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PubMedDate not supplied

Malaria control in Afghanistan: progress and challenges.

From the 1950s until 1979 malaria control in Afghanistan was implemented through a vertical programme managed by the government, but little of the original programme remained functional by the early 1990s. Delivery of basic health care including malaria diagnosis and treatment was done by non-governmental organisations (NGOs) and UN agencies, which organised cross-border operations from Pakistan and Iran and placed much less emphasis on vertical programming. From 1992 the situation in the east of Afghanistan became stable enough to allow the establishment of a network of NGO-supported clinics and to introduce standardised training and monitoring of microscopists and clinical staff, coordinated by a lead agency specialising in malaria. After the collapse of the Taliban in 2001 and the subsequent establishment of an interim government, the first steps in health-system rehabilitation have been taken. The gradual integration of malaria control into routine health-care delivery is planned. This process should be guided by the knowledge and experience gained during the complex emergency and a focus on malaria should be maintained until the disease is brought under control.

Afghanistan↗
PubMed2005

KAP surveys and malaria control in Vietnam: findings and cautions about community research.

The malaria disease burden is increasing in many countries despite the existence of effective preventative strategies and antimalarial drugs. An understanding of community perspectives and practices is one of the essential components of a successful malaria control program. This paper reports on a KAP (Knowledge, Attitudes and Practices) survey among the Raglai ethnic minority population in Ninh Thuan Province, Vietnam, which in 2003 had one of the country's highest confirmed rates of malaria. We found high levels of correct knowledge about malaria's transmission and symptoms, and self-reports of adequate bed net usage and appropriate health-seeking behavior. While the survey generated useful findings, an initial, qualitative investigation (eg, observation and focus group discussions) to explore the large numbers of potential influences on behavior and exposure risk would have provided a more robust underpinning for the design of survey questions. This would have strengthened its validity and generated additional information. The adoption of rigorous, multi-disciplinary research methods offers the best chance of contributing to the development of successful malaria control programs and effective policies.

Adolescent↗
PubMedDate not supplied

Financial management systems under decentralization and their effect on malaria control in Uganda.

A descriptive case study with multiple sites and a single level of analysis was carried out in four purposefully selected administrative districts of Uganda to investigate the effect of financial management systems under decentralization on malaria control. Data were primarily collected from 36 interviews with district managers, staff at health units and local leaders. A review of records and documents related to decentralization at the central and district level was also used to generate data for the study. We found that a long, tedious, and bureaucratic process combined with lack of knowledge in working with new financial systems by several actors characterized financial flow under decentralization. This affected the timely use of financial resources for malaria control in that there were funds in the system that could not be accessed for use. We were also told that sometimes these funds were returned to the central government because of non-use due to difficulties in accessing them and/or stringent conditions not to divert them to other uses. Our data showed that a cocktail of bureaucratic control systems, corruption and incompetence make the financial management system under decentralization counter-productive for malaria control. The main conclusion is that good governance through appropriate and efficient financial management systems is very important for effective malaria control under decentralization.

Financial Management↗
PubMed1989

Contamination of stored food and feed commodities from indoor use of HCH and DDT in malaria control programmes.

Samples of wheat grain, straw, flour and green fodder taken from houses sprayed with either HCH or DDT for mosquito control showed the presence of HCH residues at concentrations of up to 91.2, 208.8, 33.1 and 459.0 mg kg-1 and DDT residues up to 11.3, 86.1, 2.2 and 5.4 mg kg-1, respectively. The mean level of HCH residues in samples of wheat grain collected from randomly selected houses in areas sprayed with HCH for the control of malaria was approximately 8 times higher than that for corresponding samples from DDT sprayed areas. In contrast, DDT residues in wheat grain samples from the DDT sprayed area were 3 times higher than the samples from the HCH sprayed area. The results suggest that significant amounts of residues of HCH and DDT become transferred to commodities stored in houses sprayed with these insecticides for mosquito control.

Animal Feed↗
PubMed2000

Malaria control in central Malaita, Solomon Islands 2. Local perceptions of the disease and practices for its treatment and prevention.

Government health policy for malaria control in Solomon Islands has three main objectives: (1) early diagnosis and treatment of malaria at a health service; (2) reduction of human-vector contact through widespread use of insecticide-impregnated bed nets; and (3) provision of malaria chemoprophylaxis for pregnant women. Social research was carried out in thirteen villages in central Malaita to determine local attitudes toward malaria and to estimate the level of participation in malaria control activities. Interviews with 124 care-givers who had children 0-10 years of age, 20 focus group discussions and four evening structured observations were research methods used. Antimalarial drugs were the most favoured treatment, and use of traditional medicines and healers were reportedly minimal. Twenty-five percent of respondents reported keeping chloroquine at home and 42% said they would use chloroquine before seeking diagnosis and treatment from a health service. Structured observations suggest that protection against mosquitoes is poor during the evening. Fifty-two percent of respondents reported using fire and 32% said they used bed nets to protect themselves from mosquitoes. Participants had contradictory beliefs on the threat of malaria during pregnancy and the safety of taking chloroquine prophylaxis. Implications of malaria treatment and prevention practices are discussed, and recommendations for improving malaria control are presented.

Animals↗
PubMed1989

Contamination of bovine (buffalo, Bubalus bubalis (L.)) milk from indoor use of DDT and HCH in malaria control programmes.

Samples of bovine (Buffalo, Bubalus bubalis (L.)) milk collected from randomly selected houses of Ludhiana and Sangrur districts of Punjab, India, where DDT and HCH, respectively, had been sprayed for the control of malaria, were analysed for insecticide residues between September 1985 and June 1986. The average concentration of DDT residues in samples from the DDT sprayed area were approximately 4-12 times higher than those in the corresponding samples from HCH sprayed areas. Mean levels of HCH residues in samples from the HCH sprayed area were greater than those in samples from DDT sprayed areas by factors of 2-11. Milk samples collected from four rural houses in each district before and after applications of DDT or HCH for mosquito control also showed that indoor use of these insecticides results in a substantial increase in residue levels. About 74% of the samples analysed contained DDT residues above the extraneous residue limit of 0.05 mgkg-1 (whole milk basis). Estimated maximum daily intakes of DDT and beta-HCH through consumption of contaminated milk by 1-3-year-old children exceeded their acceptable daily intakes by nearly three and five times, respectively.

Animals↗
PubMed1992

DDT and HCH residues in indoor air arising from their use in malaria control programmes.

Samples of air from rooms in a residential and rural environment, treated with either DDT or HCH at rates recommended for mosquito control under the National Malaria Eradication Programme of India, i.e. 2 and 3 g m-2, respectively, were analyzed for the residues of these insecticides. During the 8-month sampling period, DDT and HCH levels in indoor air ranged from 1.0 to 14.6 and 0.9 to 2000.1 micrograms m-3, respectively. After an initial fall, residues of DDT showed an increase again and were 5.9 micrograms m-3 in samples collected 240 days after the initial application. In contrast, HCH residues declined at a fast rate in a few days after application and remained low at the time of subsequent samplings. HCH residues were present chiefly in the vapour phase throughout the study. Thirty-four to seventy-eight percent of DDT residues were found in the particulate phase in the samples collected up to 64 days after its application and exclusively in the vapour phase at the time of later samplings. Apart from the contamination of food and feed commodities stored in premises treated for malaria control by absorption of insecticides present in the indoor atmosphere, the residues of these persistent compounds in air are also likely to result in low level pollution of the surrounding and distant environmental media by their dispersion in the global ecosystem.

Air Pollutants, Occupational↗
PubMed1983

Urban malaria control situation and environmental issues, Madras City, India.

Madras was one of 22 urban places in India where centrally sponsored urban malaria control schemes were introduced in 1971-1972. Yet since 1970, malaria cases have actually registered a significant increase in Madras. This paper deals with some critical environmental issues facing malaria control schemes. The overall spatial trends and patterns of malaria incidence are illustrated through maps for the years 1975-1981. Areas of high incidence are shown in the northern part of the city which is also traditionally an endemic area. The City Corporation has identified 17 high risk divisions accounting for 75% of the total registered cases in the city. High risk areas were found to be related to environmentally deteriorating areas such as high density, older, residential areas, slums and squatter settled areas along stretches of two rivers and a canal which traverse the city, and the low-lying poorly drained areas scattered over many parts of the city. The typical breeding grounds and sources of major vectors (anophelines and culicines) are presented. A relationship exists between the density of breeding sources (of Anopheles stephensi), such as private and public wells (in use and in disuse), overhead tanks and cisterns, and malaria cases. Field observations were made in detail in four selected high risk areas. Each area presents different environmental, epidemiological and human (social) factors in understanding malaria resurgence situation and demand different types of control measures. The problems of implementation of urban control schemes are found to be political, administrative, economic, social as well as environmental in nature. The persistence of malaria problems in the city has been attributed to slackening of malaria eradication measures, rapid urban growth and deteriorating environmental conditions with sewage, drainage and sanitation programmes lagging far behind the plans. The advantages and drawbacks of various antimalaria (mostly larval) measures in practice are presented. Biological and chemical control methods of malaria seem to provide only temporary control of the vectors. Some of the problems and constraints faced by Madras City Corporation in enforcing public health measures are discussed. The study also points out that environmental improvement, management techniques and health education, including raising the public awareness and cooperation, involvement and participation at neighbourhood/community levels in a meaningful way, have a long way to go in achieving permanent vector control and eliminating the reservoir of infection.

Animals↗
PubMed2004

Public and private roles in malaria control: the contributions of economic analysis.

There has been high profile advocacy and debate about how to increase availability and uptake of effective malaria control interventions. Application of the tools of public economics indicates that market failures occur for a number of effective malaria control interventions due to monopoly, externalities, and information failures, implying a role for public action. However, additional analysis is required to determine the optimal form of public intervention, and how to set priorities. Additional criteria of cost-effectiveness, impact on poverty and catastrophic expenditures, affordability, characteristics of supply and demand, and potential for leakage are invoked to help inform decision making in the field of malaria control policies. Particular emphasis is placed on the connections between public and private actions.

Cost-Benefit Analysis↗
PubMed2002

A cost comparison of two malaria control methods in Kyunggi Province, Republic of Korea, using remote sensing and geographic information systems.

A cost-comparison of two methods for the control of malaria in the Republic of Korea was performed. The cost of larviciding with methoprene granules was estimated at $93.48/hectare. The annual cost of providing chemoprophylaxis was estimated at $37.53/person. Remote sensing and geographic information systems were used to obtain estimates of the size of vector larval habitats around two U.S. Army camps, allowing an estimate of the cost of larviciding around each of the camps. This estimate was compared to the cost of providing chloroquine and primaquine chemoprophylaxis for the camp populations. Costs on each of the camps differed by the size of the larval habitats and the size of the at-risk population. These tools allow extrapolation of larval surveillance data to a regional scale while simultaneously providing site-specific cost analysis, thus reducing the cost and labor associated with vector surveillance over large areas.

Animals↗
PubMed1999

Cost of malaria control in Sri Lanka.

The study provides estimates of the cost of various malaria control measures in an area of North-Central Province of Sri Lanka where the disease is endemic. We assumed that each measure was equally effective. In these terms, impregnating privately purchased bednets with insecticide was estimated to cost Rs 48 (US(40.87) per individual protected per year, less than half the cost of spraying houses with residual insecticides. Larviciding of vector breeding sites and especially the elimination of breeding habitats by flushing streams through seasonal release of water from upstream reservoirs was estimated to be cheaper than other preventive measures (Rs 27 (US$ 0.49) and Rs 13 (US$ 0.24) per individual protected, respectively). Inclusion of both operational and capital costs of treatment indicates that the most cost-effective intervention for the government was a centrally located hospital with a relatively large catchment area (Rs 71 (US$ 1.29) per malaria case treated). Mobile clinics (Rs 153 (US$ 2.78) per malaria case treated) and a village treatment centre (Rs 112 (US$ 2.04)) per malaria case treated) were more expensive options for the government, but were considerably cheaper for households than the traditional hospital facilities. This information can guide health planners and government decision-makers in choosing the most appropriate combination of curative and preventive measures to control malaria. However, the option that is cheapest for the government may not be so for the householders, and further studies are needed to estimate the effectiveness of the various preventive measures.

Capital Expenditures↗
PubMed2003

Molecular entomology and prospects for malaria control.

During the past decade, the techniques of molecular and cell biology have been embraced by many scientists doing research on anopheline vectors of malaria parasites. Some of the most important research advances in molecular entomology have concerned the development of sophisticated molecular tools for procedures such as genetic and physical mapping and germ line transformation. Major advances have also been made in the study of specific biological processes such as insect defence against pathogens and the manner in which malaria parasites and their anopheline hosts interact during sporogony. One of the most important highlights of this research trend has been the emergence during the past year of a formal international Anopheles gambiae genome project, which at present includes investigators in several laboratories in Europe and the USA. Although much of this molecular research is directed towards the development of malaria control strategies that are probably many years from implementation, there are some important areas of molecular entomology that may have a more near-term impact on malaria control. We highlight developments over the past decade in three such areas that we believe can make important contributions to the development of near-term malaria control strategies. These areas are anopheline species identification, the detection and monitoring of insecticide susceptibility/resistance in wild anopheline populations and the determination of the genetic structure of anopheline populations.

Animals↗
PubMed2006

Intermittent preventive treatment for malaria control administered at the time of routine vaccinations in Mozambican infants: a randomized, placebo-controlled trial.

BACKGROUND: There is an urgent need to deploy and develop new control tools that will reduce the intolerable burden of malaria. Intermittent preventive treatment in infants (IPTi) has the potential to become an effective tool for malaria control. METHODS: We performed a randomized, double-blind, placebo-controlled trial of sulfadoxine-pyrimethamine (SP) treatment in 1503 Mozambican children. Doses of SP or placebo were given at 3, 4, and 9 months of age. The intervention was administered alongside routine vaccinations delivered through the Expanded Program on Immunization (EPI). Hematological and biochemical tests were done when infants were 5 months old. Morbidity monitoring through a hospital-based passive case-detection system was complemented by cross-sectional surveys when infants were 12 and 24 months old. RESULTS: IPTi was well tolerated, and no adverse events associated with SP were documented. During the first year of life, intermittent SP treatment reduced the incidence of clinical malaria by 22.2% (95% confidence interval [CI], 3.7%-37.0%; P=.020) and the rate of hospital admissions by 19% (95% CI, 4.0%-31.0%; P=.014). Although the incidence of severe anemia (packed cell volume of <25%) did not differ significantly between the 2 groups (protective effect, 12.7% [95% CI, -17.3% to 35.1%]; P=.36), there was a significant reduction in hospital admissions for anemia during the month after dosing for both the first and second dose. The serological responses to EPI vaccines were not modified by the intervention. CONCLUSIONS: IPTi with SP has been shown to moderately reduce the incidence of clinical malaria in Mozambican infants without evidence of rebound after stopping the intervention or of interactions with EPI vaccines. Its recommendation as a malaria control strategy in Mozambique needs to be balanced against the scarcity of affordable control tools and the burden of malaria in children.

Animals↗
PubMed2006

Malaria control using indoor residual spraying and larvivorous fish: a case study in Betul, central India.

OBJECTIVES: To assess the impact of intensified malaria control interventions in an ethnic minority community in Betul using existing tools. METHODS: Two rounds of indoor residual spraying with synthetic pyrethroid insecticide were applied and larvivorous fish introduced, followed by intensive surveillance for early detection of Plasmodium falciparum with rapid diagnostic tests and prompt treatment with sulphadoxine pyrimethamine. RESULTS: Pre-intervention surveys revealed a very high fever rate in the community in all age groups with a slide positivity rate of >50% with >90%P. falciparum. The post-intervention phase showed a sharp steady decline in number of malaria cases (beta 0.972; P < 0.0001, 95% CI 0.35-0.47). Monitoring of entomological results revealed a significant decline in both Anopheles species and An. culicifacies (P < 0.0001). CONCLUSION: A combination of indoor residual spraying and early detection and prompt treatment complemented by rapid diagnostic tests and larvivorous fishes successfully brought malaria under control. These approaches could be applied in other regions of different endemicity to control malaria in India.

Animals↗
PubMed1996

Malaria control and fever management in Henan Province, China, 1992.

Henan Province, which once had the highest malaria prevalence in China, had only 318 reported cases in 1992. Our purpose was to investigate this late 'consolidation phase' of malaria control in Henan with reference to malaria surveillance. We conducted a questionnaire survey of village doctors in Shang Shi Qiao Township during the transmission period of 1992. Of the 732 recorded fever cases, 16 were probable malaria cases by clinical and treatment response criteria, but only one received a full course of antimalarials. Of the 732 patients, 61% had fever every day, 37% went for treatment the first day, 52% waited 2-3 days and 10% waited longer. One hundred and twenty-eight patients took self-medication before seeing the doctor. Blood examination was carried out in 526 (71%) fever cases but only four were positive, all for Plasmodium vivax. Our findings highlight problems relating to patient behaviour and motivation of village doctors, malaria treatment, surveillance and microscopy, rural migration, economic development and malaria transmission. All need to be considered for reforming the malaria control strategy in Henan Province.

Adolescent↗