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PubMed2006

The chequered history of malaria control: are new and better tools the ultimate answer?

Following Ronald Ross' demonstration in 1897 that mosquitoes transmit malarial parasites, efforts to control malaria were naturally focussed on attacking the mosquito vector by various measures, mainly directed against the aquatic stages. Although the results were spectacular in some areas, there was a growing realisation that effective control of malaria depended on other factors, including the availability of better drugs than quinine and a greater understanding of the epidemiology of the disease under various environmental conditions. With the discovery of DDT, an all-out effort was made to eradicate malaria by attacking adult mosquitoes. Eradication was not achieved in many countries, mainly because of inadequate health infrastructures. With the emergence of chloroquine-resistant parasites, the search for more effective drug regimens intensified, various drugs and drug combinations were assessed, and methods were developed to monitor and assess degrees of resistance. Since resistance to drugs can develop very quickly, the use of drug combinations, especially those containing artemisinin derivatives, is now recommended. Insecticide-impregnated bednets have become the preferred method of vector control. Although the search for better tools must continue, the events of the past century emphasise the need to strengthen health systems to ensure that they are capable of delivering effective interventions and of assessing their effectiveness in controlling malaria.

Animals↗
PubMed2004

Cost-effectiveness of malaria control interventions when malaria mortality is low: insecticide-treated nets versus in-house residual spraying in India.

Malaria is one of the leading causes of morbidity and mortality in the developing world and a major public health problem in India. Disillusioned by in-house residual spraying (IRS), and increasingly aware that insecticide-treated nets (ITNs) have proved to be effective in reducing malaria mortality and morbidity in various epidemiological settings, policy-makers in India are keen to identify which is the more cost-effective malaria control intervention. A community randomised controlled trial was set up in Surat to compare the effectiveness and efficiency of IRS and ITNs. Both control strategies were shown to be effective in preventing malaria over the base-case scenario of early diagnosis and prompt treatment. The mean costs per case averted for ITNs was statistically significantly lower (Rs. 1848, 1567-2209; US$ 52) than IRS (Rs. 3121, 2386-4177, US$ 87). The incremental cost-effectiveness ratio for ITNs over IRS was Rs. 799 (US$ 22). The conclusions were robust to changes in assumptions. This study expands the scope of recent comparative economic evaluations of ITNs and IRS, since it was carried out in a low mortality malaria endemic area.

Analysis of Variance↗
PubMed1999

Cost-effective malaria control in Brazil. Cost-effectiveness of a Malaria Control Program in the Amazon Basin of Brazil, 1988-1996.

Malaria transmission was controlled elsewhere in Brazil by 1980, but in the Amazon Basin cases increased steadily until 1989, to almost half a million a year and the coefficient of mortality quadrupled in 1977-1988. The government's malaria control program almost collapsed financially in 1987-1989 and underwent a turbulent reorganization in 1991-1993. A World Bank project supported the program from late 1989 to mid-1996, and in 1992-1993, with help from the Pan American Health Organization, facilitated a change toward earlier and more aggressive case treatment and more concentrated vector control. The epidemic stopped expanding in 1990-1991 and reversed in 1992-1996. The total cost of the program from 1989 through mid-1996 was US$616 million: US$526 million for prevention and US$90 million for treatment. Compared to what would have happened in the absence of the program, nearly two million cases of malaria and 231,000 deaths were prevented; the lives saved were due almost equally to preventing infection and to case treatment. Converting the savings in lives and in morbidity into Disability-Adjusted Life Years yields almost nine million DALYs, 5.1 million from treatment and 3.9 million from prevention. Nearly all the gain came from controlling deaths and therefore from controlling falciparum. The overall cost-effectiveness was US$2672 per life saved or US$69 per DALY, which is low compared to most previous estimates and compares favorably to many other disease control interventions. Contrary to much previous experience, case treatment appears more cost-effective than vector control, particularly where falciparum is prevalent and unfocussed insecticide spraying is relatively ineffective. Halting the epidemic by better targeted vector control and emphasizing treatment paid off in much reduced mortality from malaria and in significantly lower costs per life saved.

Brazil↗
PubMed2002

The potential of intermittent irrigation for increasing rice yields, lowering water consumption, reducing methane emissions, and controlling malaria in African rice fields.

Rice production in sub-Saharan Africa has more than doubled in the last 3 decades and the potential to further develop rice-harvested areas is considerable. Several studies have demonstrated that the transformation of arable land into rice irrigation might create suitable habitats for large populations of disease vectors. Prominent among those are anopheline mosquitoes responsible for transmission of malaria. The method of irrigation on an intermittent basis during the rice-cropping calendar has gained renewed interest as a potentially effective malaria control strategy since the early 1980s. We review the experiences of the past 80 years with intermittent irrigation in the cultivation of rice. This method has been shown to reduce significantly the density of malaria vectors by curtailing their larval development. Furthermore, reduced methane emissions and water savings with at least equal yields were achieved in intermittently irrigated rice fields. We explore and discuss under what conditions intermittent irrigation might be beneficial in new rice-growing areas and identify steps that have to be taken to expand such programs in the future.

Africa South of the Sahara↗
PubMed1992

Efficacy of insecticide impregnated bed-nets to control malaria in a rural forested area in southern Cameroon.

Due to current spreading of chemoresistant strains of Plasmodium falciparum malaria control must incorporate vector control programmes. Due to well known constraints house sprayings cannot be performed as before. Personal protection can be developed and a large scale use of insecticide treated bed-nets appeared to be very useful to reduce man-vector contact in Asia, South America and West and East Africa. No trial has been done in forest Central Africa where transmission is permanent. We performed such a trial in the southern part of Cameroon (using deltamethrin, at 25 mg/m2) and obtained similar data to those observed in The Gambia, Burkina Faso and Tanzania with a noteworthy reduction of both transmission and high parasitaemia of P. falciparum (respectively 78% and 75%) meaning a drop of malaria morbidity.

Animals↗
PubMed2001

Controlling malaria: challenges and solutions.

Antimalarial drug resistance is a major public health challenge and the principal reason for the erosion of efficacious treatments. Cost and the limited number of antimalarial drugs in current use impose considerable constraints on malaria control, especially in sub-Saharan Africa. The paper describes a multilateral, multidisciplinary research project on artemisinin-based combination therapy, which offers a new and potentially highly effective way to prevent or retard the development of drug resistance.

Advisory Committees↗
PubMed1992

Adopting the primary health care approach in malaria control in Malaysia: lessons in community participation.

The Primary Health Care approach in Malaysia was first tried out in Sarawak, East Malaysia in 1982. In 1984, the Vector Borne Disease Control Program, Kelantan decided to adopt the Primary Health Care approach as an additional strategy in its effort to control malaria in the state, which then experienced an increase in malaria cases. Much effort was directed at creating the awareness and stimulating the interest of health staff and communities to adopt the strategy. Kelantan was made the model state. The paper gives an outline of the process involved and some characteristics of PHC workers. A study was carried out among health workers, community members and health staff on their knowledge and involvement in PHC in three states, including Kelantan. In view of the overall success of this approach, and the weaknesses which have been identified possible solutions have been suggested and should be acted upon.

Communicable Disease Control↗
PubMed1996

Application of deltamethrin-impregnated bednets for mosquito and malaria control in Yunnan, China.

The results of research in China in recent years show that: 1) Different laboratory sensitivity of adult Anopheles minimus, An. sinensis and Culex pipiens quinquefasciatus to deltamethrin exist in Yunnan. Although the range and duration for the use of permethrin and deltamethrin was limited, resistance of An. minimus, An. sinensis and Cx. pipiens quinquefasciatus to different extent in some areas existed. 2) On walls built with cement and covered with a thin layer of lime on which deltamethrin at a dosage of 0.025 g/m2 was sprayed, 100% of the mosquitos were stricken down within 3 days, 80% at the 15th day, 50% at the 20th day. The residual effectiveness on the bamboo and wood walls was good and could last for over 40 days, but on the mud walls a mortality of only 40% on the spraying day was observed, indicating that deltamethrin was not suitable for this purpose. Deltamethrin spraying reduced total caught mosquitos within 30 days, but there was no difference between the effects of deltamethrin (0.025 g/m2) and DDT (2 g/m2) at the 60th day. Deltamethrin effect on reducing densities of endophilic An. vagus, An. culicifacies and exophilic An. philippinensis was better than that of DDT (lasting over 60 days), but its effect on semi-endophilic An. sinensis lasted only 15 days. Against An. mininus, it showed good effects within 20 days but did not last as long as DDT (60 days). Residual deltamethrin and DDT spraying could both control malaria vectors, reduce the infection of infants by malaria, and reduce malaria parasite carrier rates (within 50 days). 3) Laboratory experiments showed that deltamethrin-impregnated bednets at a dosage of 0.015 g/m2 had a positive effect on An. minimus. The residual effect of unwashed deltamethrin-impregnated bednets at a dosage of 0.015 mg/m2 against An. sinensis was apparent and could last for 13 months. When an impregnated bednet was washed for the first time at the 12th month, its mortality effect on An. sinensis was reduced quickly to lower than 50%. The residual effect could last for 2-3 months when washed at the 6th month, but was lost when washed for the second time at the 12th month. 4) The effects of the impregnated-bednets on An. sinensis were different, even opposite, between different investigations. However, the treated bednets caused the density of An. minimus in houses to fall by 67.94%, and the total density in houses and cattle shelters by 67.91%. Moreover, it could shorten the life span of An. minimus. It did not work on the outdoor density of An. minimus. It is necessary to integrate with other measures, for achieving the desired effect.

Adult↗
PubMedDate not supplied

[Integration of malaria control in primary health care in rural environment. General considerations].

Only 20 to 40% of the rural populations in Africa south of Sahara have the possibility to benefit from the classical health care. This situation interferes in the campaign against the main endemic diseases. Thus, in the efforts to control malaria, it appears necessary to get the population participation through the development of the primary health care services. Systematic chemotherapy of febrile attacks seems to be the easiest field strategy on a large way. The authors believe that such a strategy is possible through the development of primary health care services within the progressive decentralization of the health service network.

Africa↗
PubMed2005

Nutritional status following malaria control in a Vietnamese ethnic minority commune.

OBJECTIVE: To study whether control of malaria leads to catch-up growth or an increase of obesity in a marginally nourished population. SETTING: A Vietnamese ethnic minority commune in southern Vietnam. DESIGN: Repeated annual anthropometric surveys were performed from 1995 to 2000. Z-scores for height, weight and BMI for age and weight-for-height were determined by using NCHS 1978 and CDC 2000 reference tables and by the LMS method. INTERVENTION: Active malaria control that reduced the parasite carrier rate from 50% in 1994 to practically nil in 1998. RESULTS: Inhabitants were generally of short stature and very thin. Using the US reference tables, the prevalence of moderate/severe stunting among children was 53/24% and of wasting 27/9% in the first survey in 1995. Physical condition and normal daily activities of most inhabitants were normal. The repeated LMS-Z-scores uncovered a significant recovery of stunting, extending into preadolescence, including the development of a pubertal growth spurt for girls and enhancement of pubertal growth in boys, after control of malaria. The mean (95% CI) annual increase of Z-height-for-age was 0.11 (0.09-0.12) for boys and 0.14 (0.13-0.15) for girls (P<0.001). As a consequence, weight-for-age and BMI Z-scores decreased without indication of developing obesity. CONCLUSION: Catch-up growth, extending into preadolescent age, was observed in a Vietnamese ethnic minority population with a chronic state of low food intake, without indication of developing obesity. The control of malaria was probably the most significant contribution to this catch-up growth.

Adolescent↗
PubMed1986

Cost-effectiveness research in malaria control and the need for health behaviour and socio-economic research in malaria control in Thailand.

The complexity of the malaria situation in Thailand requires behavioural and socio-economic research in wide variety of areas including; migration, illness behaviour, motivation of staff and communities and the relationship of institutional and community expenditure to reduction in morbidity. The research ideally should be constructed in such a way as to maximize the availability of methods for incorporation into routine monitoring, evaluation, and policy making activities of the Anti-Malaria Programme.

Cost-Benefit Analysis↗
PubMed1998

[The role of village doctors and their influence factors in malaria control].

AIM: To consolidate the acquired achievements of malaria control and to work out an effective programme for training the village doctors in Yibin District. METHODS: A stratified sampling was done at random with sampling 27 village medical stations and 67 village doctors from 9 townships of 3 counties. A questionnaire concerning malaria control knowledge of the village doctors and the quality of their carrying out antimalaria measures was used in this study. RESULTS: The accuracy rate of answering the questionnaire among the village doctors was 79.3%, being higher in the village doctors receiving antimalaria training than in those not receiving antimalaria training. 82.5% of the doctors could correctly complete the tasks of controlling malaria. In addition, the quality of malaria control implementing in areas where the doctors and their stations had timely got investment funds, preferential policy, system of reward and subsidy from local governments, was superior to those areas where the doctors and their stations had not received those on time. 91.9% of the trained doctors completed the tasks of controlling malaria better than untrained ones. CONCLUSION: Greater efforts should be made to give a systematic training to village doctors on the knowledge and technique of malaria control, and to strengthen management and support in order to help these doctors accomplishing the tasks of malaria control better.

Community Health Workers↗
PubMed1991

An assessment of low birthweight risk in primiparae as an indicator of malaria control in pregnancy.

Malaria is an important environmental factor which reduces fetal growth in primiparae more than multiparae living under holoendemic conditions for malaria. This relates to greater susceptibility to malaria infection in first pregnancies. The relative risk for low birthweight (less than 2500 g) associated with primiparity is increased in malaria-endemic areas and significantly correlates with the malaria parasite rate at delivery in primiparae. Because of this association, the relative risk is proposed as an indicator to assess malaria control in pregnant women as well as in the community. The sensitivity and specificity of the relative risk for low birthweight in primiparae are calculated for 13 malarious and 15 non-malarious populations. The highest sensitivity and specificity is achieved at a relative risk of 1.7. Social and environmental variables which could alter the sensitivity of the estimate are discussed. Estimates of the population-attributable risk per cent of low birthweight due to malaria in primiparae are calculated and vary between 10% and 40% in endemic areas. The method is applied to observations from malaria-intervention studies in pregnancy in the Solomon Islands and Papua New Guinea and appears sensitive in these prospective studies to changes in malaria prevalence. Calculation of these estimates is straightforward and their use to assess malaria control measures in areas of high transmission has not been suggested previously, it could have wide epidemiological application and requires further field evaluation.

Adolescent↗