Prevention and Control of Malaria

Protozoal disease caused by infection with parasites of the genus plasmodium

And transmitted to man by certain species of infected female anopheline mosquito.

Clinical feautures if malaria vary from mild toSevere and complicated according to the,

Species of parasite present pts state of immunityIntensity of the infectionPresence of concomitant

conditions like malnutrition and others.

Febrile paroxysms occur with definite intermittent periodicity depending upon the species of the parasite.

Most of the deaths due to malaria caused by anaemia & cerebral malaria.

RBC WITH MALARIAL PARASITE

Malaria Control MeasuresMalaria Control Measures

NMCP NMCP 5353 NMEP NMEP 5858 UMS UMS 7171

MPO MPO 7777

MAP MAP 9595 EMCP EMCP 9797 NAMP NAMP 9999

History of Malaria Control Programs in IndiaHistory of Malaria Control Programs in India

RBM RBM 9898National Malaria Control ProgramNational Malaria Control Program

National Malaria Eradication ProgramNational Malaria Eradication Program

Urban Malaria SchemeUrban Malaria Scheme

Modified Plan of OperationModified Plan of Operation

Enhanced Malaria Control ProgramEnhanced Malaria Control Program

National AntiNational Anti--malaria Program NAMPmalaria Program NAMP

Roll Back MalariaRoll Back Malaria

Malaria Action PlanMalaria Action Plan

ROLLBACK MALARIAWHO PROJECT TO CO –ORDINATE GLOBAL ACTION

MAIN OBJECTIVE

TO REDUCE THE GLOBAL MALARIA BURDEN SIGNIFICANTLY THROUGH INTERVENTION ADAPTED TO LOCAL NEEDS

TIME LIMITED PROJECT – 5YEARS

NAMP CONTROL STATEGIES

API>2SPRAYINGENTOMOLOGICAL ASSESSMENTSURVEILLANCE (active & passive)TREATMENT

API<2FOCAL SPRAYINGSURVEILLANCE (active & passive )TREATMENTFOLOW UPEPIDEMIOLOGICAL INVESTIGATION

PARAMETERS OF MALARIA SURVEILLANCE

API = CONFIRMED CASES DURING THE YR POPULATION UNDER

SURVEILLANCE

ABER= NO OF SLIDES EXAMINEDPOPULATION UNDER

SURVEILLANCE

ANNUAL FALCIPARUM RATESLIDE POSITIVITY RATESLIDE FALCIPARUM RATEPF PROPORTIONSPLEEN RATE

(MEASURES OF ENDEMICITY OF MALARIA)

X 1000 INDEX OF ENDEMICITY

X 100 1NDEX OF OPERATIONALEFFICIENCY

APPROACHES TO MALARIA CONTROL

A ) THE MANAGEMEN T OF MALARIA CASES IN THECOMMUNITY

B) ACTIVE INTERVENTION TOCONTROL/ INTERRUPT MALARIA TRANSMISSION

WITH COMMUNITY PARTICIPATION

A.MANAGEMENT OF MALARIA CASES IN THE COMMUNITY

CASE DETECTION * ACTIVE * PASSIVE

TREATMENT *PRESUMPTIVE*RADICAL

SURVEILLANCE

MASS DRUG ADMINISTRATION & CHEMOPROPHYLAXIS

MANAGEMENT OF MALARIAL CASES

Recognition of signs & symptoms which could be caused by malaria.

Diagnosis of malaria and other febrile conditions

Referral to higher level of care if necessary

Prescription of correct treatment

Education of the patient or carrier on how to take or administer the drugs.

The expected result of treatment

CONTD….When to return to the health facilities

Danger signs

Side effects

Prevention of malaria

Dispensing or selling the the correct drugs of assuredQUALITY WITH THE 1st DOSE ALWAYS BEING TAKEN UNDER SUPERVISION.

Patient compliance with prescription instructions.

Follow up to check whether the expected therapeutic effect has been achieved.

TREATMENTPRESUMPTIVE TREATMENT

TAB PRIMAQUINE 0.75mg/Kgbody weight+ tab CHLOROQUINE 10mg/kg body weight on day 1

TAB CHLOROQUINE 10 mg/kg body weight & 5 mg/kg body weight on DAY 2 &DAY 3 respectively

TREATMENT CONTD….

RADICAL TREATMENTTAB PRIMAQUINE 0.25mg/kg body weight daily for 5 days

SEVERE AND COMPLICATED MALARIAQUININE 10mg/kg body weight IV drip in 5% dextrose saline to be run over 4 hours ( 8th hourly )7 days then switch over to oral doseARTIMISINE or ARTESUNATE or ARTETHER at appropriate doses also prescribed

TAB MEFLOQUININE is to be used only in pf cases having

proven resistance to chloroquine.

PROGUANIL 200mg 2 tab /day can be used as a chemoprophylaxis for those who are travelling toendemic areas

CONTRAINDICATIONS AND TOXICITY

PRIMAQUINE is contraindicated in G6-PD deficient patients,

AND in pregnant women.

PRIMAQUINE is cardiotoxiceven a single dose produced

cyanosis in some patients,

SO Mulipurpose workers should check for conditions like that for pts who are taking these drugs.

B) ACTIVE INTERVENTION TO CONTROL / INTERRUPT MALARIA TRANSMISSION

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BEFORE IMPLEMENTING VECTOR CONTROL

STRATEGIES……….Preliminary malaria surveys about

* Which anopheline species are present* Which of them are vectors of malaria.

The biology and behaviour of adult vector

mosquitos * including their resting habits *indoor and outdoor * feeding habits *seasonal changes in the no biting the humans * duration of adult life andAreas in which they are present.

The breeding habits of the mosquitos .

Which are the vector susceptible to the insecticide.

BEFORE USING INSECTICIDES…..

Susceptibility of the target species to the insecticides available for use.

The acceptability of the pesticide and method of application to local community

Safety of the insecticide formulation for the human and non target organisms.

The stability and residual activity of the insecticide.

Skill and competence of the personnel applying the insecticides.

ANTI LARVAL MEASURESLARVICIDES

ENVIRONMENTAL CONTROL

BIOLOGICAL CONTROL

LARVICIDESMINERAL OILS

Petroleum hydrocarbon on the surface of a water will prevent mosquito larvae from breathing

SYNTHETIC INSECTICIDESFENTHION ,CHLORPYRITOS,

ABATE, Are least toxic and commonly used.

ANTI ADULT MEASURESSPACE SPRAYING APPLICATION

Sprayed into the atmosphereIn the form of a mist or fog

Pyrethrum extract malathion,Fenitrothion through ulvFogging is used.

RESIDUAL SPRAYINGDDT is most commonly used

now resistance arise to it

so periodic testing for the susceptibility is needed

INDIVIDUAL PROTECTION

PERSONAL PROTECTION METHODUSING UNTREATED OR INSETICIDE

IMPREGNATED BEDNIGHTS AT NIGHT.

FIXING OF SCREENS ON WINDOWS TO

PREVENT MOSQUITO FROM ENTERING

THE HOUSES.

USING INSECTICIDE IMPREGNATED

CURTAINS ON WINDOWS OR DOORWAYS

AND OR IN GAPS BETWEEN THE ROOF

AND WALLS

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PERSONAL PROTECTION METHODS

VAPOURS PRODUCED BY THEM CAUSE DISORIENTATING

EFFECTS IN MOSQUITO AND PREVENT FROM BITING .

.

The environmental management is themost appropriate and cost effective course of action for eliminating and controlling vectors in urban areas.

Main aim of this method

IS SOURCE REDUCTION

SOURCE REDUCTION IS DONE BY

Eliminate the breeding place

Intermittent irrigation of the rice fields

Minor engineering methods like filling , levelling and drainage if the breeding places

Modifying the prefferedareas of breeding places of vectors

Drainage and filling of the areas whwre the water collects

BIOLOGICAL CONTROLCOST EFFECTIVE

RELATIVELY SAFETY

AMONG THEM ARE

PREDATORY MOSQUITOS TOXORHYNICITES -Effective for those in tree holes

LARVIVOROUS FISH

GAMBUSIA –EFFECTIVE In controlling mosquitos that breed in under storm drains

They have high tolerance to pollution

…..CONTDSeveral species of fungi are

pathogenic to larvae in clear water

EX; LAGENIDIUM GIGANTEUM

Procedures should be developed to breed larvivorous fish at theLocal level so that it can be distributed tothe community to introduction at the breeding places

….CONTDMICROBIAL CONTROL AGENTS SUCH

AS BACTERIA SHOULD BE EMPLOYED

IN PREFERENCE TO CHEMICAL

CONTROL AGENTS BECAUSE OF

THEIR PROVEN ACTIVITY AGAINST

VECTOR

MOST PROMISING AMONG THEM ARE

BACILLUS THURINGIENSIES H-14

BACILLUS SPHAERICUS

bacillus bacillus thuringiensisthuringiensis

Good activity against broadSpectrum of mosquito species

New trend in mosquito controlIs the use of bacterial

agents in combination with natural y occuring predatory

insects and fish

GENETIC CONTROLSTERILE MALE TECHNIQUE.

CYTOPLASMIC INCOMPATIBILITY.

CHROMOSOMAL TRANSLOCATION.

SEX DISTORTION

They are cheaper potentially more efficient above all not subjected to Vector resistance

MALARIA VACCINES

A vaccine could provide a much needed adjunt to the generally inadequate resources currentlyAvailable for malaria control

Canditate antigens for malaria vaccines

Sporozoite anigens—prevent theHost from being infected

Asexual blood stage antigens–restrict parasite multiplication

Sexual stage antigens—serum with the antidodies ingested by theMosquito & block parasite development in the mosquito midgut

A vaccine could provide a much needed adjunt to the generally inadequate resourcescurrently available for malaria control

The most effective vaccine might prove to be one incorparating antigen from more than one stage of the parasite “s lifecycle .

PREVENTION AND CONTROL IN PREGNANCYIn the view of the high maternal

and infant morbidty and mortality associated with malaria in pregnancy

• Intermittent preventive treatment (IPT) with antimalarialdrugs

• Insecticide-treated bed nets (ITN)• Febrile malaria case management

SHOULD BE IN THE PART OF ANTENATAL CARE

OBSTACLES TO CONTROL

Cost & ecological unacceptability in certain areasVector resistance to insecticidesCost and toxicityExophilic behaviour of certain vector speciesParasite resistance to & rising cost of

antimalarial drugs

CONTD,,,,,

Inaccessibility of large population

Population movements

Peoples inadequate knowledge about health & diseases

Paucity of basic health facilities & well trained health service staff

Inadequate epidemiological information about the disease

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C) INVOLEMENT OF THE NONGOVERNMENTAL ORGANISATION AND THE PRIVATE SECTOR

D) COMMUNITY PARTICIPATION

E) INTERSECTORAL COLLABARATION

F) TRAINING OF VECTOR CONTROL STAFF AND PERSONNEL , INSPECTORS AND FIELD STAFF ,COMMUNITY WORKERS.

F) TRAINING OF VECTOR CONTROL STAFF AND PERSONNEL ,

INSPECTORS AND FIELD STAFF ,COMMUNITY WORKERS

- Data gathering , analysis , interpretation

-Practical aspects of vector biology and control

-surveillance

-use and maintenance of the equipment

- Pesticides their formulations and their safe use

- Biological control agents

G) HEALTH EDUCATION

As a regular part of the programme

to popularize control measures

To motivate and sustain community participation .

H) COLLECTIVE RESPONSIBILITY AND GOOD TEAMWORK ARE INDESPENSIBLE

FOR EFFECTIVE URBAN VECTOR CONTROL

Mosquito Genome Sequenced !!Mosquito Genome Sequenced !!

MOSQUITO GENOME

Genomic sequence of plasmodium

falciparum most lethal parasite

causing malaria and parasite

transmitting mosquito anophles

gambiae are completed.

This will be essential for

understanding plasmodium biology

And malaria pathogenesis in

molecular terms

These datasets can greatly help us

For identification of canditate

Targets for drugs vaccines,and

Diagnostic development in addition to

enhancing our basic understanding of

MALARIA

WEB SITEShttp://mrcindia.org/

http://tnhealth.org/

health .allrefer.com

http;//www.pon.nic.in/vcrc

http://tropicaldiseaseswebring.org/

REFERENCESPARKS TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 17th EDITION;2003WHO MODEL PRESCRIBING INFORMATION; DRUGS USED IN PARASITIC DISEASES 2nd EDITION WHO 1988Entomological field techniques for malaria control part i learners guide 2000TROPICAL DISEASE RESEARCH A GLOBAL PARTNERSHIP 8th PROGRAMME REPORT RESEARCH AND TRAINING IN TROPICAL DIDEASES1987WHO EXPERT COMMITTEE ON MALARIA ; who technical research series 892 REPORT WHO;1999URBAN VECTOR AND PEST CONTROL 11th REPORT ON VECTOR BIOLOGY &CONTROL BY WHO 1988