Malaria Obstacles and Opportunities (1991) / Chapter Skim
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1Conclusions and Recommendations DEFINING THE PROBLEM The outlook for malaria control is grim. The disease, caused by mosquitoborne parasites, is present in 102 countries and is responsible for over 100 million clinical cases and 1 to 2 million deaths each year.
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inappropriately. The situation in many African nations is particularly dismal, exacerbated by a crumbling health infrastructure that has made the implementation of any disease control program difficult.
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where malaria is present. Many, at the recommendation of their travel agent or physician, take antimalarial medications as a preventive measure, but a significant number do not.
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transmission in San Diego Country (and in much of California) is attributed to the presence of individuals from malaria-endemic regions who lack access to medical care, the poor shelter and sanitation facilities of migrant workers, and the ubiquitous presence of Anopheles mosquitoes in California.
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disease, so children are at high risk until they have been infected enough times to develop a partial immunity. • A 52-year-old American woman, the secretary to the U.S.
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In most malarious regions of the world, there is inadequate access to malaria treatment. Appropriate health facilities may not exist; those that do exist may be inaccessible to affected populations, may not be supplied with effective drugs, or may be staffed inappropriately.
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to the U.S. government on promising and feasible strategies to address the problem.
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the problem of malaria. This is best done by encouraging balanced research and control strategies and developing a mechanism for periodically adjusting support for promising approaches.
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The committee believes that the maximum return on investment of funds devoted to malaria research and control can be achieved only by rigorous review of project proposals. The committee further believes that the highestquality review is essential to ensure that funding agencies spend their money wisely.
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biosafety hazards, deflects attention from the treatment of ill individuals, and has little practical relevance for malaria control efforts today. Instead of the mass collection of slides, the committee believes that the most effective surveillance networks are those that concurrently measure disease in human populations, antimalarial drug use, patterns of drug resistance, and the intensity of malaria transmission by vector populations.
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greatest momentum for the development of new tools exists in vaccine and drug development, and the committee believes it essential that this momentum be maintained. The committee recognizes that commendable progress has been made in defining the characteristics of antigens and delivery systems needed for effective vaccines, but that the candidates so far tested fall short of the goal.
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control activities. Four government agencies and many non-governmental organizations in the United States are actively involved in malaria-related activities.
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Research in Support of Available Control Measures Risk Factors for Severe Malaria People who develop severe and complicated malaria lack adequate immunity, and many die from the disease. Groups at greatest risk include young children and pregnant women in malariaendemic regions; nonimmune migrants, laborers, and visitors to endemic regions; and residents of regions where malaria has been recently reintroduced.
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into program design. In most countries, little is known about how the demand for and utilization of health services is influenced by such things as user fees, location of health clinics, and the existence and quality of referral services.
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use of novel scientific technologies to construct vaccines that induce immunity against all relevant stages of the parasite life cycles. Drug Discovery and Development Few drugs are available to prevent or treat malaria, and the spread of drug-resistant strains of malaria parasites is steadily reducing the limited pool of effective chemotherapeutic agents.
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antimalarial tools, the committee suggests that donor agencies support four priority areas for malaria control in endemic countries. The committee believes that the first and most basic priority in malaria control is to prevent infected individuals from becoming severely ill and dying.
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The committee recommends that resources be allocated to develop and disseminate malaria treatment guidelines for physicians, drug vendors, pharmacists, village health workers, and other health care personnel in endemic and nonendemic countries. The guidelines should be based, where appropriate, on the results of local operational research and should include information on the management of severe and complicated disease.
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B. Design a training program for decision makers, managers, and technical staff to support and sustain the interventions.
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The committee recommends that support for malaria control programs include funds to permit a reassessment and optimization of antimalarial tools based on relevant analyses of local epidemiologic, parasitologic, entomologic, socioeconomic, and behavioral determinants of malaria and the costs of malaria control. Management Poor management has contributed to the failure of many control programs.
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Problem Solving (Optional Research) and Evaluation At the outset of any malaria prevention or control initiative and during the course of implementation, gaps in knowledge will be identified and problems will arise.
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between institutions in developed and developing countries; through the encouragement of both formal and informal linkages among malariaendemic countries; through the use of existing training courses; and through the development of specific training courses. The committee recommends further that malaria-endemic countries be supported in the development of personnel programs that provide longterm career tracks for managers, decision makers, and technical staff, and that offer professional fulfillment, security, and competitive financial compensation.
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