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PubMed1984

Malaria control with residual fenitrothion in Central Java, Indonesia: an operational-scale trial using both full and selective coverage treatments.

An operational-scale trial, using residual fenitrothion, for control of malaria was carried out in Central Java, Indonesia, from 1980 to 1982. Two areas, each comprising about 70 km(2) and a population of about 50 000, were treated with fenitrothion (40% water dispersible powder) at a target dosage of 2 g/m(2) for 3 cycles at 6-monthly intervals. One area was treated with full coverage (i.e., the interiors of houses and cattle shelters were sprayed to a height of 3 m) for 2 cycles, followed by a third cycle with selective coverage (i.e., the interiors of houses were sprayed with one 75 cm horizontal swath between 10 cm and 85 cm from the floor while the cattle shelters were sprayed to a height of 3 m). The other area was treated for 3 cycles with only selective coverage. While both treatment methods reduced malaria rates and vector populations to very low levels, the full coverage treatment was more rapidly effective and also reduced the Plasmodium falciparum index. However, the selective coverage treatment was 68% less expensive than full coverage and greatly reduced the degree of cholinesterase depressions among the spraymen. The trial also showed that a dosage of 1 g/m(2) with full coverage was nearly as effective as the 2 g/m(2) dosage.

Animals↗
PubMed2002

Malaria control by residual insecticide spraying in Chingola and Chililabombwe, Copperbelt Province, Zambia.

Malaria is endemic in the whole of Zambia and is the leading cause of morbidity and mortality. Prior to 1980, effective malaria control was achieved in the northern mining towns of Chingola and Chililabombwe by means of annual residual spraying programmes. In the 1970s, incidence rates were as low as 20/1000 p.a., but by 2000 had increased to 68/1000 p.a. in Chingola and to 158/1000 p.a.in Chililabombwe. Konkola Copper Mines (KCM) initiated a malaria control programme in which all dwellings in the two towns and within a 10-km radius were sprayed with either dichlorodiphenyltrichloroethane or a synthetic pyrethroid (Icon by ZENECA or Deltamethrin by Aventis). Houses were sprayed in November and December 2000, at the start of the peak transmission period. There was a statistically significant reduction in malaria incidence recorded at KCM health facilities in the two towns, representing a protective incidence rate ratio of 0.65 (95% CI 0.44, 0.97) when comparing the post-spraying period with the corresponding period of the previous 2 years. This reduction followed a single round of house spraying during a year with higher rainfall than the preceding two and in an area where chloroquine was first-line treatment. This house-spraying programme is an example of private/public sector collaboration in malaria control.

Adult↗
PubMed1993

Field evaluation of bednets impregnated with deltamethrin for malaria control.

Trials were undertaken in a hypoendemic area of malaria in an area bordering Vietnam, in Napo County of Guangxi Zhuang Autonomous Region, China. The aim was to compare the relative cost effectiveness of DDT residual spraying and of bednets impregnated with deltamethrin in the malaria control program. The trials were divided into three subgroups: (1) two farming areas and one coal mining area with a total population > 20,000, where the trial consisted of mass bednets impregnated with deltamethrin 15 mg/m2 net surface once a year, (2) one farming area with a population of approximately 3,600 where DDT residual spraying at 2g/m2 was carried out twice a year in May and August; (3) one farming area and one coal mining village with a population of > 4,000 were used as a control. The malaria vector population consisted mainly of Anopheles minimus and An. anthropophagus with a small contribution from An. sinensis. After bednets were impregnated with deltamethrin the mosquitos resting on the surface of the bednets decreased significantly, although there was less effect on the total vector population. The results showed that malaria incidence decreased significantly both in areas where impregnated bednets were used and in areas where residual spraying was undertaken. The positive IFAT rates of residents who slept under impregnated bednets decreased significantly in farming areas, especially in that area where bednet impregnation as a vector control measure had been undertaken for two years, but there was no change in the IFAT rate in DDT sprayed or control areas.(ABSTRACT TRUNCATED AT 250 WORDS)

Bedding and Linens↗
PubMed1993

Is malaria control a priority? Evidence from Nepal.

The research reported here assessed the value of malaria control through a cost-effectiveness study of the vertically-organized malaria control programme in Nepal. It presents a methodological framework for analysing cost-effectiveness which includes resource-saving consequences as well as health consequences. The methods used to collect data on control costs, cases and deaths prevented, treatment costs averted and production gains are described and the assumptions required by the analysis are made explicit. A variety of cost-effectiveness ratios are calculated, sensitivity analysis applied and the policy implications of the results considered. The results from Nepal are compared to estimates for parasitic disease and other health programmes in other countries: it is concluded that the Nepalese programme appears no less cost-effective than many other health interventions. It can also be justified by reference to the population groups benefiting from malaria control.

Absenteeism↗
PubMed1996

Deltamethrin-impregnated bednets as an operational tool for malaria control in a hyper-endemic region of Burundi: impact on vector population and malaria morbidity.

Within the framework of the National Malaria Control Programme Burundi, impregnated bednets were promoted through health care facilities, schools and local administration in Nyanza Lac district. The decision to buy a bednet was left to the inhabitants and, as a result, coverage rates between 6 and 65% were observed at sub-district level. Three intervention regions were specified based on the intervention start date. From November 1992 until March 1995, bi-monthly parasitological and entomological surveys were carried out in two areas each of Region 1 and Region 2. After introduction of impregnated bednets in Region 1 the proportions of children under 5 with high parasitaemia were reduced by 42 and 53% in the 2 parasitological survey areas, where the average bednet coverages were 55 and 44% respectively. In the survey areas of Region 2 (control) no significant change occurred during the same period. During the second part of the intervention from September 1994, when intervention was also operational in Region 2, significant decreases in the proportion of high parasitaemia (63 and 42%) among children under 5 years were obtained in both parasitological survey areas of Region 2 (average coverages of 51 and 29%). The positive output of the intervention was maintained and even reinforced in the survey areas of Region 1. Bednets as a tool for malaria control entail specific problems such as coverage, daily use, reimpregnation, and renewal of old and torn nets. Further evaluation has to point out the possible shift of the clinical spectrum and the age-specific admission of malaria cases to assess the long-term benefit of this control method.

Animals↗
PubMed1987

Malaria control in Iran--present and future.

The malaria eradication campaign in Iran, which started in 1958, has not been able to achieve its final goals. The technical, administrative, socio-economic and financial obstacles involved in this unfinished task are mentioned and the present status of malaria in the country is discussed. It is urged that eradication policy, presently used, be substituted by malaria control program, as defined by The World Health Organization. This would serve as a prerequisite for eventual eradication of malaria, from the country, in the future. Within such agreement, the improvement of basic health services and search for better technical means of controlling the transmission of the infection are emphasized as vital to achieve this goal. Intensive training of experienced staff, in Iran, for stimulation and promotion of relevant research and training activities in malaria control is highly recommended.

Animals↗
PubMed2000

The United States Army and malaria control in World War II.

The United States Army faced difficult malaria control problems both at home and abroad during World War II. This challenge forced the Army to develop new tools and strategies for use in malarious areas where fighting was occurring. Due to the severe malaria problems being faced in some combat areas and the need to solve these problems quickly, intensive malaria research and operational programs were developed and implemented. With these concerted efforts and the simultaneous development of new control technologies, malaria was successfully controlled in most locations. In order to accomplish this high level of control both in the US and overseas, the Army developed a very organized approach to the malaria problem and implemented it in an effective manner. The creation of new technical solutions was also strongly emphasized and out of this effort came the development of effective antimalaria drugs to replace quinine, of new insecticides and of more effective systems for delivering these insecticides. Some of the major new tools which came out of this research were DDT and drugs such as Atabrine and chloroquine. The availability of Atabrine and DDT revolutionized malaria control throughout the world. The knowledge and experience gained through the use of these new tools by the US Army and other agencies in World War II provided the basis for a new optimism regarding malaria control which then led to the development of the global malaria eradication strategy in the post-war years.

Animals↗
PubMed1994

Evaluation of national malaria control programmes in Africa.

Evaluation is an essential management tool for the improvement of public health programmes or projects. As malaria morbidity and mortality continue to increase in most countries in Africa, international agencies and malaria control programme managers have identified the strengthening of programme evaluation as an important strategy for improving the efficiency and effectiveness of malaria control programmes. Managers can develop an evaluation strategy only after they have defined programme objectives and planned specific programme activities. Indicators should be directly related to programme objectives and should be selected on the basis of the following criteria: their validity; reliability; ability to detect change within a reasonable time period and as a result of successful programme implementation; ability to be interpreted; and usefulness in guiding programme change. Only those indicators that can be measured with available programme resources should be selected. Managers will also need to identify the sources of indicator data and to determine how often each indicator will be measured. Programme managers should develop criteria or indicators for the following: programme policies and plans; the process of programme implementation; the outcomes of malaria control interventions in disease management and prevention; and programme impact in terms of reductions in malaria-related mortality and morbidity. Key issues related to the management of evaluation activities within a national programme include the need to begin with available resources and build incrementally; to explore options for administering evaluation activities; to select, train and supervise staff who carry out evaluation activities; to develop quality control strategies; and to ensure that data are managed and communicated in ways that support effective programme decision-making. For evaluation to lead to improvements in malaria control programmes it must be clearly defined as a part of the programme management process. Programme managers should lead this developmental process, ensuring that evaluation methods produce the information they need to monitor and improve their programmes at reasonable cost.

Africa↗
PubMed1999

Knowledge, beliefs and practices relevant for malaria control in an endemic urban area of the Colombian Pacific.

Research projects for malaria control must involve communities to elicit strategies to be successful and programs to be sustainable. Therefore, knowledge, beliefs and practices of the population concerned must be taken into account in the design of interventions against malaria transmission. We conducted a KAP study in Buenaventura, a port on the Pacific Coast of Colombia where transmission was on the increase at the beginning of this decade. The purpose of the study was to help in the design and implementation of a primary health care approach for malaria control. Both qualitative and quantitative research methods were used. The focus group technique was applied in five urban and peri-urban communities and a cross sectional survey was conducted on a random sample of 1380 subjects with a structured interview on knowledge, practices and also on demographic and epidemiological aspects. The information obtained by the two methods was comparable on knowledge of symptoms, causes and ways of malaria transmission, and prevention practices like the use of bednets or provision of health services. We discuss the relevance of obtaining this information and analyze the elements that must be taken into account for communities to become more involved in malaria control strategies.

Adult↗
PubMed1981

Progress in malaria vector control.

Malaria control, except in tropical Africa, will probably continue to be based to a large extent on the use of insecticides for many years. However, the development of resistance to insecticides in the vectors has caused serious difficulties and it is necessary to change the strategy of insecticide use to maximize their efficacy. A thorough knowledge of the ecology and behaviour of each vector species is required before the control strategy can be adapted to different epidemiological situations. The behavioural differences between sibling species have been recognized for several years, but study of this problem has recently been simplified by improved means of identification that involve chromosomal banding patterns and electrophoretic analysis. Behavioural differences have also been associated with certain chromosomal rearrangements.New records of insecticide resistance among anophelines continue to appear and the impact of this on antimalaria operations has been seriously felt in Central America (multi-resistance in Anopheles albimanus), Turkey (A. sacharovi), India and several Asian countries (A. culicifacies and A. stephensi), and some other countries. Work continues on the screening and testing of newer insecticides that can be used as alternatives, but DDT, malathion, temephos, fenitrothion, and propoxur continue to be used as the main insecticides in many malaria control projects. The search for simpler and innovative approaches to insecticide application also continues.Biological control of vectors is receiving increased attention, as it could become an important component of integrated vector control strategies, and most progress has been made with the spore-forming bacterium, serotype H-14 of Bacillus thuringiensis. Larvivorous fish such as Gambusia spp. and Poecilia spp. continue to be used in some programmes.Application of environmental management measures, such as source reduction, source elimination, flushing of drainage and irrigation channels, and intermittent irrigation have been re-examined and currently a great deal of interest is being shown in these approaches.There has been limited interest in the genetic control of mosquitos and the phenomenon of refractoriness in some strains of the disease vectors, with the idea of replacing the vector species with the refractory strain. More research is needed before this approach can become a practical tool.It is apparent that in future a more integrated approach will have to be used for vector control within the context of antimalaria programmes. Training of staff, research, and cooperation at all levels will be an essential requirement for this approach.

Animals↗
PubMed2004

The role of mathematical modeling in evidence-based malaria control.

Mathematical models have long provided basic insights for malaria control. The recent success of the Onchocerciasis Control Program in west Africa shows that models can make great pragmatic contributions to intervention programs if the modeling is integrated into the overall program, and if the participants are clear about what models can and cannot do. This lesson can be applied to evidence-based malaria control.

Animals↗
PubMed2000

Malaria control in East Africa: the Kampala Conference and the Pare-Taveta Scheme: a meeting of common and high ground.

The 1950 Malaria Conference in Equatorial Africa, held in Kampala, Uganda, has been remembered primarily for its decision to control malaria '...by modern methods as soon as feasible, whatever the original degree of endemicity, and without awaiting the outcome of further experiments.' This decision was far from conclusive and, indeed, reflects only one side of the argument which brought two groups of malariologists into direct opposition on the wisdom of malaria control in equatorial Africa, using modern methods such as DDT. Through an examination of the unpublished verbatim transcript of the Kampala Conference, we are able to document the 'furious debates' which took place at Kampala in 1950. We highlight, in particular, the adamant concerns expressed by some of the delegates that intervention in areas of high malaria transmission might lead to a loss of naturally acquired immunity which, in turn, could give rise to a resurgence of malaria, should the control strategies fail to be sustained. As we show, this concern had been expressed by a number of malariologists working in East Africa in the first half of the twentieth century, but it was only with the advent of DDT, as a residual insecticide, that the implications of wide-spread control, in the absence of any knowledge of the long-term consequences, became a serious possibility. While the Kampala Conference gave the 'go ahead' to control malaria in Africa without awaiting the outcome of 'further experiments', a number of participants insisted that a field trial should be set up to evaluate the impact of malaria on areas of high transmission both before and after spraying: to this end, a field trial in Pare-Taveta was carried out in 1954-59. In this paper we look at the Kampala Conference for its scientific debates and the Pare-Taveta Scheme for its field applications. In the final part of the paper, we address a number of questions raised at Kampala which have, once more, become contentious issues, following the recent successful trials of ITBNs. We believe that an understanding of the historical foundations of these issues should provide an important component of the new WHO campaign to Roll Back Malaria.

Adult↗
PubMed1998

Commentary: malaria control in the 1990s.

In May 1955 the Eighth World Health Assembly adopted a Global Malaria Eradication Campaign based on the widespread use of DDT against mosquitos and of antimalarial drugs to treat malaria and to eliminate the parasite in humans. As a result of the Campaign, malaria was eradicated by 1967 from all developed countries where the disease was endemic and large areas of tropical Asia and Latin America were freed from the risk of infection. The Malaria Eradication Campaign was only launched in three countries of tropical Africa since it was not considered feasible in the others. Despite these achievements, improvements in the malaria situation could not be maintained indefinitely by time-limited, highly prescriptive and centralized programmes. Also, vector resistance to DDT and of malaria parasites to chloroquine, a safe and affordable drug, began to affect programme activities. A global Malaria Control Strategy was endorsed by a Ministerial Conference on Malaria Control in 1992 and confirmed by the World Health Assembly in 1993. This strategy differs considerably from the approach used in the eradication era. It is rooted in the primary health care approach and calls for flexible, decentralized programmes, based on disease rather than parasite control, using the rational and selective use of tools to combat malaria. The implementation of the Global Strategy is beginning to have an impact in several countries, such as Brazil, China, Solomon Islands, Philippines, Vanuatu, Viet Nam and Thailand. The lesson from these areas is clear: malaria is being controlled using the tools that are currently available. The challenge is now to apply these tools among vulnerable individuals and groups experiencing high levels of morbidity and mortality, particularly in sub-Saharan Africa, for which long-term investments are required.

DDT↗
PubMed1954

Present status of malaria control in Asia.

The author summarizes the information given by 13 governments-Afghanistan, Burma, Ceylon, China, India, Indonesia, Malaya, Netherlands New Guinea, Philippines, Portuguese India, Sarawak, Thailand, and Viet Nam-on their existing and proposed malaria-control programmes in response to a questionnaire prepared by WHO for discussion at the First Asian Malaria Conference, which was held in Bangkok in September 1953.Although in late 1953 nearly 46.5 million of the 271 million people living in malarious regions were protected against the disease, more than 224 million others were still unprotected.It is noted that residual-insecticide spraying-the basis of most campaigns-has significantly reduced spleen- and parasite-rates; that the minor opposition to spraying initially encountered in some places quickly disappeared as the benefits became apparent; that malaria control has resulted in general improvements in public health and has promoted socio-economic development; that anopheline resistance to the insecticides used has not been observed; that ten governments voiced the need for indoctrination of public officials concerning malaria control; and that there is a trend among governments to make financial provision for long-term malaria-control schemes.

Afghanistan↗
PubMed1983

Malaria control and primary health care: or the art of squaring the circle.

The present trends of malaria control in developing countries aim at integrating the specific antimalaria activities, as much as possible, with the tasks of the primary health care. This seems to have been achieved in a few countries through the close involvement of the community and the support of the national, politically orientated health programme. However, such social and administrative discipline is seldom seen, although it can be of immense long-term value. In view of the present increasing difficulties of malaria control by residual insecticides and by antiplasmodial methods, it is doubtful if the primary health care can achieve the desirable aims of comprehensive malaria control, even if can greatly help in implementing such measures as are necessary. A realistic appraisal of intermediate health targets is needed, together with a maintenance of a core of technical expertise to advise and conduct the necessary activities. There is also great need of a reorientation of individual and community attitudes throughout the endemic malarious areas of the Third World.

Developing Countries↗
PubMed1992

Malaria control program in Indonesia.

The malaria situation in Indonesia is reviewed in the major island group of Java-Bali and the remainder of the archipelago called the Outer Islands. Based on their varying epidemiological patterns the areas for control have been stratified and efforts are directed towards the rational use of antimalarial drugs and the institution of integrated vector control ie chemical control in conjunction with biological control and environmental management. The targets of malaria control vary as well between island groups. Administrative, technical and operational constraints are identified. Drug-resistant malaria, forest-related malaria, lack of personnel, supervision and coordination, inadequate resources, and community participation are among the main issues confronting the national malaria control program. Research and training needs are emphasized in the recommendations.

Animals↗
PubMed1989

Integrated malaria control achieves results in Mayotte.

A malaria control campaign in the island territory of Mayotte has achieved remarkable success owing to the integration of activities with the general health service and to the high degree of decentralization practised.

Animals↗