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PubMed2000

Progress in malaria control in China.

PURPOSE: To summarize the main achievements of the control of malaria in the People's Republic of China. DATA SOURCES: The data are from national case reporting system (1955-1998), and bibliographic reviews of textbooks and review articles. STUDY SELECTION: Successes in control and research of malaria were identified and selected to address the stated purpose. DATA EXTRACTION: In the past 50 years, large-scale malaria control activities were conducted in the country, relying on primary health care networks and community participation. The control of malaria was implemented according to the time- and locality-oriented approaches. As a result, remarkable success has been achieved. By the end of 1998, there were 31.3 thousand malaria cases in China, with a morbidity of 0.25 per ten thousand, which dropped by 99% in comparison with that in the 1950s. RESULTS: Most of the original hyper-endemic areas became meso- or hypo-endemic and for most of the previously meso- or hypo-endemic areas, the disease became sporadic. Malaria distribution and epidemic pattern also demonstrated great changes. CONCLUSIONS: Malaria control in China has been considerably successful in the past 50 years, which coincides with the target of the World Health Organization's "Health for all by the year 2000".

China↗

PubMedDate not supplied

DDT, global strategies, and a malaria control crisis in South America.

Malaria is reemerging in endemic-disease countries of South America. We examined the rate of real growth in annual parasite indexes (API) by adjusting APIs for all years to the annual blood examination rate of 1965 for each country. The standardized APIs calculated for Brazil, Peru, Guyana, and for 18 other malaria-endemic countries of the Americas presented a consistent pattern of low rates up through the late 1970s, followed by geometric growth in malaria incidence in subsequent years. True growth in malaria incidence corresponds temporally with changes in global strategies for malaria control. Underlying the concordance of these events is a causal link between decreased spraying of homes with DDT and increased malaria; two regression models defining this link showed statistically significant negative relationships between APIs and house-spray rates. Separate analyses of data from 1993 to 1995 showed that countries that have recently discontinued their spray programs are reporting large increases in malaria incidence. Ecuador, which has increased use of DDT since 1993, is the only country reporting a large reduction (61%) in malaria rates since 1993. DDT use for malaria control and application of the Global Malaria Control Strategy to the Americas should be subjects of urgent national and international debate. We discuss the recent actions to ban DDT, the health costs of such a ban, perspectives on DDT use in agriculture versus malaria control, and costs versus benefits of DDT and alternative insecticides.

Agriculture↗

PubMed1993

Prospects for the use of larvivorous fish for malaria control in Ethiopia: search for indigenous species and evaluation of their feeding capacity for mosquito larvae.

Because of problems with drug and insecticide resistance, the National Organization for the Control of Malaria and other Vectorborne Diseases, Ethiopia, has embarked on a programme of research on alternative malaria control methods, including the use of biological control agents, such as larvivorous fish. The objectives of the study were to identify indigenous larvivorous fish species which could be potential candidates for use as biological control agents; to extend knowledge of their distribution in Ethiopia; and to conduct laboratory tests to determine their feeding capacity. An extensive search resulted in the identification of 11 larvivorous fish species indigenous to Ethiopia, including five species previously unrecorded in the country. Seven species were assessed under standard laboratory conditions for their feeding capacity on larvae of Anopheles gambiae s.l. and Culex andersoni. All species tested were efficient larvivores in the laboratory. However, their larvivorous capacity should be tested further in field trials. Based on the findings of this study, two priority areas for the assessment of biological control using larvivorous fish were identified, the port city of Assab, using the local species Aphanius dispar, and the Ogaden, south-eastern Ethiopia, using the local species Oreochromis spilurus spilurus.

Animals↗

PubMed1998

'Anti-malaria month'--a step forward in multisectoral collaboration and community involvement in malaria control.

For a long time malaria control in India has largely been a government responsibility with little involvement of the community at large, and other sectors of the economy in the control efforts. There is now increasing realisation that involvement of the community and a multi-sectoral approach should be essential components of the malaria control strategy. The National Malaria Eradication Programme is accordingly laying greater emphasis on coordination with other sectors of the economy, and changing community perceptions and health-related behaviour. A massive programme of community mobilisation with this objective in view has been taken up since 1997. A major component of this community mobilisation programme is the observance of an 'Anti-Malaria Month', during which, country wide awareness campaigns are undertaken at all levels of implementation, to promote inter-sectoral collaboration and community action for malaria control. The present paper summarises the rationale and messages of the 'Anti-Malaria month'.

Animals↗

PubMedDate not supplied

Antimalarial drug resistance: surveillance and molecular methods for national malaria control programmes.

National malaria control programmes have the responsibility to develop a policy for malaria disease management based on a set of defined criteria as efficacy, side effects, costs and compliance. These will fluctuate over time and national guidelines will require periodic re-assessment and revision. Changing a drug policy is a major undertaking that can take several years before being fully operational. The standard methods on which a decision can be taken are the in vivo and the in vitro tests. The latter allow a quantitative measurement of the drug response and the assessment of several drugs at once. However, in terms of drug policy change its results might be difficult to interpret although they may be used as an early warning system for 2nd or 3rd line drugs. The new WHO 14-days in vivo test addresses mainly the problem of treatment failure and of haematological parameters changes in sick children. It gives valuable information on whether a drug still 'works'. None of these methods are well suited for large-scale studies. Molecular methods based on detection of mutations in parasite molecules targeted by antimalarial drugs could be attractive tools for surveillance. However, their relationship with in vivo test results needs to be established.

Animals↗

PubMed1991

Historical review of malaria control program in Taiwan.

Malaria had been a very serious endemic disease in Taiwan before it was eradicated. There has been a long history of struggle against this disease since the beginning of this century. A large scale chemotherapy program was initiated in 1910 following Koch's method. The inhabitants in the highly malarious area were subject to monthly blood examination and those positive for malaria parasites were compulsorily treated with antimalaria drugs. This program was continued until 1944. Malaria transmission was not interrupted, but the parasite rate among the inhabitants included in the program was maintained at 2% to 3% level for 35 consecutive years, and the number of deaths caused by malaria was brought down gradually from an average of 36 per 10,000 population before 1910(1906-1909) to less than 8 in the 1930s. Throughout the history of malaria control in Taiwan, other control measures were also applied. They were: personal protection, source reduction and antilarval operations. All these methods were proven to be effective, but with limitations. The availability of DDT and other residual insecticides in the 1940s marked a new era for malaria control in the world, as well as in Taiwan. A 6-year malaria eradication program using the DDT residual house spraying method was launched in 1952 and then followed by vigorous malaria surveillance activities which finally eliminated all the remaining foci of transmission. In 1965, Taiwan was registered by the World Health Organization on its list of countries where malaria eradication has been achieved. Although there has been no indigenous malaria in Taiwan, cases have been imported continuously from abroad. In the last 25 years, with the painstaking vigilance efforts, the malaria-free status has been maintained. It is hoped that these efforts will be continued so that malaria will never again come back to Taiwan as an endemic disease.

Animals↗

PubMed1990

[Mosquito-net spraying with deltamethrin for malaria control].

Mosquito-nets were sprayed with 9.6mg deltamethrin per square meter for control of malaria vectors in Yibin County, Sichuan Province in 1986. In the study area, the relative population indices of Anopheles anthropophagus and An. sinensis in 35 mosquito-nets were 0.6 and 1.4 respectively; the man biting rates of these two vectors dropped by 97.8 and 90.8% respectively. The residual toxic effect of sprayed mosquito-nets, up to 104 days after spray, caused a mortality of 93.1-100% of An. anthropophagus and 87.1-100% of An. sinensis. The multiparous mosquito rate dropped by 48.4 and 51.3%. Indoor-intruding An. anthropophagus and An. sinensis were reduced by 76% and 78.3% respectively. The incidence of malaria decreased by 94.4%, the positive rate in school children declined by 77.5%. Both entomological and epidemiological indices indicated that mosquito-nets sprayed with deltamethrin could effectively control the malaria prevalence. This measure is economical and practical for control of malaria.

Animals↗

PubMed2002

[Malaria control in Brazil: 1965 to 2001].

This paper reviews malaria control initiatives in Brazil, from the Malaria Eradication Campaign (Campanha de Erradicação da Malária), which was launched in 1965 and was based on spraying dichlorodiphenyltrichloroethane (DDT) and on administering antimalarial drugs, to the implementation, in 2000, of the Program for Intensification of Malaria Control in the nine-state Legal Amazon region of Brazil (Plano de Intensificação das Ações de Controle da Malária na Amazônia Legal), which was implemented in response to the World Health Organization's Roll Back Malaria effort. Among the Brazilian initiatives discussed are epidemiological stratification, the Impact Operation (Operação Impacto), the Amazon Basin Malaria Control Project (Projeto de Controle da Malária na Bacia Amazônica), and the Integrated Malaria Control Program (Programa de Controle Integrado da Malária). Although there was progress in the control of malaria before the Intensification Program was launched in 2000, the actions carried out were not sustained. From 1998 to 1999 there was even a 34% increase in the number of malaria cases in the Brazilian Amazon. The Intensification Program set a goal, in comparison to 1999, of reducing by 50% the number of malaria cases by the end of 2001 and of cutting by 50% the mortality due to malaria by the end of 2002. Data for 2001 showed an overall 39% decrease in the number of malaria cases in the nine Amazonian states of the Intensification Program. The smallest decrease (15%) was in the state of Amapá, where the plan was not implemented until the second half of 2001. In terms of incidence by species, there was a 35% reduction in cases caused by Plasmodium falciparum and a 41% reduction in cases caused by P. vivax. The only independent variable that explains this reduction is the implementation of the Intensification Program. Although preliminary, these results indicate considerable gains. Decisive to this progress has been the strong mobilization of federal, state, and municipal governments.

Brazil↗

PubMed1999

Malaria control in Nicaragua: social and political influences on disease transmission and control activities.

Throughout Central America, a traditional malaria control strategy (depending on heavy use of organic pesticides) became less effective during the 1970s. In Nicaragua, an alternative strategy, based on frequent local epidemiological assessments and community participation, was developed in the 1980s. Despite war-related social instability, and continuing vector resistance, this approach was highly successful. By the end of the contra war, there finally existed organisational and ecological conditions that favoured improved malaria control. Yet the expected improvements did not occur. In the 1990s, Nicaragua experienced its worst recorded malaria epidemics. This situation was partly caused by the country's macroeconomic structural adjustment programme. Volunteers now take fewer slides and provide less treatment, malaria control workers are less motivated by the spirit of public service, and some malaria control stations charge for diagnosis or treatment. To "roll back malaria", in Nicaragua at least, will require the roll-back of some erroneous aspects of structural adjustment.

Developing Countries↗

PubMed2001

Monitoring antimalarial drug resistance within National Malaria Control Programmes: the EANMAT experience.

The National Malaria Control Programme (NMCP), organized within the Ministry of Health (MoH), is an essential component for the planning, execution and coordination of malaria control activities. As effective case management remains the mainstay of malaria control in almost every African country, antimalarial drug resistance is a major barrier to the implementation of effective malaria control policies. In order to function effectively, these units must have an efficient surveillance system which can provide reliable and current estimates of the severity of drug resistance. Without this information, it is impossible for the MoH to design and promote a rational antimalarial policy, but because of limited resources, especially of people and expertise, most NMCPs have been unable to initiate and manage such a system. The need for collaborative partnerships between the MoH and the research community prompted the establishment of the East Africa Network for Monitoring Antimalarial Treatment (EANMAT). EANMAT has attempted to bring together the complimentary skills of malaria researchers and MoH staff in four east African countries. After 3 years of operation, data generated by EANMAT have been used to review and modify national malaria treatment policies in Kenya, Uganda, Rwanda and Tanzania. This new approach, which forges a closer working relationship between the research and policy communities, has effectively built capacity around the complex of surveillance, interpretation and use of evidence within a policy environment. The added-value of this approach is that the research community has learned to appreciate the constraints of policy development, and that the control community has established the need to build capacity and ownership of research evidence. Networks similar to EANMAT should be encouraged elsewhere in Africa to engender similar partnerships: to assist the development of rational treatment policies, and thus more effective malaria chemotherapy leading to significant lowering of malaria morbidity and mortality.

Africa, Eastern↗

PubMed2000

Cost-comparison of DDT and alternative insecticides for malaria control.

In anti-malaria operations the use of DDT for indoor residual spraying has declined substantially over the past 30years, but this insecticide is still considered valuable for malaria control, mainly because of its low cost relative to alternative insecticides. Despite the development of resistance to DDT in some populations of malaria vector Anopheles mosquitoes (Diptera: Culicidae), DDT remains generally effective when used for house-spraying against most species of Anopheles, due to excitorepellency as well as insecticidal effects. A 1990 cost comparison by the World Health Organization (WHO) found DDT to be considerably less expensive than other insecticides, which cost 2 to 23 times more on the basis of cost per house per 6 months of control. To determine whether such a cost advantage still prevails for DDT, this paper compares recent price quotes from manufacturers and WHO suppliers for DDT and appropriate formulations of nine other insecticides (two carbamates, two organophosphates and five pyrethroids) commonly used for residual house-spraying in malaria control programmes. Based on these 'global' price quotes, detailed calculations show that DDT is still the least expensive insecticide on a cost per house basis, although the price appears to be rising as DDT production declines. At the same time, the prices of pyrethroids are declining, making some only slightly more expensive than DDT at low application dosages. Other costs, including operations (labour), transportation and human safety may also increase the price advantages of DDT and some pyrethroids vs. organophosphates and carbamates, although possible environmental impacts from DDT remain a concern. However, a global cost comparison may not realistically reflect local costs or effective application dosages at the country level. Recent data on insecticide prices paid by the health ministries of individual countries showed that prices of particular insecticides can vary substantially in the open market. Therefore, the most cost-effective insecticide in any given country or region must be determined on a case-by-case basis. Regional coordination of procurement of public health insecticides could improve access to affordable products.

Animals↗

PubMed2006

Web-based climate information resources for malaria control in Africa.

Malaria remains a major public health threat to more than 600 million Africans and its control is recognized as critical to achieving the Millennium Development Goals. The greatest burden of malaria in Africa occurs in the endemic regions where the disease pathogen is continuously present in the community. These regions are characterized by an environment that is conducive to interactions between the Anopheles mosquito, malaria parasites and human hosts, as well as housing of generally poor quality, which offers little protection from mosquito-human contact. Epidemic malaria tends to occur along the geographical margins of endemic regions, when the equilibrium between the human, parasite and mosquito vector populations is occasionally disturbed and a sharp but temporary increase in disease incidence results. When malaria control measures are inadequate, as is the case in much of sub-Saharan Africa, the disease distribution is closely linked with seasonal patterns of the climate and local environment. In the absence of good epidemiological data on malaria distribution in Africa, climate information has long been used to develop malaria risk maps that illustrate the boundaries of 'climatic suitability for endemic transmission.' The best known of these are produced by the Pan-African-based MARA Collaboration. This paper describes the development of additional malaria suitability maps which have been produced in an online, interactive format to enable temporal information (i.e., seasonality of climate conditions) to be queried and displayed along with spatial information. These maps and the seasonal information that they contain should be useful to the malaria control and health service communities for their planning and operational activities.

Africa↗

PubMed2006

Ethical dilemmas in malaria control.

Because the term "malaria control" specifies an anti-malaria activity rather than an outcome of that action, progress has been evaluated in terms of the effort expended. Plans that specify goals and time lines tend to lack irreversible endpoints. Anti-malaria interventions that are stimulated by economic considerations focus on sites in which the residents enjoy some employment advantage, while interventions based on humanitarian objectives serve the neediest residents of broad regions. Site-specific interventions are conducted by industrial or municipal agencies, while regional interventions are conducted by public agencies. Industry contributes an element of sustainability by injecting the possibility of gainful employment into the site. Efforts that distribute assets mainly to the richest-of-the-poor may fail to preserve lives that would otherwise have been preserved, while those that serve the poorest-of-the-poor may fail to create sustainable cycles of health and wealth. Progress in relieving the burden imposed by malaria requires economically motivated as well as humanitarian contributions, and both should specify realistically time-limited goals that ultimately permit deintensification.

Chemical Industry↗

PubMed2003

Using a geographical information system to plan a malaria control programme in South Africa.

INTRODUCTION: Sustainable control of malaria in sub-Saharan Africa is jeopardized by dwindling public health resources resulting from competing health priorities that include an overwhelming acquired immunodeficiency syndrome (AIDS) epidemic. In Mpumalanga province, South Africa, rational planning has historically been hampered by a case surveillance system for malaria that only provided estimates of risk at the magisterial district level (a subdivision of a province). METHODS: To better map control programme activities to their geographical location, the malaria notification system was overhauled and a geographical information system implemented. The introduction of a simplified notification form used only for malaria and a carefully monitored notification system provided the good quality data necessary to support an effective geographical information system. RESULTS: The geographical information system displays data on malaria cases at a village or town level and has proved valuable in stratifying malaria risk within those magisterial districts at highest risk, Barberton and Nkomazi. The conspicuous west-to-east gradient, in which the risk rises sharply towards the Mozambican border (relative risk = 4.12, 95% confidence interval = 3.88-4.46 when the malaria risk within 5 km of the border was compared with the remaining areas in these two districts), allowed development of a targeted approach to control. DISCUSSION: The geographical information system for malaria was enormously valuable in enabling malaria risk at town and village level to be shown. Matching malaria control measures to specific strata of endemic malaria has provided the opportunity for more efficient malaria control in Mpumalanga province.

Databases, Factual↗

PubMed1990

Development of a methodology for malariogenic stratification as a tool for malaria control.

Modified plan of operation (MPO) for malaria control launched in 1977 failed to curb malaria incidence beyond about 2 million cases per annum and thus necessitated development of multipronged malaria control strategies based upon malariogenic stratification. A model for such stratification based upon six most sensitive, but quantifiable, epidemiological parameters for which records are easily available at PHC level, namely, topography, average annual rainfall, vector(s), average annual parasite incidence (API) for the last five years, epidemic potential and vulnerability was developed. This model has been successfully tried in the State of Karnataka and on that basis the whole State has been divided into five strata in order of increasing endemicity. Objectives of malaria control for each of the stratum so defined have been proposed.

Animals↗

PubMed2002

Eradication of Anopheles gambiae from Brazil: lessons for malaria control in Africa?

Current malaria-control strategies emphasise domestic protection against adult mosquitoes with insecticides, and improved access to medical services. Malaria prevention by killing adult mosquitoes is generally favoured because moderately reducing their longevity can radically suppress community-level transmission. By comparison, controlling larvae has a less dramatic effect at any given level of coverage and is often more difficult to implement. Nevertheless, the historically most effective campaign against African vectors is the eradication of accidentally introduced Anopheles gambiae from 54000 km(2) of largely ideal habitat in northeast Brazil in the 1930s and early 1940s. This outstanding success was achieved through an integrated programme but relied overwhelmingly upon larval control. This experience was soon repeated in Egypt and another larval control programme successfully suppressed malaria for over 20 years around a Zambian copper mine. These affordable approaches were neglected after the advent of dichlorodiphenyl trichloroethane (DDT) and global malaria-control policy shifted toward domestic adulticide methods. Larval-control methods should now be re-prioritised for research, development, and implementation as an additional way to roll back malaria.

Africa↗

PubMed1992

Strategies for malaria control in Colombia.

Attempts at malaria eradication this century have been highly effective but early successes have not been sustained. This has been ascribed to the lack of community involvement in these campaigns. Colombia has put huge effort into malaria control on a number of fronts, from vaccine development to the evaluation of the integrated use of more traditional methods. William Rojas, Fernando Peñaranda and Mouricio Echavarria describe a pilot programme for integrated malaria control in Colombia whose success they attribute to committed community participation.

Journal Article↗

PubMed1999

Malaria control priorities and constraints.

The capacity to prioritize correctly actions in malaria control depends on good knowledge not only of the epidemiology of the disease in the area but also of the behaviour of the people. Health policy makers frequently believe that the people already know enough about malaria and there is no need to commit further resources on finding out what the people actually know and do about the disease in order to modify their wrong habits. One of the pressing priorities for malaria control in Africa is therefore changing the attitude of malaria control policy makers. Considering the constraints to malaria control it is stressed that the health budget is usually below a level sufficient to finance an effective health care system. This is further compounded by inequities in the allocation of funds between health care institutions located in the urban areas compared with those located in the rural areas. Another important constraint is lack of manpower suitably trained to undertake the various elements of the global malaria control strategy. Finally, a very well known constraint is the unavailability of effective drugs at the locations where they are needed.

Behavior↗