Malaria Control In Africa Research Articles

The malaria burden and Africa.

The malaria burden and Africa.

Can Roll Back Malaria Achieve its Goal?: A Challenge

Worldwide interest in combating malaria has once again been sparked and several initiatives for malaria control in Africa have been established that are well-motivated and enthusiastically supported by International Agencies and major research organizations. While this has been done with good intentions, one cannot help but wonder where and by whom the agendas were set, and to what extent people involved with control of malaria were consulted.

Changing home treatment of childhood fevers by training shop keepers in rural Kenya.

Malaria control in Africa relies primarily on early effective treatment for clinical disease, but most early treatments for fever occur through self-medication with shop-bought drugs. Lack of information to community members on over-the-counter drug use has led to widespread ineffective treatment of fevers, increased risks of drug toxicity and accelerating drug resistance. We examined the feasibility and measured the likely impact of training shop keepers in rural Africa on community drug use. In a rural area of coastal Kenya, we implemented a shop keeper training programme in 23 shops serving a population of approximately 3500, based on formative research within the community. We evaluated the training by measuring changes in the proportions of drug sales where an adequate amount of chloroquine was purchased and in the percentage of home-treated childhood fevers given an adequate amount of chloroquine. The programme was assessed qualitatively in the community following the shop keeper training. The percentage of drug sales for children with fever which included an antimalarial drug rose from 34.3% (95% CI 28.9%-40.1%) before the training to a minimum of 79.3% (95% CI 71.8%-85.3%) after the training. The percentage of antimalarial drug sales where an adequate amount of drug was purchased rose from 31.8% (95% CI 26.6%-37.6%) to a minimum of 82.9% (95% CI 76.3%-87.3%). The percentage of childhood fevers where an adequate dose of chloroquine was given to the child rose from 3.7% (95% CI 1.2%-9.7%) before the training to a minimum of 65.2% (95% CI 57.7%-72.0%) afterwards, which represents an increase in the appropriate use of over-the-counter chloroquine by at least 62% (95% CI 53.7%-69.3%). Shop keepers and community members were strongly supportive of the aims and outcome of the programme. The large shifts in behaviour observed indicate that the approach of training shop keepers as a channel for information to the community is both feasible and likely to have a significant impact. Whilst some of the impact seen may be attributable to research effects in a relatively small scale pilot study, the magnitude of the changes support further investigation into this approach as a potentially important new strategy in malaria control.

Malaria: an emerging and re-emerging global plague.

Worldwide, malaria is the most prevalent infectious disease affecting humans. Malaria parasites presently infect more than 500 million people annually, killing up to 2 million and causing at least 100 million cases of acute illness. At the macroepidemiologic level, malaria is therefore an established, endemic public health plague for about one-third of the world's population. At the microepidemiologic level, malaria is a highly dynamic infection and disease. Although some countries have effectively managed the threat of malaria, there has been a dramatic, worldwide increase in malaria-related morbidity and mortality over the past 2 decades. In many parts of the globe, malaria is both a major threat to public health and a major obstacle to development given its ability to create high public health costs, lost productivity, and impaired individual growth. Plasmodium falciparum infections, regional differences and changes in malaria epidemiology, drug resistance, changing malaria control strategies, and implementing malaria control in Africa are discussed.

What's new in malaria control ?

Malaria remains a significant health problem in many tropical areas but the main impact of the infection is felt in sub-Saharan Africa, where malaria continues to cause many deaths and much morbidity. Recently, several new initiatives to improve malaria control in Africa have been started. Control is difficult to achieve in areas with very high levels of transmission but something can be accomplished with existing tools, which include provision of good treatment facilities, chemoprophylaxis in pregnancy and use of insecticide-treated materials. In some areas, especially on the fringes of sub-Saharan Africa, households spraying may also have a role. Use of insecticide-treated materials has had a major impact on child mortality in several countries in Africa, although there are concerns that the dramatic effects achieved initially may not be sustained. A major constraint on malaria control in Africa has been poor organization of malaria-control programmes. New approaches that combine elements of vertical and of horizontal control systems are being tried. Malaria control, even when carried out efficiently and cost-effectively, is relatively expensive. New ways of financing malaria control in the countries where it is needed most must be found.

An efficacy trial of a malaria vaccine in Gambian infants and comparison with insecticide-treated bednets

The SPf66 hybrid malaria vaccine is a polymeric, synthetic protein with amino-acid sequences derived from the pre-erythrocytic and asexual-blood-stage proteins of Plasmodium falciparum. SPf66 has already been found to have a 31% protective efficacy in Tanzanian children aged 1-5 years who lived in an area of intensive malaria transmission. A randomized, double-blind, placebo-controlled trial of SPf66 was carried out in Gambian infants. Overall, 630 children, aged 6-11 months at the time of the first dose, each received three doses of SPf66 or inactivated polio vaccine (IPV). Morbidity was monitored during the following rainy season by means of active and passive case detection. Cross-sectional surveys were carried out at the beginning and at the end of the rainy season. Analysis of efficacy was restricted to 547 of the children (316 receiving SPf66 and 231 IPV). Although the efficacy of SPf66 on the first or only clinical attack was found to be 8% when results were compared with those for the children given the placebo (IPV), the malarial vaccine had no significant effect on fever with any parasitaemia, the overall incidence of clinical attacks, packed-cell volumes, parasite prevalences or spleen rates. Compared with the present vaccine, insecticide-treated bednets appear to offer better prospects for control of malaria in Africa.

Vector biology and the control of malaria in Africa.

Vector biology and the control of malaria in Africa.

BED-NETS (MOSQUITO-NETS) AND MORBIDITY FROM MALARIA

A study was undertaken in the Farafenni area of The Gambia to determine the relation between morbidity from malaria in children and the use of bed-nets (mosquito-nets). From comparisons of parasite and spleen rates in bed-net users and in non-users it seemed that bed-nets had a strong protective effect. However, the prevalence of malaria in the study population was also influenced by ethnic group and place of residence, and the association of bed-net use with these two confounding factors accounted for some of the differences observed between bed-net users and non-users. Nevertheless, a significant inverse correlation between splenomegaly and the use of bed-nets remained. This suggests that bed-nets give Gambian children some protection against malaria and that the use of bed-nets, either untreated or treated with an insecticide such as permethrin, should be investigated further as a means of malaria control in Africa.