Malaria Obstacles and Opportunities (1991) / Chapter Skim
Currently Skimming:
Pages 211-236
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 211... ...
10 Epidemiologic Approaches to Malaria Control WHERE WE WANT TO BE IN THE YEAR 2010 Epidemiologists will have made great strides in elucidating the complex determinants of malaria, including the risk factors for severe and complicated disease and the role of acquired immunity. It will be clear how chemoprophylaxis and drug therapy reduce morbidity and mortality, and how malaria more severely affects pregnant women and young children.
|
From page 212... ...
parasite but also on the level of malaria-specific acquired immunity in the individual. Malaria is a focal disease whose distribution is influenced by literally dozens of factors related both to human, mosquito and parasite populations and to the environment.
|
From page 213... ...
the risk of transmitting the human immunodeficiency virus, hepatitis B virus, and other blood-borne pathogens through nonsterile finger-prick methods, such routine mass screening cannot be recommended. In countries where malaria is highly endemic, the epidemiology is focal, the burden of disease varies greatly, and surveys that evaluate the prevalence of malaria infection can be particularly deceptive.
|
From page 214... ...
including antimosquito measures (e.g., insecticide-treated bednets) and antimalarial drugs (given as chemoprophylaxis, as therapy, or for both purposes)
|
From page 215... ...
a mother about the fate of her previous child. Analysis of prospectively recorded deaths by village health workers over an extended period of time can also helpful in determining both overall mortality and disease-specific mortality.
|
From page 216... ...
of stratification varied considerably, from the characterization of large homogeneous areas to that of very small epidemiologic units, such as a locality. With a few exceptions, however, stratification has not been widely adopted or implemented, in part because a large amount of detailed baseline information was required.
|
From page 217... ...
While the malaria paradigms may be oversimplifications, the simplicity may allow the approach to work where others have failed. Previous epidemiologic approaches to malaria control, including stratification, have been faulted for being overly complex.
|
From page 218... ...
and correlates with relatively predictable patterns of rainfall, although transmission may continue at lower levels during the dry season. Because of the extremely high inoculation rates, virtually all of those living in these areas become infected early in life.
|
From page 219... ...
Sugarcane cultivation in dry areas that require irrigation has also resulted in an increase in malaria transmission where it had not been a serious problem in the past. Highland Fringe Malaria Although malaria has been transmitted at altitudes of up to 2,800 meters, the disease does not generally occur above about 1,500 meters (Bruce-Chwatt, 1985)
|
From page 220... ...
the archetypal urban vector of South Asia)
|
From page 221... ...
of these paradigms. Malaria on islands, for example, falls generally under one or more of the eight paradigms; many of the islands of the South Pacific have coastal and highland fringe malaria.
|
From page 222... ...
of its contribution to malaria relapse, is able to persist in areas of wide climatic fluctuation. Plasmodium malariae and P
|
From page 223... ...
such regions will necessarily focus on preventing death in young children and nonimmune people coming into the area. In parts of mainland South-east Asia, however, where forest malaria prevails, exposure to malaria parasites may occur first in young adult males during work-related activities.
|
From page 224... ...
potential for vector control. Houses that have integral walls and screened windows and doors will greatly limit the risk of indoor infection, particularly when used in conjunction with other measures, such as application of residual sprays.
|
From page 225... ...
Health Infrastructure The organization of health services in a malarious area must be known in order to determine the feasibility of potential antimalarial measures. The national health budget -- both the amount available for malaria control and the relative importance assigned to health -- must be known for appropriate planning to proceed and for affordable interventions to be selected.
|
From page 226... ...
Drug resistance is becoming a major limiting factor in the use of affordable antimalarial drugs. Chloroquine resistance in P
|
From page 227... ...
information available in the determinants of a given paradigm should allow decisions to be made regarding affordability, efficacy, and feasibility. Antimalarial Drugs and Malaria Treatment Facilities Drugs may be used to prevent, treat, and (theoretically)
|
From page 228... ...
contact. Sleeping each night under an insecticide-treated bednet is likely to reduce the individual's overall risk of infection and is a useful form of personal protection.
|
From page 229... ...
Residual insecticides are useful against susceptible mosquitoes that rest on sprayed surfaces. These insecticides have been the mainstay of malaria control operations in many parts of the world for decades.
|
From page 230... ...
Application of the Paradigm Approach Logical progression through the steps (identifying the major types of malaria occurring in a country or area, considering the impact of major determinants, and matching available tools to the requirements defined should provide a shortcut to an analysis of the malaria situation and promote a better understanding of the components of the problem. The paradigm approach can serve to orient those who plan malaria control programs, reminding them that a single control strategy applied on a country-wide basis is not likely to affect the problem throughout the country.
|
From page 231... ...
centralized fashion. Other activities, such as the establishment and support of treatment facilities, implementation of vector control operations, health education, and intersectoral cooperation, are more suited to a decentralized approach.
|
From page 232... ...
the design or management of control programs) or for study tours or conducting low-level courses for implementing staff.
|
From page 233... ...
cases should not be the goal of surveillance and reporting. Instead, the malaria control program core staff must be able to design surveys to obtain the specific epidemiologic information required for operations management.
|
From page 234... ...
malaria. Public health generalists do not have the level of technical expertise needed to plan and guide an effective malaria control program.
|
From page 235... ...
Chemoprophylaxis and Therapy There is conflicting evidence on the role of chemoprophylaxis and therapy in reducing overall morbidity and malaria-related morbidity and mortality, and it may well be that the efficacy of measures will vary according to the intensity of malaria transmission. RESEARCH FOCUS: Assessment of the role of therapy and chemoprophylaxis in reducing overall and malaria-related morbidity and mortality in areas of varied intensity of malaria transmission.
|
From page 236... ...
transmission, morbidity, and mortality in areas of varying malaria endemicity. REFERENCES Alonso, P
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.