Ehiri John E, Anyanwu Ebere C, Scarlett Henroy
Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, 35294-0022, USA.
J Public Health Policy. 2004;25(1):9-22. doi: 10.1057/palgrave.jphp.3190001.
Epidemiological evidence arising mainly from studies undertaken in sub-Saharan Africa suggests that sleeping under insecticide-treated mosquito nets is a cost-effective and efficacious method of controlling malaria. For this reason, promotion of use of insecticide-treated nets (ITNs) has become a key malaria control strategy. In 1999, the United Nations Children's Fund (UNICEF) and WHO set the goal of providing 32 million nets and 320 million net treatments a year for the next 10 years to protect 80% of African households against malaria. All pesticides are toxic by nature and are associated with adverse health risks that depend on the toxicity of each chemical, as well as the type and degree of exposure. Thus, massive scale-up of use of ITNs in malaria endemic poor countries can be expected to present tangible risks to health, especially where the insecticides for net treatment and re-treatment are handled mostly by untrained persons in uncontrolled settings. This paper examines potential health risks of mass use of ITNs in malaria endemic poor countries and calls for the implementation of strategies to minimize potential risks through careful selection of products, appropriate labeling (including labeling in the local languages of the user communities), pesticide safety education of the public and training of health personnel, and active monitoring of adverse health effects to document actual and potential hazards, and to facilitate planning of mitigation efforts.
主要来自撒哈拉以南非洲地区研究的流行病学证据表明，睡在经杀虫剂处理的蚊帐下是控制疟疾的一种经济有效且高效的方法。因此，推广使用经杀虫剂处理的蚊帐（ITN）已成为一项关键的疟疾控制策略。1999年，联合国儿童基金会（UNICEF）和世界卫生组织（WHO）设定了目标，即在未来10年每年提供3200万顶蚊帐和3.2亿次蚊帐处理，以保护80%的非洲家庭免受疟疾侵害。所有农药本质上都是有毒的，并且与不良健康风险相关，这些风险取决于每种化学物质的毒性以及接触的类型和程度。因此，预计在疟疾流行的贫困国家大规模扩大使用经杀虫剂处理的蚊帐会给健康带来切实风险，尤其是在蚊帐处理和重新处理所用杀虫剂大多由未经培训的人员在无控制的环境中处理的情况下。本文研究了在疟疾流行的贫困国家大规模使用经杀虫剂处理的蚊帐可能带来的健康风险，并呼吁实施相关策略，通过谨慎选择产品、进行适当标注（包括使用用户社区的当地语言标注）、对公众进行农药安全教育和对卫生人员进行培训，以及积极监测不良健康影响以记录实际和潜在危害，并促进减轻危害措施的规划，来将潜在风险降至最低。
