prevention and control of malaria
TRANSCRIPT
Protozoal disease caused by infection with parasites of the genus plasmodium
And transmitted to man by certain species of infected female anopheline mosquito.
Clinical feautures if malaria vary from mild toSevere and complicated according to the,
Species of parasite present pts state of immunityIntensity of the infectionPresence 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.
RBC WITH MALARIAL PARASITE
Malaria Control MeasuresMalaria Control Measures
NMCP NMCP 5353 NMEP NMEP 5858 UMS UMS 7171
MPO MPO 7777
MAP MAP 9595 EMCP EMCP 9797 NAMP NAMP 9999
History of Malaria Control Programs in IndiaHistory of Malaria Control Programs in India
RBM RBM 9898National Malaria Control ProgramNational Malaria Control Program
National Malaria Eradication ProgramNational Malaria Eradication Program
Urban Malaria SchemeUrban Malaria Scheme
Modified Plan of OperationModified Plan of Operation
Enhanced Malaria Control ProgramEnhanced Malaria Control Program
National AntiNational Anti--malaria Program NAMPmalaria Program NAMP
Roll Back MalariaRoll Back Malaria
Malaria Action PlanMalaria Action Plan
ROLLBACK MALARIAWHO 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>2SPRAYINGENTOMOLOGICAL ASSESSMENTSURVEILLANCE (active & passive)TREATMENT
API<2FOCAL SPRAYINGSURVEILLANCE (active & passive )TREATMENTFOLOW UPEPIDEMIOLOGICAL INVESTIGATION
PARAMETERS OF MALARIA SURVEILLANCE
API = CONFIRMED CASES DURING THE YR POPULATION UNDER
SURVEILLANCE
ABER= NO OF SLIDES EXAMINEDPOPULATION UNDER
SURVEILLANCE
ANNUAL FALCIPARUM RATESLIDE POSITIVITY RATESLIDE FALCIPARUM RATEPF PROPORTIONSPLEEN RATE
(MEASURES OF ENDEMICITY OF MALARIA)
X 1000 INDEX OF ENDEMICITY
X 100 1NDEX OF OPERATIONALEFFICIENCY
APPROACHES TO MALARIA CONTROL
A ) THE MANAGEMEN T OF MALARIA CASES IN THECOMMUNITY
B) ACTIVE INTERVENTION TOCONTROL/ 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 which could be caused by malaria.
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 assuredQUALITY 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.
TREATMENTPRESUMPTIVE 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 TREATMENTTAB PRIMAQUINE 0.25mg/kg body weight daily for 5 days
SEVERE AND COMPLICATED MALARIAQUININE 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 doseARTIMISINE 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 toendemic areas
CONTRAINDICATIONS AND TOXICITY
PRIMAQUINE is contraindicated in G6-PD deficient patients,
AND in pregnant women.
PRIMAQUINE is cardiotoxiceven 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
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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 andAreas 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 MEASURESLARVICIDES
ENVIRONMENTAL CONTROL
BIOLOGICAL CONTROL
LARVICIDESMINERAL OILS
Petroleum hydrocarbon on the surface of a water will prevent mosquito larvae from breathing
SYNTHETIC INSECTICIDESFENTHION ,CHLORPYRITOS,
ABATE, Are least toxic and commonly used.
ANTI ADULT MEASURESSPACE SPRAYING APPLICATION
Sprayed into the atmosphereIn the form of a mist or fog
Pyrethrum extract malathion,Fenitrothion through ulvFogging is used.
RESIDUAL SPRAYINGDDT is most commonly used
now resistance arise to it
so periodic testing for the susceptibility is needed
INDIVIDUAL PROTECTION
PERSONAL PROTECTION METHODUSING 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
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PERSONAL PROTECTION METHODS
VAPOURS PRODUCED BY THEM CAUSE DISORIENTATING
EFFECTS IN MOSQUITO AND PREVENT FROM BITING .
.
The environmental management is themost 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 prefferedareas of breeding places of vectors
Drainage and filling of the areas whwre the water collects
BIOLOGICAL CONTROLCOST 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
…..CONTDSeveral species of fungi are
pathogenic to larvae in clear water
EX; LAGENIDIUM GIGANTEUM
Procedures should be developed to breed larvivorous fish at theLocal level so that it can be distributed tothe community to introduction at the breeding places
….CONTDMICROBIAL 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 bacillus thuringiensisthuringiensis
Good activity against broadSpectrum of mosquito species
New trend in mosquito controlIs the use of bacterial
agents in combination with natural y occuring predatory
insects and fish
GENETIC CONTROLSTERILE 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 currentlyAvailable for malaria control
Canditate antigens for malaria vaccines
Sporozoite anigens—prevent theHost from being infected
Asexual blood stage antigens–restrict parasite multiplication
Sexual stage antigens—serum with the antidodies ingested by theMosquito & block parasite development in the mosquito midgut
A vaccine could provide a much needed adjunt to the generally inadequate resourcescurrently 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 PREGNANCYIn the view of the high maternal
and infant morbidty and mortality associated with malaria in pregnancy
• Intermittent preventive treatment (IPT) with antimalarialdrugs
• 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 areasVector resistance to insecticidesCost and toxicityExophilic behaviour of certain vector speciesParasite 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
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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 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 SITEShttp://mrcindia.org/
http://tnhealth.org/
health .allrefer.com
http;//www.pon.nic.in/vcrc
http://tropicaldiseaseswebring.org/
REFERENCESPARKS TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 17th EDITION;2003WHO MODEL PRESCRIBING INFORMATION; DRUGS USED IN PARASITIC DISEASES 2nd EDITION WHO 1988Entomological field techniques for malaria control part i learners guide 2000TROPICAL DISEASE RESEARCH A GLOBAL PARTNERSHIP 8th PROGRAMME REPORT RESEARCH AND TRAINING IN TROPICAL DIDEASES1987WHO EXPERT COMMITTEE ON MALARIA ; who technical research series 892 REPORT WHO;1999URBAN VECTOR AND PEST CONTROL 11th REPORT ON VECTOR BIOLOGY &CONTROL BY WHO 1988