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SummaryWe investigated the interaction between social and economic circumstances with malaria awareness in rural South African villages effectively protected from malaria infection by community-passive, indoor residual spray (IRS) performed by government. We conducted interviews with 120 caregivers of children using both open-ended and closed fixed-answer questions. The mean income was between 27 and56% of the national mean, indicating a community under considerable pressure. Male parents were often absent due to work commitments. Unemployment, poverty, crime, and clean water were the main, unprompted, threats, but malaria was volunteered by none. Only when malaria was prompted (caregivers had good knowledge of malaria), did its concern rise. Malaria, therefore, was not a prominent conscious concern. This implies that alternatives to IRS that require increased community and personal engagement, behavioural changes, and time commitment (such as certain components of integrated vector management and bed nets), will 2 face implementation challenges. Unless community-passive malaria control measures can be developed that is as good or better than IRS, it seems unreasonable to expect poor communities to adopt community-active systems. Our findings should be considered in malaria control strategies, rural policy development, climate change adaptation, and communication strategies.

Highlights No published studies on DDT in chicken eggs from a malaria controlled area  Median and maximum ΣDDT concentrations were 11 000 and 48 000 ng/g wet mass  The maximum residue limit was exceeded 100 times  Calculated acceptable daily intake was not exceeded (3 eggs/week/60 kg bm)  Reductions of DDT in soil ingested by chickens may reduce human intake via eggs ABSTRACT In malaria endemic areas, where DDT is still used for vector control by indoor residual spraying (IRS), concentrations of DDT in human blood and breast milk are high, and there are indications of human health impact. In order to identify possible avenues of exposure reduction, we created the concept of a Total Homestead Environment Approach (THEA). THEA characterises the interactions between DDT, humans, and biota within and around homesteads. One dietary route of human exposure and uptake of DDT, namely chicken egg consumption, has, to our knowledge, never been published. ΣDDT in eggs from a DDT-sprayed village ranged between 5200-48 000 ng/g wm (wet mass), with a median of 11 000 ng/g wm. On a lipid mass-basis (lm), the mean ΣDDT for eggs from the sprayed village was 100 000 ng/g lm. The maximum egg concentration observed was three orders of magnitude higher than the median. The acceptable daily intake (ADI) was exceeded 2.5 times based 1

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