Healthy malaria control

According to an article in the May 27, 1998, issue of the Times of India, Dr. Menno Jan Bouma, an epidemiologist from the London School of Hygiene and Tropical Medicine, has suggested spraying India's cows, goats, and buffaloes with insecticide in a bid to combat malaria. This strategy, however, fails to fully consider what is currently known about insect behavior, insecticides' modes of action, and the interaction between the two in the environment. A population of insects can ultimately develop resistance and adapt to the repeated onslaught of insecticides. Furthermore, each type of insecticide which could potentially be used has its own set of problems with regard to the environment, the products into which they break down, and how they affect wildlife and humans. The once commonplace spraying of livestock in the West led to Mad Cow Disease, Chicken Flu, and other problems. India's meat and dairy products will definitely be contaminated should the country's livestock be sprayed with insecticides. In the long-term interest of humankind, efforts must be made to contain, not eradicate, mosquitoes and malaria.     

Aggressive active case detection: a malaria control strategy based on the Brazilian model

Since 1996, the Brazilian Ministry of Health has adopted a malaria control strategy known as aggressive active case detection (AACD) in which most or all members of every community are tested and treated for malaria on a monthly basis. The strategy attempts to identify and treat cases of asymptomatic malaria, which, if untreated, continue to transmit the infection. Malaria remains uncontrolled because almost all health care systems in the world rely on passive case detection: the treatment of only symptomatic cases of malaria. Research has shown conclusively that asymptomatic cases exist in any population where malaria transmission is stable and incidence is high: therefore passive case detection simply will not succeed in breaking the cycle of transmission. Numerous case studies show that malaria has been successfully controlled on a regional or national level by mass blood surveys. AACD is an effective malaria control strategy if used in conjunction with other methods, especially when (1) an effective treatment exists, (2) influx of potential carriers of the infection can be monitored, and (3) people are inclined to cooperate with monthly blood testing. AACD requires access to rapid diagnostic tests (RDTs), microscopy supplies, extensive human resources, and prompt, affordable, and effective treatment. AACD is compared to PCD in terms of clinical efficacy and cost effectiveness in a case study of malaria in the Brazilian Yanomami Indians. Where it is feasible, AACD could drastically reduce the incidence of malaria and should be an integral part of the World Health Organization's Roll Back Malaria strategy.     

Towards an appropriate malaria control strategy: issues of concern and alternatives for action

A resurgence of malaria in India prompted formation of a Malaria Expert Group, which met in 1996 to formulate an appropriate malaria control strategy. An estimated 20-30 million episodes of malaria occur in India each year. Since malaria is an exclusively focal phenomenon, strategies should be responsive to the epidemiologic characteristics of the five ecotypes: tribal, rural, urban, industrial, and border. Also needed are flexible, individualized strategies for development project areas and Triple Insecticide Resistance Areas. Most malaria deaths are attributable to delayed diagnosis and treatment. Recommended are streamlined logistics for laboratory supplies, monitoring of anti-malarial drugs for possible resistance, training of nongovernmental organizations to open peripheral laboratories, rigorous training for laboratory technicians in malaria diagnosis, training of supervisors for laboratory work and cross-checking of findings, and establishment of graded laboratory facilities for different levels of the health care delivery system. Integration of malaria control into India's primary health care system will require community participation, appropriate technology, intersectoral coordination, and social equity.     

Permethrin-impregnated curtains in malaria control

The impact of permethrin-impregnated curtains on the incidence of malaria episodes, parasitaemia and splenomegaly was assessed during a 22 month period in 2 groups of children aged 0.5-6 years. One group lived in houses where permethrin-impregnated curtains had been installed, the other group lived in houses without curtains. A significant reduction of incidence of malaria episodes, mean parasite density, parasite prevalence and splenomegaly was consistently observed in the intervention group towards the end of the period of moderate transmission, whereas no clear-cut impact could be demonstrated during the high transmission period. The influence of malaria pressure and community utilization on the protective efficiency of curtains is discussed. Because of their acceptability and the ease of reimpregnation, curtains proved to be a suitable technique for integration into primary health care.     

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.     

口岸疟疾检疫防控策略和措施探讨

疟疾是疟原虫寄生于人体所引起的传染病,经按蚊叮咬传播,曾经在中国广泛流行,近20年来得到了很好的控制.但从世界范围来看,目前疟疾仍然是一种严重威胁人类健康的寄生虫病.据世界卫生组织2009年全球疟疾报告报道[1],2008年全球有2.43亿临床病例,86.3万人因疟疾死亡.     

From strategy development to routine implementation: the cost of Intermittent Preventive Treatment in Infants for malaria control

Background  

Achieving the Millennium Development Goals for health requires a massive scaling-up of interventions in Sub Saharan Africa. Intermittent Preventive Treatment in infants (IPTi) is a promising new tool for malaria control. Although efficacy information is available for many interventions, there is a dearth of data on the resources required for scaling up of health interventions.     

Control of malaria in Africa: from the eradication of malaria to the control of malaria

The control strategies usually recommended in Africa south of the Sahara have not been followed by a lasting decline in the endemic level of the disease in the rural environment. The set-backs of the eradication period have revealed the need to redefine control objectives and strategies adapted to each type of malaria. Systematic chemotherapy for attacks of fever is a strategy that can be proposed in all circumstances; it avoids mortality from malaria; it can be carried out in the field on a country scale. The other means of control, directed against the parasites and the vectors, may be used depending of the specific situation in each country and on each type of malaria. Malaria control has to be integrated into the basic health system of each country, and we need to improve health education and develop primary health care. We must continue with our efforts to develop new antimalarial drugs, insecticides and vaccines; urgent steps must be taken to train malariologists capable of adapting the new techniques to the actual situation in the field. It is by associating socioeconomic development with the control means as a whole that we shall be able to control the various types of malaria and to reach out towards the objective of health for all by the year 2000.     

Epidemiological basis of malaria control

The epidemiology of malaria is discussed with special reference to the pattern observed in equatorial Africa, where the disease is very stable and where certain features, such as severe epidemic tendencies and ready amenability to control, commonly found in other malarious regions, are lacking. The particular conditions giving rise to stability are described in detail, and the ways in which they can be modified to bring about control of the disease in its stable form are outlined. The importance of measuring certain rates-for example, the basic reproduction rate, the index of stability, and the actual reproduction rate-when making any major malaria survey is emphasized, and formulae by means of which such rates can be readily calculated are included in an annex.     

Housing as a factor in malaria control

It is often stated as axiomatic that one of the fundamental measures to be adopted for the prevention of malaria is the proper construction of dwellings with ceiled rooms so clean, light and well-ventilated as to make them unattractive to anophelines as resting-places. We believe that, however desirable such housing standards may be in the general interests of hygiene, they are practically of no value in the specific case of protection from malaria. Houses are attractive by night to visiting anophelines not because of their structural features but because they offer a certain kind of food-supply to which by instinct the anopheles is drawn. The “haunting” of houses by certain species is not linked with their efficiency as malaria carriers, and there is no good evidence that they ever return except by chance to the place where they have fed. There is no correlation, in fact, in Italy or Germany between the “unattractiveness” of the homes or any recent improvement in standards of living, and the disappearance of malaria in certain areas. Recent studies indicate that the latter is due to the dissociation of A. maculipennis from man, a phenomenon dependent on the fixed food preferences of an easily identified race of this mosquito and not on the relative attractiveness of houses and stables. The doctrine that better and brighter bedrooms will ever obviate the necessity for laborious antilarval campaigns and the meticulous mosquito-proofing of houses does not seem to us well-founded either scientifically or in ordinary experience.     

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.     

屈家岭管理区疟疾防治工作调查报告

为弄清屈家岭管理区疟疾发病情况,指导今后的疟疾防治工作,2005年9月6～8日荆门市疾控中心派专业人员对屈家岭管理区疟疾发病情况进行了调查,2005年10月17～19日荆门市疾控中心专业人员同省疾控中心寄生虫控制部2名专家一起对屈家岭管理区2003-2005年疟疾防治工作情况进行了全面的调查。现将调查结果报告如下。     

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.     

湖南省消除疟疾历程及策略评价

目的 分析湖南省疟疾流行规律与防治历程,总结评估消除疟疾策略及措施。 方法 对湖南省历年疟疾防治疫情数据报表、文件、工作计划、防治策略与措施等资料进行描述性分析和总结,根据国家相关文件的要求,从保障措施、技术措施、防控效果3个方面对消除疟疾工作进行评估。 结果 湖南省曾发生过3次疟疾大流行,1954—1956年、1962—1965年和1971—1973年,发病率分别为87.45/万～156.04/万、39/万～ 58.98/万和44.46/万～69.51/万,通过及时调整防治策略和措施,大多数地区疟疾流行得到了有效控制。在启动消除疟疾行动计划以来,通过不断地落实各项疟疾防治策略和措施,疟疾发病率持续稳定在1/10万以下。2010年湖南省报告最后一例本地感染病例后,已连续多年未报告本地感染病例。至2016年,全省122个县(市、区)和14个市(州)均通过了消除疟疾的县级考核和市级评估,2020年通过国家评估达到消除疟疾的标准。 结论 湖南省经过多年疟疾防治,保持连续11年无本地疟疾病例,达到消除疟疾标准,巩固工作重点是加强输入性病例监测,降低本地再传播风险。