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Malaria Control
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  • 1. Objective Familiarisation with malaria and the most relevant vector control tools and strategies: ITNs and IRS. Program Day 1 Intro malaria Prevention tools; pro’s and con’s; selecting the most appropriate tool Exercise Day 2 IRS theory IRS practice
  • 2.
      • 300-500 million clinical cases per year
      • 1 million deaths per year
      • 2/3 rd deaths are children < 5 years
      • 90% of deaths in Sub-Saharan Africa
      • Accounts for 10-13% of maternal deaths
      • In many parts of Africa, children experience at least 3 life-threatening malaria infections by the age of one
    The Burden of Malaria
  • 3.  
  • 4.
    • Linked to mosquito presence and survival (av. 30 day) vs. pathogen development (9 days in 30ºC; 20 days 20ºC)
    • Temperature (>16ºC) below 2000 metres
    • Humid environment, often seasonal
    Environment for Malaria
  • 5.
    • Malaria can be endemic: continuous transmission severe malaria mostly in children, pregnant women (unborn child), immuno-compromised
    • Malaria can be epidemic: occur in outbreaks severe malaria in all age-groups
    Endemic vs epidemic
  • 6.
    • Immunity is acquired through repeated infection
    • Asymptomatic infections common
    • When regularly exposed: people create immunity -> vulnerable children, pregnant women
    • Immunity of humans is short-lived
    • Mosquitoes are infected for life
    Immunity
  • 7. Where would you expect a high risk of malaria outbreaks?
    • Susceptible population entering endemic area
    • Infected population entering non-endemic area
    • Reduced resistance in population
    • No access to effective treatment
    • Change in environment/ climate
  • 8. Malaria: The Big Picture China N.America & Europe Africa World 1900 1930 1950 1970 1990 2000 0.1 1.0 3.0 2.0 Annual Deaths from Malaria (millions) Central & S.America Asia
  • 9. Stable War Refugees 1 in 3 of the worlds annual malaria deaths occurs in Africa in countries affected by conflict
  • 10. Malaria Transmission
  • 11.
    • Aedes spp. Dengue, yellow fever & filariasis
    • Culex spp. filariasis & nuisance
    Malaria Transmission
    • ~ 3000 mosquito spp.
    • ~ 400 Anopheles spp
    • ~ 60 transmit malaria
    • Principal African malaria vector is Anopheles gambiae
    Mosquito Host Susceptible person
  • 12. Malaria Control Mosquito Host Susceptible person Cure hosts: - treatment Isolate host - bednet
    • Control mosquito
    • insecticidal bednet
    • indoor residual spraying
    • other…
    • Isolate mosquito
    • bednet
    • building
    • repellant
    • prophylaxis
  • 13.
    • Malaria control: “measures designed to reduce morbidity and mortality due to malaria”  prevention, surveillance and case management
    • Malaria prevention: “measures designed to sharply reduce, or stop, people from becoming infected”
      •  Vector Control (IRS, fogging, larvaciding), personal protection (ITN, repellents), prophylaxis and IPT
    • Vector control: “measures designed to control (= reduce) the disease transmitting vector”
    Terminology
  • 14. Malaria Prevention
    • Chemoprophylaxis daily/weekly, IPT
    • Home use products coils, aerosols, repellents
    • (LL)ITN
    • ITM tarpolin, tents, blankets, chaddars, wallpaper, paint, cattle
    • IRS
    • Fogging / aerosol spraying
    • Larviciding
    • Environmental control
  • 15.
    • Indoor Residual Spraying (IRS)
    • (Long Lasting) Insecticide Treated Nets ((LL)ITN)
    Most effective/efficient control methods in emergencies
  • 16.
    • Provides physical barrier, repellent and kills vectors (mosquitoes will normally not ‘drop dead’ directly, may need up to 30 minutes before you see effect)
    (LL)ITNs
    • Protects against other diseases
    • Untreated nets: little impact
  • 17.
    • Can be used indoors an outdoors
    • Can be taken/set up on the move
    • Can be looted
    • Only appropriate where people are used to using them or where extensive sensitisation component is feasible
    (LL)ITNs
  • 18.
    • Residual effect up to 5 years (20 washes)
    • Re-treatment < 5%
    • Pre-treated nets unreliable
    • Re-treatment of coloured conventional nets
    • No storage & handling of hazardous chemicals
    LLITNs
  • 19. LLITNs Source: WHOPES updated: December 2007 http://www.who.int/whopes/Long-lasting_insecticidal_nets_ok2.pdf
  • 20.
            • Olyset Permanet 2.0
    • Insecticide permethrin deltamethrin
    • Material/fibre polyethylene polyester
    • Deniers 150 75 and 100
    • Mesh 50 and 100 156
    • Size
    • Shape
    • Colour
    LLITNs
  • 21. ITN and/or IRS What do you need to know in order to select the right tools at the right time in an emergency situation?
  • 22. What do you need to know in order to select the right tools at the right time in an emergency situation?
    • Is there malaria transmission in the area?
    • Feasibility access, security, HR, funding, logistics
    • Malaria epidemiology perennial or seasonal transmission, endemic or epidemic
    • Vector behaviour indoor/outdoor feeding, indoor/outdoor resting, day/dusk/night feeding, insecticide resistance
    • ‘ Demography’ composition, vulnerable groups, mobility, sleeping arrangements, bed/hut size, shelter material
    • Population’s KAP Knowledge, attitude & practices

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