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. RBC WITH MALARIAL PARASITE

Clinical feautures if malaria vary from mild to Severe and complicated according to the, Species of parasite present pts state of immunity Intensity of the infection Presence 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.

Malaria Control Measures

History of Malaria Control Programs in India NMCP 53

NMEP 58

UMS 71

MAP 95

EMCP 97

MPO 77

National Malaria Control Program

National Malaria Eradication Program Urban Malaria Scheme Modified Plan of Operation Malaria Action Plan Enhanced Malaria Control Program

National Anti-malaria Program NAMP Roll Back Malaria

NAMP 99 RBM 98

ROLLBACK MALARIA WHO 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>2 SPRAYING ENTOMOLOGICAL ASSESSMENT SURVEILLANCE (active & passive) TREATMENT

API<2 FOCAL SPRAYING SURVEILLANCE (active & passive ) TREATMENT FOLOW UP EPIDEMIOLOGICAL INVESTIGATION

PARAMETERS OF MALARIA SURVEILLANCE API = CONFIRMED CASES DURING THE YR POPULATION UNDER X 1000 INDEX OF ENDEMICITY SURVEILLANCE ABER= NO OF SLIDES EXAMINED POPULATION UNDER SURVEILLANCE

X 100 1NDEX OF OPERATIONAL EFFICIENCY

ANNUAL FALCIPARUM RATE SLIDE POSITIVITY RATE SLIDE FALCIPARUM RATE PF PROPORTION SPLEEN RATE (MEASURES OF ENDEMICITY OF MALARIA)

APPROACHES TO MALARIA CONTROL A ) THE

MANAGEMEN T OF

MALARIA CASES IN THE COMMUNITY

B)

ACTIVE INTERVENTION TO

CONTROL/ 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 could be caused by malaria.

which

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 assured QUALITY 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.

TREATMENT PRESUMPTIVE 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 TREATMENT TAB PRIMAQUINE 0.25mg/kg body weight daily for 5 days SEVERE AND COMPLICATED MALARIA QUININE 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 dose ARTIMISINE 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 to endemic areas

CONTRAINDICATIONS AND TOXICITY PRIMAQUINE is contraindicated in G6-PD deficient patients, AND in pregnant women. PRIMAQUINE is cardiotoxic even 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


   

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 and Areas 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 MEASURES LARVICIDES ENVIRONMENTAL CONTROL

BIOLOGICAL CONTROL

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

SYNTHETIC INSECTICIDES FENTHION ,CHLORPYRITOS, ABATE, Are least toxic and commonly used.

ANTI ADULT MEASURES SPACE SPRAYING APPLICATION Sprayed into the atmosphere In the form of a mist or fog

Pyrethrum extract malathion, Fenitrothion through ulv Fogging is used.

RESIDUAL SPRAYING DDT is most commonly used now resistance arise to it so periodic testing for the susceptibility is needed

INDIVIDUAL PROTECTION

PERSONAL PROTECTION METHOD USING 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

PERSONAL PROTECTION METHODS VAPOURS PRODUCED BY THEM CAUSE DISORIENTATING EFFECTS IN MOSQUITO AND PREVENT FROM BITING .

.

The environmental management is the most 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 preffered areas of breeding places of vectors Drainage and filling of the areas whwre the water collects

BIOLOGICAL CONTROL COST 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

…..CONTD Several species of fungi are pathogenic to larvae in clear water EX; LAGENIDIUM GIGANTEUM Procedures should be developed to breed larvivorous fish at the Local level so that it can be distributed tothe community to introduction at the breeding places

….CONTD MICROBIAL 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 thuringiensis

Good activity against broad Spectrum of mosquito species New trend in mosquito control Is the use of bacterial agents in combination with natural y occuring predatory insects and fish

GENETIC CONTROL STERILE 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 currently Available for malaria control

Canditate antigens for malaria vaccines Sporozoite anigens—prevent the Host from being infected Asexual blood stage antigens– restrict parasite multiplication Sexual stage antigens—serum with the antidodies ingested by the Mosquito & block parasite development in the mosquito midgut

A vaccine could provide a much needed adjunt to the generally inadequate resources currently 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 PREGNANCY In the view of the high maternal and infant morbidty and mortality associated with malaria in pregnancy

• Intermittent preventive treatment (IPT) with antimalarial drugs • 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 areas Vector resistance to insecticides Cost and toxicity Exophilic behaviour of certain vector species Parasite 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

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 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 SITES http://mrcindia.org/ http://tnhealth.org/ health .allrefer.com http;//www.pon.nic.in/vcrc http://tropicaldiseaseswebring.org/

REFERENCES PARKS TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 17th EDITION;2003 WHO MODEL PRESCRIBING INFORMATION; DRUGS USED IN PARASITIC DISEASES 2nd EDITION WHO 1988 Entomological field techniques for malaria control part i learners guide 2000 TROPICAL DISEASE RESEARCH A GLOBAL PARTNERSHIP 8th PROGRAMME REPORT RESEARCH AND TRAINING IN TROPICAL DIDEASES1987 WHO EXPERT COMMITTEE ON MALARIA ; who technical research series 892 REPORT WHO;1999 URBAN VECTOR AND PEST CONTROL 11th REPORT ON VECTOR BIOLOGY &CONTROL BY WHO 1988