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Other publication - Peer-reviewed, 2011

DDT and Malaria Prevention: Addressing the Paradox

Bouwman Henk, van den Berg Henk, Kylin Henrik


Background: The debate regarding DDT in malaria prevention and human health is polarized. It can be classified into three positions: anti-DDT, centrist-DDT, pro-DDT. Objective: To arrive at a synthesis by matching a series of questions on the use of DDT as indoor residual spray (IRS) with literature and insights, and to identify options and opportunities. Discussion: Overall, community health is significantly improved through all available malaria control measures, which includes IRS with DDT. Is DDT ‘good’? Yes, as it has saved many lives. Is DDT safe as used in IRS? Recent publications have added to concern - an unqualified statement that DDT used in IRS is safe is therefore untenable. Are inhabitants and applicators exposed? Yes, and to high levels. Should DDT be used? The fact that DDT is ‘good’ because it saves lives, and ‘not safe’ because it has health and environmental consequences, raises ethical issues. The evidence of adverse human health effects due to DDT is mounting. However, under certain circumstances malaria control using DDT cannot yet be halted. Therefore, the continued use of DDT poses a paradox recognized by a centrist-DDT position. It is time now, at the very least, to invoke precaution. Precautionary actions could include use and exposure reduction. Conclusions: There are situations where DDT will provide the best achievable health benefit, but maintaining that DDT is safe ignores the cumulative indications of many studies. In such situations, addressing the paradox from a centrist-DDT position and invoking precaution will help design choices for a healthier life


Risk-benefit analysis; human health; environmental health; vector control; pesticides

Published in

Environmental Health Perspectives
2011, Volume: 119, number: 6, article number: 1002127

    Associated SLU-program

    Non-toxic environment

    UKÄ Subject classification

    Environmental Sciences related to Agriculture and Land-use
    Food Science

    Publication identifier


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