Abstract
Malaria epidemics affect nonimmune populations in many highland and semi-arid areas of Africa. Effective prevention of these epidemics is challenging, particularly in the highlands where predictive accuracy of indicators is not sufficiently high to allow decisions involving expensive measures such as indoor residual spraying of insecticides. Advances in geographic information systems have proved useful in stratification of areas to guide selective targeting of interventions, including barrier application of insecticides in transmission foci to prevent spread of infection. Because rainfall is associated with epidemics in semi-arid areas, early warning methods based on seasonal climate predictions have been proposed. For most areas, response measures should focus on early recognition of anomalies and rapid mass drug administration. Vector control measures are useful if abnormal transmission is highly likely and if they can be selectively implemented at the early stages of an outbreak.
Highlights
Malaria epidemics affect nonimmune populations in many highland and semi-arid areas of Africa
After detection of abnormal increases, mostly increased numbers of clinically diagnosed cases, the actual causes of the increases should be rapidly confirmed through laboratory diagnosis before intervention measures are recommended
Many countries still need to improve their technical and logistics capacity to deal with high demands in resources to prevent or contain malaria epidemics
Summary
Malaria epidemics affect nonimmune populations in many highland and semi-arid areas of Africa Effective prevention of these epidemics is challenging, in the highlands where predictive accuracy of indicators is not sufficiently high to allow decisions involving expensive measures such as indoor residual spraying of insecticides. Malaria epidemics frequently affect highlands and semi-arid areas where populations lack immunity Rapid response to these epidemics can be made where effective surveillance systems are in place for early recognition of disease incidence anomalies. A plan in which 2 persons were found positive among a random sample of 36, denoted as [36,2], classified communities correctly with 100% sensitivity and 94% specificity After such assessments, the use of IRS for epidemic control should only be considered if continuation of transmission is anticipated over a long period and if rapid implementation of IRS is feasible at the early phase of an epidemic. Health services need to focus on more feasible measures such as strengthening preparedness by stocking drugs and diagnostic materials, closely monitoring changes in malaria incidence, educating communities to seek prompt treatment, classifying areas according to their risk levels, and making contingency plans to rapidly deploy mobile treatment teams
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