT use, but do not see how to move to alternative strategies, which are often more costly. Current malaria policy may be acceptable in the short term, but the hazards of DDT to humans, livestock and the natural environment warrant finding a more sustainable way of controlling malaria mosquitoes. At present there is no concrete research on alternatives in Ethiopia, although funds are available from multilateral donors. Government and other stakeholders need to collaborate on developing safer and inexpensive alternatives. SEG has made the following recommendations to minimize environmental and health costs of pesticides among agricultural workers, rural communities and Ethiopian society:

• Proper handling of pesticides Guidelines are required to ensure proper recording and implementation of safer use during agricultural and medical pest control operations at farm or community levels.
• Inventories and consumption of pesticides Pesticide stock records are not reconciled at the end of each spray season. Better stock and use accountability would minimise ‘leakage’ from stores and stock management should be improved.
• Recording of pesticide accidents A National Pesticide Poison Information Service is required to lead and support institutions to collaborate, collect incidents of pesticide poisonings, encourage users to report pesticide-related problems, and to alleviate the existing pesticide related problems. 
• Understanding of pesticide problems The conditions of use in Ethiopia make it extremely difficult to use pesticides without harm. A precautionary approach is needed in policy to reduce dependence on pesticides.
• Enforcement and implementation The Ministry of Agriculture has delegated to the regions the inspection and regulation of pesticides and licensed pesticide dealers. The Ministries of Health and Agriculture need to work together on how to enforce and implement safer use of pesticides at all levels. 
• Operational research Environmental and health costs and impacts of IRS, bed net, larval control and environmental sanitation methods need to be assessed and compared. An effective education and uptake strategy for bed nets is lacking, especially for rural areas.
• Integration of malaria control Decentralisation has created a gap in maintaining information flows on prevention and control activities. Standardisation of mapping, houses registration, dosage and sprayable surface area is needed for evaluation and site prioritisation.
• DDT diversion Regional Health Bureaux authorities and malaria experts have made some progress in preventing diversion but strategies for more rigorous implementation are required. 

The SEG-EPA study report is being finalised and arrangements are being made for a joint workshop to discuss the findings with representatives from the various bodies concerned as well as civil society. It is hoped that the results of this study will make it possible for an effective phase-out of the use of DDT in the country to be started, and at the same time, to retain economic and effective control of the malaria spreading mosquito.

1. The Dependency Syndrome: Pesticide Use by African Smallholders. PAN UK, London, 2003.
2. National Five Year Strategic Plan for Malaria Control in Ethiopia 2001-2005. Malaria and Other Vector Borne Disease Prevention and Control Team, Diseases Prevention and Control Department, Ministry of Health, Addis Ababa, 2001.
3. Fact findings on DDT use in Ethiopia. A study conducted by SEG in collaboration with the Ethiopian EPA, March 2003, Addis Ababa, Ethiopia (publication in process).

Hadera Gebre Medhin and SEG Coordinator, Abiye Alemu, can be contacted at SEG, Post Box 8265, Addis Ababa, email segpan@telecom.net.et. SEG works to minimise the import and use of hazardous pesticides, raise awareness of hazards with policymakers and promote the effective use of alternatives. Abiye Alemu also coordinates the East African NGOs working with the African Stockpiles Programme. 

[This article first appeared in Pesticides News No. 62, December 2003, pages 12-13]