This document discusses malaria diagnosis, measurement, control, and prevention. It describes microscopic examination of blood films to detect malaria parasites, as well as serological and rapid diagnostic tests. Key metrics for measuring malaria like API, ABER, and SPR are defined. Approaches to control include case management, vector control through indoor residual spraying and larval source reduction, and use of insecticide-treated bed nets. The history of national malaria programs in India including NMCP, NMEP, UMS, and current RBM partnership are summarized.

1. MALARIA CONTROL AND
PREVENTION

2. DIAGNOSIS-
 Microscopic
 Serological test
 Rapid diagnostic test

3. microscopy
 Two types of blood films are useful in searching for
and identification of malaria parasite.
 The "thin film" and the "thick film".
 It is recommended that both types of film be
prepared on a single microscope glass slide.
 The thick film is more reliable in searching for
parasite, as large volume of blood is examined
under each microscope field.
 The thin slide is more valuable for identifying the
species of the parasite present.

4. Serological test
 The malarial fluorescent antibody test usually
becomes positive two weeks or more after primary
infection.
 The test is of the greatest value in epidemiological
studies and in determining whether a person has
had malaria in the past.

5. Rapid diagnostic test (RDT)
 Rapid Diagnostic Tests are based on the detection of
circulating parasite antigens with a simple dipstick
format.

6. Measurement of malaria-
 It is used to know the malaria load in the
community.
 API- Annual Parasite Incidence
 ABER-Annual Blood Examination Rate
 AFI- Annual Falciparum Incidence
 SPR- Slide Positivity Rate
 SFR-Slide Falciparum Rate
 among these API AND ABER and SPR Important.

7.  Annual blood examination rate (ABER): It is the
percentage of the population examined for
peripheral blood smear during a given year.
 Government of India, under MPO, fixed a
minimum of ABER of 10 percent per year. This is an
index of operational efficiency (i.e. quality of case
detection).

8.  Annual parasite incidence (API): It is the number of
new confirmed cases of malaria occurring in an
area during a given year and confirmed by blood
smear examination and is expressed per 1000
population.
 This is a sophisticated indicator to measure
malaria. Based on this, India was redefined, under
the Modified Plan of Operation of Malaria Control,
into two areas, for spray operations.

9.  Slide positivity rate (SPR): It is the percentage of
slides (smears) found positive for malarial
parasites, irrespective of type of species.
 This gives information about the parasite load in
the community.

10. Approaches to malaria control
 Management of malaria cases in the community.
 Active intervention to control or interrupt
malaria transmission with community
participation.

11. Management of malaria cases in community-
 Health guides and multipurpose workers are fully
trained to detect and treat cases of malaria at the
community level with support from referral
system(PHC,CHC and higher levels).

13. Prevention and control-
 Elimination of reservoirs
 Breaking the channel of transmission
 Protection of susceptible

14. Elimination of reservoirs-
 This consists of making the infectious cases
non-infectious by giving treatment.
 The treatment consists of presumptive treatment,
radical treatment and mass treatment.
 Early diagnosis and treatment of the infectious
malaria cases.
 Mass treatment in cases of highly endemic
areas.
 Chemoprophylaxis with chloroquine for travelers to
malarious areas, pregnant women living in endemic
and hyperendemic areas.

15.  Presumptive treatment: All fever cases attending
hospitals for the treatment, are assumed to be the
cases of malaria and treated accordingly, depending
upon whether that area is a low-risk area or high-risk
area .
 Radical treatment: This is given for those, whose blood
smear report comes as positive for malarial parasites
 Mass treatment: This is recommended in highly
endemic areas, where API is more than 5 per 1000
population. This will be more effective, when
supplemented by anti-mosquito measures.

16. Breaking the Channel of Transmission
 This measure consists of control of vectors.
 The different methods of control of vectors are-
a. Antiadult measures
b. Antilarval measures.

18. Anti-adult measures:
 This consists of spraying the insecticides-
i. Residual spraying: This consists of spraying of
indoor surfaces of houses, cattle sheds with
residual insecticides like DDT, malathion,
fenitrothion.
ii. Space spraying: This consists of out-door
spraying of the insecticides. The technology is
that the insecticide (malathion) is sprayed in the
form of fog or mist by ultra low volume thermal
fogging method by using agricultural aircraft or by
using ground equipment, fitted over a vehicle. This
method controls the vectors quickly.

19. Anti-larval measures:
This consists of bioenvironmental control strategy
components are-
 Source reduction.
 Environmental modification and manipulation.
 Biological control.
Source reduction: This consists of elimination of
nonessential water bodies, which includes periodical
emptying of domestic water container, sealing of water
tanks, filling pot holes, puddles, burrow–pits and
canalizing drains so that water does not stagnate.

20. Environmental modification and manipulation:
This consists of leveling of land or filling of
depressions and making of soakage pits help in
prevention of mosquito breeding.
Biological control:
Mosquitoes (Larvae) can also be controlled by
employing their natural enemies such as fish,
bacteriae and fungi.

21. Biological control
 Larvivorous fish: Use of larvivorous fish are the
most promising ones.
 Gambusia affinis and Lebister reticulates (often
known as Barbados millions). Other fish which can
also be employed is Poecilia reticulata.
 Use of bacteriae (i.e. Biocides): The best known
biocides are Bacillus sphaericus and Bacillus
thuringiensis. They kill the mosquito larvae.
should not be used for larval control in potable
water, i.e. drinking water collections.

23. Integrated control:
 It includes bioenvironmental and personal
protection measures, so that the vectors can be
controlled effectively. Thus, integrated control is
an approach, considering more than one
method, whether directed only against larvae or
adults or both.

25. Personal Protection
These measures are directed against mosquito bites.
 a. Bednets:
 Nylon nets are preferred over cotton nets, because
of their durability .They are impregnated with an
insecticide either one g of deltamethrin or 0.5 g of
cyfluthrin or 0.25 g of lambda cyhalothrin per square
meter of mosquito-net. T he impregnated net will
have efficacy for 6 months when not washed.

26. b. Use of mosquito repellents:
 They are applied on the skin. They repell the
mosquitoes by their smell and protect the individual
from the mosquito bites.
 Diethyl-toluamide (DEET) has been found to be very
effective.
 Other repellents are Indalone, Dimethyl phthalate,
Dimethyl carbate, Ethyl hexanediol, etc.
 However these repellents are effective for short
period of 8 to 10 hours.

27. Malaria vaccines:
They are under trial. Following are the types:
i. Asexual blood stage vaccines(merozoite vaccine)
ii. Sporozoite vaccines
iii. Gamete vaccines
iv. A synthetic cocktail vaccine: This vaccine for P.
falciparum is called ‘PfS 66’. It is formulated as a
peptide–alum combination. It has been found to
be 30 percent effective.
v. Transmission blocking vaccine: Like ‘PfS 25’, it is
also under trial

28. NATIONAL ANTIMALARIA PROGRAM
History
 Control of malaria in the country was first
recommended by Bhore Committee in 1946.
 Government of India, in April 1953, launched
National Malaria Control Program (NMCP), when
malaria was the principal health problem.
 During 1953 malaria accounted for annual morbidity
of 75 million cases.

29.  The objective was to reduce the morbidity and
mortality of malaria to such a low level that it
should no more be a public health problem.
 The strategy to achieve the objective was to
interrupt the transmission of malaria by
controling the vectors (anopheline mosquitoes)
by indoor residual spraying with DDT, twice a year in
endemic areas, where spleen rates were above 10
percent.

30. NMEP
 Encouraged by the spectacular results of success of
NMCP, it was decided by Government of India to
eradicate the disease and therefore Government of
India launched National Malaria Eradication
Program (NMEP).
 Government of India decided in favor of eradication
and launched NMEP during 1958.

31. The objectives were:
 Elimination of reservoir of infection (by case detection
and prompt treatment)
 Total ending of transmission of malaria, (by control of
vectors)
 Prevention of re-establishment of malaria by 1968-69.
(That means there should not be occurrence of
malaria even in the presence of carrier mosquitoes).
 The entire country was brought under NMEP including
non-endemic areas, which were not covered under
NMCP.

32. The NMEP was carried out in the same 4 phases:
 Preparatory Phase: This consisted of collection of
data about the extent of the problem of malaria
and to prepare for attacking the problem.
 Attack Phase- This was taken up directly and it was
extended for 3 years from April 1958 to 61
April. The term ‘Attack’ implied on the attack of
vector anopheline mosquitoes by the principal
activity of spraying insecticides like DDT/BHC
in all the human dwellings, twice a year.

33.  Consolidation Phase :
 This phase was started when API was reduced to 0.1
per 1000 population, i.e. during 1961. The principal
activity of this phase was stopping DDT spraying due to
complete interruption of transmission and carrying out
only active and passive surveillance and
presumptive and radical treatment.
 Maintenance phase: The word ‘maintenance’ implied
maintenance of vigilance to detect re-entry of
infection in those areas declared ‘free’ of malaria.

34. The scenario of malaria eradication was as follows:-
 API came down to 0.1 per 1000 population
 Annual incidence was hardly 50,000 cases, by 1961.
 25 percent of the population was under attack phase,
25 percent in the consolidation phase and 50 percent
under maintenance phase.

35.  From 1961, focal outbreaks of malaria began to occur
and the annual incidence went on increasing year by
year. By 1965, the cases reported were 1,00,000
(doubled).
 Malaria came back with greater force, i.e., vectors
developed resistance against DDT and parasites
started developing resistance against chloroquine.
Hence the term ‘Resurgence’.

36. Urban Malaria Scheme
 Urban Malaria Scheme (UMS) was launched during
1971, when it was realized that urban malaria was a
significant problem and the vectors breed largely in
man-made containers like over-headtanks,
ornamental ponds, water coolers, flower vases,
building constructions etc.

37. Plan of action
 Early diagnosis and treatment of malaria cases.
 Bioenvironmental management by source reduction
measures such as emptying the water containers including
overhead tanks, ponds, etc. once a week and observing
weekly dry day.
 Controlling the larvae by weekly application of
larvicidal oil, temphos, fenthion. Use of larvivorous fish as a
good alternative method.
 Health education to the public was given to extend
their co-operation in the control of malaria.

38. ROLL BACK MALARIA
 Roll black malaria (RBM) is a global partnership
founded in 1998 by the WHO, UNDP, UNICEF and
World Bank.
The aim is to halve the world’s malaria burden
by the year 2010. Political commitment is a key
priority of RBM.
RBM is giving priority to four technical strategies-
Prompt access to effective treatment
Promotion of insecticide treated bednets and
improved vector control

39.  Prevention and management of malaria in pregnancy and
 Improving response to malaria in epidemics and endemic
areas.
 RBM also seeks to encourage the research in new and
better drugs, insecticides and malaria vaccines.
 Goals
The goals for the malaria control set for the Tenth Five
Year Plan are: -
 ABER over 10 percent
 API 1.3 or less
 25 % reduction in malaria morbidity and mortality by
2007 and 50% by 2010.