Cross Border Malaria Control Programs

BackgroundThe Global Fund alone contributed 56% of all international financing for malaria and has invested more than US$13.5 billion in malaria treatment, prevention, and control programmes by June 2021. These investments include interventions such as mosquito nets, indoor residual spraying, and preventive treatment for children and pregnant women. However, there is paucity of studies for assessment of such investments to a reduction in malaria prevalence. This study was aimed at quantifying the impact of household access to insecticide-treated nets (ITNs) and the indoor residual spraying (IRS) on self-reported malaria prevalence among women of reproductive age in Ghana.MethodsThe study analysed the 2016 Ghana Malaria Indicator Survey (MIS) data. The MIS is a nationwide survey that included women aged 15–49 years. Poisson regression model with inverse probability to treatment weighting was used to determine average treatment effect estimate of the two malaria interventions on self-reported malaria prevalence among women of reproductive age in Ghana.ResultsA total sample of 4861 women interviewed from the 2016 Ghana MIS was used for analysis. The prevalence of self-reported malaria in 2016 was 34.4% (95% CI [32.4%, 36.4%]). Approximately 80.0% of women lived in households with access to ITNs [Percentage (Pr) = 79.9%, (95% CI [78.0%, 81.7%])], 12.4% (95% CI [7.5%, 19.8%]) of the households had access to IRS and 11.4% (95% CI [7.0%, 18.0%]) of the households had access to both ITNs and IRS. Household access to only ITN contributed to 7.1 percentage point (pt) reduction in the self-reported malaria among women (95% CI [− 12.0%, − 2.1%], p = 0.005) whilst IRS at the households contributed to 6.8pt reduction in malaria prevalence (95% CI [− 12.0%, − 2.1%], p = 0.005). Households with access to both ITNs and IRS contributed to a 27.1pt reduction in self-reported malaria prevalence among women (95% CI [− 12.0%, − 2.1%], p = 0.005).ConclusionAccess to both ITNs and application of IRS at the household level contributed to a significant reduction in self-reported malaria prevalence among women of reproductive age in Ghana. This finding confirms the need for integration of malaria control interventions to facilitate attainment of malaria elimination in Ghana.

Laboratory and experimental hut evaluation of mosquito net and indoor residual spray (IRS) insecticides for improved malaria control

Malaria control. generating evidence from local to global level

Introduction: Malaria continues to be a significant public health issue, particularly in tropical and subtropical regions. Despite extensive efforts to reduce its burden through various control programs, malaria remains a major cause of morbidity and mortality. This study aims to assess the burden of malaria in a community and evaluate the community's response to malaria control and management programs.Objective: This study aimed to assess the prevalence of malaria and evaluate the community's awareness, participation, and response to malaria control and management programs.Methodology: This cross-sectional study included 550 participants from a community-based population. Data were collected through interviews, surveys, and medical records to determine malaria prevalence, treatment-seeking behavior, and knowledge of malaria control measures such as insecticide-treated nets (ITNs), indoor residual spraying (IRS), and antimalarial treatments.Results: The study found a malaria prevalence of 32% (176 participants), with higher rates in females at 35% (96 out of 275) compared to males at 30% (81 out of 275). A total of 85% (468 participants) recognized malaria symptoms. Awareness of prevention methods was reported by 72% (396 participants) for ITNs and 58% (319 participants) for IRS. Regarding treatment-seeking behavior, 60% (330 participants) visited health facilities, while 25% (138 participants) relied on traditional healers. Participation in malaria control programs was moderate: 62% (341 participants) reported using ITNs, and 50% (275 participants) had participated in IRS activities. Identified barriers included a lack of awareness in 30% (165 participants) and high costs in 20% (110 participants). Socioeconomic status influenced program engagement, with higher participation observed among individuals from wealthier households.Conclusion: Although malaria control and management programs have had a positive impact, only 62% (341 participants) used ITNs and 50% (275 participants) engaged in IRS, indicating a gap in community adherence. Despite 85% (468 participants) being aware of malaria symptoms, knowledge and practical application of preventive measures remain suboptimal. Improving public education, enhancing access to malaria control tools, and addressing socioeconomic barriers are essential to effectively reduce the malaria burden in the community.

Integrated vector management (IVM) is defined as "a rational decision-making process for the optimal use of resources for vector control" and includes five key elements: 1) evidence-based decision-making, 2) integrated approaches 3), collaboration within the health sector and with other sectors, 4) advocacy, social mobilization, and legislation, and 5) capacity-building. In 2004, the WHO adopted IVM globally for the control of all vector-borne diseases. Important recent progress has been made in developing and promoting IVM for national malaria control programmes in Africa at a time when successful malaria control programmes are scaling-up with insecticide-treated nets (ITN) and/or indoor residual spraying (IRS) coverage. While interventions using only ITNs and/or IRS successfully reduce transmission intensity and the burden of malaria in many situations, it is not clear if these interventions alone will achieve those critical low levels that result in malaria elimination. Despite the successful employment of comprehensive integrated malaria control programmes, further strengthening of vector control components through IVM is relevant, especially during the "end-game" where control is successful and further efforts are required to go from low transmission situations to sustained local and country-wide malaria elimination. To meet this need and to ensure sustainability of control efforts, malaria control programmes should strengthen their capacity to use data for decision-making with respect to evaluation of current vector control programmes, employment of additional vector control tools in conjunction with ITN/IRS tactics, case-detection and treatment strategies, and determine how much and what types of vector control and interdisciplinary input are required to achieve malaria elimination. Similarly, on a global scale, there is a need for continued research to identify and evaluate new tools for vector control that can be integrated with existing biomedical strategies within national malaria control programmes. This review provides an overview of how IVM programmes are being implemented, and provides recommendations for further development of IVM to meet the goals of national malaria control programmes in Africa.

Brian Leslie Sharp

Synergies in integrated malaria control

Insecticide resistance threatens malaria control in Africa

Bayesian spatio-temporal modelling for malaria surveillance and residual pockets of transmission identification in Swaziland

Malaria epidemiology and key control interventions in the Democratic Republic of Congo

Malaria in Children: Updates on Management and Prevention.

BackgroundMalaria continues to pose a significant public health threat in northern Brazil. Current control strategies for Anopheles darlingi, the primary malaria vector in the Amazon region, depend on long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) with pyrethroid insecticides. Despite decades of insecticide use, there are very few records of pyrethroid resistance in this mosquito species in Brazil, likely due to a lack of investigations, underscoring the urgent need for further actions. ObjectivesTo assess the susceptibility of An. darlingi from all malaria-endemic regions in Brazil to the pyrethroids used by the Malaria Prevention and Control Programme (NMCP) for vector control.MethodsAdult females An. darlingi were collected from 28 locations in the states of Amapá, Acre, Amazonas, Pará, Rondônia, Roraima, Mato Grosso, Maranhão, and Tocantins. These locations were chosen because of their high malaria incidence in recent years. The collected mosquitoes were sent to the Laboratory of Biology, Control, and Surveillance of Insect Vectors to produce F1 progeny. Discriminating concentration (DC) WHO tube bioassays were performed on deltamethrin (0.05%), etofenprox (0.5%), and permethrin (0.75%). The intensity of resistance was evaluated by comparing the mortality rates of mosquitoes exposed to papers treated with 1 × and 5 × the DC of these insecticides. ResultsOf the 19 An. darlingi populations evaluated, only four were susceptible to deltamethrin (Tapauá, Jacareacanga, Cantá, and Caracaraí). For etofenprox, 13 populations were resistant, whereas five were susceptible (Tapauá, Porto Velho, Porto Grande, Cantá, and Caracaraí). With respect to permethrin, 18 populations were evaluated, of which 12 were classified as susceptible and 6 as resistant (Coari, Manaus, Barcelos, Guajará, Rodrigues Alves, and Cruzeiro do Sul). Resistance intensity tests indicated that all populations, except Barcelos, presented low resistance to pyrethroids according to the WHO classification.ConclusionsThe first large scale detection of pyrethroid resistance in An. darlingi in Brazil is concerning and calls for urgent action to prevent its spread in the Amazon region. This study represents a critical step toward establishing comprehensive resistance monitoring and management plans for malaria vectors in Brazil.

BACKGROUND: Primary malaria prevention on a large scale depends on two vector control interventions: indoor residual spraying (IRS) and insecticide-treated mosquito nets (ITNs). Historically, IRS has reduced malaria transmission in many settings in the world, but the health effects of IRS have never been properly quantified. This is important, and will help compare IRS with other vector control interventions. OBJECTIVES: To quantify the impact of IRS alone, and to compare the relative impacts of IRS and ITNs, on key malariological parameters. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group Specialized Register (September 2009), CENTRAL (The Cochrane Library 2009, Issue 3), MEDLINE (1966 to September 2009), EMBASE (1974 to September 2009), LILACS (1982 to September 2009), mRCT (September 2009), reference lists, and conference abstracts. We also contacted researchers in the field, organizations, and manufacturers of insecticides (June 2007). SELECTION CRITERIA: Cluster randomized controlled trials (RCTs), controlled before-and-after studies (CBA) and interrupted time series (ITS) of IRS compared to no IRS or ITNs. Studies examining the impact of IRS on special groups not representative of the general population, or using insecticides and dosages not recommended by the World Health Organization (WHO) were excluded. DATA COLLECTION AND ANALYSIS: Two authors independently reviewed trials for inclusion. Two authors extracted data, assessed risk of bias and analysed the data. Where possible, we adjusted confidence intervals (CIs) for clustering. Studies were grouped into those comparing IRS with no IRS, and IRS compared with ITNs, and then stratified by malaria endemicity. MAIN RESULTS: IRS versus no IRSStable malaria (entomological inoculation rate (EIR) 1): Two studies; for incidence and prevalence, the malaria rates were higher in the IRS group compared to the ITN group in one study. Malaria incidence was higher in the IRS arm in India (risk ratio IRS:ITN = 1.48) and in South Africa (risk ratio 1.34 but the cluster unadjusted CIs included 1). For malaria prevalence, ITNs appeared to give better protection against any infection compared to IRS in India (risk ratio IRS:ITN = 1.70) and also for both P. falciparum (risk ratio IRS:ITN = 1.78) and P. vivax (risk ratio IRS:ITN = 1.37). AUTHORS' CONCLUSIONS: Historical and programme documentation has clearly established the impact of IRS. However, the number of high-quality trials are too few to quantify the size of effect in different transmission settings. The evidence from randomized comparisons of IRS versus no IRS confirms that IRS reduces malaria incidence in unstable malaria settings, but randomized trial data from stable malaria settings is very limited. Some limited data suggest that ITN give better protection than IRS in unstable areas, but more trials are needed to compare the effects of ITNs with IRS, as well as to quantify their combined effects

Exploring the epidemiology of malaria and the impact of malaria control interventions in malaria-endemic and Ebola-epidemic West Africa

Malaria control programs in Africa encounter daunting challenges that hinder progressive steps toward elimination of the disease. These challenges include widespread insecticide resistance in mosquito vectors, increasing outdoor malaria transmission, lack of vector surveillance and control tools suitable for outdoor biting vectors, weakness in malaria surveillance, and an inadequate number of skilled healthcare personnel. Ecological and epidemiological changes induced by environmental modifications resulting from water resource development projects pose additional barriers to malaria control. Cognizant of these challenges, our International Center of Excellence for Malaria Research (ICEMR) works in close collaboration with relevant government ministries and agencies to align its research efforts with the objectives and strategies of the national malaria control and elimination programs for the benefit of local communities. Our overall goal is to assess the impact of water resource development projects, shifting agricultural practices, and vector interventions on Plasmodium falciparum and P. vivax malaria in Kenya and Ethiopia. From 2017 to date, the ICEMR has advanced knowledge of malaria epidemiology, transmission, immunology, and pathogenesis, and developed tools to enhance vector surveillance and control, improved clinical malaria surveillance and diagnostic methods, and strengthened the capacity of local healthcare providers. Research findings from the ICEMR will inform health policy and strategic planning by ministries of health in their quest to sustain malaria control and achieve elimination goals.