Malaria Eradication Program Research Articles

Artemisinin-Resistant Malaria as a Global Catastrophic Biological Threat.

The global spread of artemisinin resistance brings with it the threat of incurable malaria. Already, this disease threatens over 219 million lives per year and causes 5-6% losses in GDP in endemic areas, even with current advances in prevention and treatment. This chapter discusses the currently tenuous position we are in globally, and the impact that could be seen if artemisinin treatment is lost, whether due to the unchecked spread of K13 mutations or poor global investment in treatment and prevention advances. Artemisinin is the backbone of current ACT treatment programs and severe malarial treatment; without it, the success of future malaria eradication programs will be in jeopardy.

Impact of training of mothers, drug shop attendants and voluntary health workers on effective diagnosis and treatment of malaria in Lagos, Nigeria.

Background:The National Malaria Eradication Program and international agencies are keen on scaling up the use of malaria rapid diagnostic tests (mRDTs) and artemisinin-based combination therapies (ACTs) for effective diagnosis and treatment of the disease. However, poor diagnostic skills and inappropriate treatment are limiting the efforts. In Nigeria, a large proportion of infected patients self-diagnose and treat while many others seek care from informal drug attendants and voluntary health workers.Aims:This study describes the impact of training voluntary health workers, drug shop attendants, and mothers on effective case detection and treatment of malaria in Lagos, Nigeria. METHODS: We trained mothers accessing antenatal care, drug shop attendants, and voluntary health workers selected from the three districts of Lagos, on the use of histidine-rich protein-2-based mRDTs and ACTs. Pre- and post-training assessments, focus group discussions (FGDs), and in-depth interviews (IDIs) were carried out.Results:The knowledge, attitude, and skill of the participants to achieve the goal of “test, treat, and track” using mRDT and ACTs were low (11%–55%). There was a low awareness of other non-malaria fevers among mothers. Self-medication was widely practiced (31.3%). FGDs and IDIs revealed that health-care providers administered antimalarials without diagnosis. Training significantly improved participants' knowledge and expertise on the use of mRDTs and ACTs (P = 0.02). The participants' field performance on mRDT use was significantly correlated with their category (bivariate r = 0.51, P = 0.001). There was no statistically significant association between the participants' level of education or previous field experience and their field performance on mRDT (r = 0.12, P = 0.9; χ 2= 38, df = 2 and P = 0.49).Conclusion:These findings suggest that training of stakeholders in malaria control improves diagnosis and treatment of malaria. However, a broader scope of training in other settings may be required for an effective malaria control in Nigeria.

Identification of a PH domain-containing protein which is localized to crystalloid bodies of Plasmodium ookinetes

BackgroundFor the success of the malaria control and eradication programme it is essential to reduce parasite transmission by mosquito vectors. In the midguts of mosquitoes fed with parasite-infected blood, sexual-stage parasites fertilize to develop into motile ookinetes that traverse midgut epithelial cells and reside adjacent the basal lamina. Therefore, the ookinete is a promising target of transmission-blocking vaccines to break the parasite lifecycle in mosquito vectors. However, the molecular mechanisms of ookinete formation and invasion of epithelial cells have not been fully elucidated. A unique structure called the crystalloid body has been identified in the ookinete cytoplasm by electron microscopy, but its biological functions remain unclear.MethodsA recombinant protein of a novel molecule, designated as crystalloid body specific PH domain-containing protein of Plasmodium yoelii (PyCryPH), was synthesized using a wheat germ cell-free system. Specific rabbit antibodies against PyCryPH were obtained to characterize the expression and localization of PyCryPH during sexual-stage parasite development. In addition, PyCryPH knockout parasites were generated by targeted gene disruption to examine PyCryPH function in mosquito-stage parasite development.ResultsWestern blot and immunofluorescence assays using specific antibodies showed that PyCryPH is specifically expressed in zygotes and ookinetes. By immunoelectron microscopy it was demonstrated that PyCryPH is localized within crystalloid bodies. Parasites with a disrupted PyCryPH gene developed normally into ookinetes and formed oocysts on the basal lamina of midguts. In addition, the number of sporozoites residing in salivary glands was comparable to that of wild-type parasites.ConclusionsCryPH, containing a signal peptide and PH domain, is predominantly expressed in zygotes and ookinetes and is localized to crystalloid bodies in P. yoelii. CryPH accumulates in vesicle-like structures prior to the appearance of typical crystalloid bodies. Unlike other known crystalloid body localized proteins, CryPH does not appear to have a multiple domain architecture characteristic of the LAP/CCp family proteins. Although CryPH is highly conserved among Plasmodium, Babesia, Theileria, and Cryptosporidium, PyCryPH is dispensable for the development of invasive ookinetes and sporozoites in mosquito bodies.

Epidemiological Characteristics of Re-emerging Vivax Malaria in the Republic of Korea (1993-2017).

Historically, Plasmodium vivax malaria has been one of the most highly endemic parasitic diseases in the Korean Peninsula. Until the 1970s, vivax malaria was rarely directly lethal and was controlled through the Korean Government Program administered by the National Malaria Eradication Service in association with the World Health Organization’s Global Malaria Eradication Program. Vivax malaria has re-emerged in 1993 near the Demilitarized Zone between South and North Korea and has since become an endemic infectious disease that now poses a serious public health threat through local transmission in the Republic of Korea. This review presents major lessons learned from past and current malaria research, including epidemiological and biological characteristics of the re-emergent disease, and considers some interesting patterns of diversity. Among other features, this review highlights temporal changes in the genetic makeup of the parasitic population, patient demographic features, and spatial distribution of cases, which all provide insight into the factors contributing to local transmission. The data indicate that vivax malaria in Korea is not expanding exponentially. However, continued surveillance is needed to prevent future resurgence.

Sense of community and willingness to support malaria intervention programme in urban poor Accra, Ghana

BackgroundThe extensive research on community members’ willingness to support malaria interventions ignores the role of psychosocial determinants. This study assesses the impact of individuals’ sense of community (perceptions of community cohesion, altruism, seeking help from neighbours and migrant status) on their willingness to participate in a mosquito control programme using data on 768 individuals from the 2013 RIPS Urban Health and Poverty Survey in poor coastal communities in Accra, Ghana. A contingent valuation experiment was employed to elicit individuals’ willingness to support the programme by contributing nothing, labour time/money only or both.ResultsFindings show that different dimensions of sense of community related differently with willingness to support the programme. Perceived community cohesion was associated with lower odds while help-seeking from neighbours and being a migrant were associated with higher odds of supporting the programme. Altruism was the only dimension not linked to willingness to participate.ConclusionsDifferent dimensions of sense of community are associated with community members’ willingness to provide labour, time or both to support the malaria eradication programme. The findings of this study have implications for targeting social relational aspects, in addition to geographical aspects, of communities with malaria-resilient policy and intervention. They also warrant further research on psychosocial factors that predict willingness to support health programmes in urban poor settings.

Factors Associated with the Rapid and Durable Decline in Malaria Incidence in El Salvador, 1980-2017.

.A decade after the Global Malaria Eradication Program, El Salvador had the highest burden of malaria in Mesoamerica, with approximately 20% due to Plasmodium falciparum. A resurgence of malaria in the 1970s led El Salvador to alter its national malaria control strategy. By 1995, El Salvador recorded its last autochthonous P. falciparum case with fewer than 20 Plasmodium vivax cases annually since 2011. By contrast, its immediate neighbors continue to have the highest incidences of malaria in the region. We reviewed and evaluated the policies and interventions implemented by the Salvadoran National Malaria Program that likely contributed to this progress toward malaria elimination. Decentralization of the malaria program, early regional stratification by risk, and data-driven stratum-specific actions resulted in the timely and targeted allocation of resources for vector control, surveillance, case detection, and treatment. Weekly reporting by health workers and volunteer collaborators—distributed throughout the country by strata and informed via the national surveillance system—enabled local malaria teams to provide rapid, adaptive, and focalized program actions. Sustained investments in surveillance and response have led to a dramatic reduction in local transmission, with most current malaria cases in El Salvador due to importation from neighboring countries. Additional support for systematic elimination efforts in neighboring countries would benefit the region and may be needed for El Salvador to achieve and maintain malaria elimination. El Salvador’s experience provides a relevant case study that can guide the application of similar strategies in other countries committed to malaria elimination.

Rapid and sensitive multiplex single-tube nested PCR for the identification of five human Plasmodium species

Malaria is caused by five species of Plasmodium in humans. Microscopy is currently used for pathogen detection, requiring considerable training and technical expertise as the parasites are often difficult to differentiate morphologically. Rapid diagnostic tests are as reliable as microscopy and offer faster diagnoses but possess lower detection limits and are incapable of distinguishing among the parasitic species. To improve global health efforts towards malaria control, a rapid, sensitive, species-specific, and economically viable diagnostic method is needed. In this study, we designed a malaria diagnostic method involving a multiplex single-tube nested PCR targeting Plasmodium mitochondrial cytochrome c oxidase III and single-stranded tag hybridization chromatographic printed-array strip. The detection sensitivity was found to be at least 40 times higher than that of agarose gel electrophoresis with ethidium bromide. This system also enables the identification of both single- and mixed-species malaria infections. The assay was validated with 152 Kenyan samples; using nested PCR as the standard, the assay's sensitivity and specificity were 88.7% and 100.0%, respectively. The turnaround time required, from PCR preparation to signal detection, is 90min. Our method should improve the diagnostic speed, treatment efficacy, and control of malaria, in addition to facilitating surveillance within global malaria eradication programs.

MalERA: An updated research agenda for insecticide and drug resistance in malaria elimination and eradication.

Resistance to first-line treatments for Plasmodium falciparum malaria and the insecticides used for Anopheles vector control are threatening malaria elimination efforts. Suboptimal responses to drugs and insecticides are both spreading geographically and emerging independently and are being seen at increasing intensities. Whilst resistance is unavoidable, its effects can be mitigated through resistance management practices, such as exposing the parasite or vector to more than one selective agent. Resistance contributed to the failure of the 20th century Global Malaria Eradication Programme, and yet the global response to this issue continues to be slow and poorly coordinated—too often, too little, too late. The Malaria Eradication Research Agenda (malERA) Refresh process convened a panel on resistance of both insecticides and antimalarial drugs. This paper outlines developments in the field over the past 5 years, highlights gaps in knowledge, and proposes a research agenda focused on managing resistance. A deeper understanding of the complex biological processes involved and how resistance is selected is needed, together with evidence of its public health impact. Resistance management will require improved use of entomological and parasitological data in decision making, and optimisation of the useful life of new and existing products through careful implementation, combination, and evaluation. A proactive, collaborative approach is needed from basic science and the development of new tools to programme and policy interventions that will ensure that the armamentarium of drugs and insecticides is sufficient to deal with the challenges of malaria control and its elimination.

Frequency of G6PD Mediterranean in individuals with and without malaria in Southern Pakistan

BackgroundPakistan has an estimated annual burden of 1.5 million malaria cases. The current situation calls for an effective malaria control and eradication programme in this country. Currently, primaquine is an attractive option for eliminating reservoirs of Plasmodium vivax hypnozoites and killing gametocytes of Plasmodium falciparum. However, this drug causes haemolysis in individuals who are glucose-6-phosphate (G6PD) deficient. It is important to map G6PD deficiency and malaria distribution in Pakistan to design an effective malaria eradication regimen. Frequency of G6PD deficiency (G6PDd) in malaria patients has not been reported from Pakistan in any meaningful way. The purpose of this study was to evaluate the frequency of G6PD c.563C>T (G6PD Mediterranean) in male individuals with and without falciparum malaria.MethodsTwo hundred and ten archived DNA samples from males (110 from falciparum malaria patients and 100 from healthy individuals) were utilized in this study. Healthy blood donors were selected based on stringent pre-defined criteria. Patients were confirmed for malaria parasites on microscopy and or immune chromatographic assay detecting P. falciparum histidine-rich protein 2. Parasitaemia was also computed. DNA samples were tested for G6PD c.563C>T mutation through PCR–RFLP according to the previously defined protocol and its allelic frequency was computed.ResultsG6PD c.563C>T was observed in four of 110 patients with falciparum malaria and in two of 100 healthy donors. Mean (± SD) haemoglobin, median (IQR) platelet and median (IQR) parasite count in G6PD-deficient malaria-patients were 8.9 ± 0.9 g/dL, 124 × 109/L (IQR 32, 171) and 57,920/μL of blood (IQR 12,920, 540,000) respectively.ConclusionsCumulative allelic frequency for G6PD 563c.C>T was 0.0285 detected in 6 of 210 X-chromosomes in Southern Pakistan. Frequency for this G6PD allele was 0.0364 in malaria-patients and 0.0200 in healthy individuals. Large studies including females are needed to elucidate the true burden of G6PDd in malaria-endemic areas. The information will enable local health policy makers to design effective strategies for eliminating malaria form this region.

Spatiotemporal Modeling for Fine-Scale Maps of Regional Malaria Endemicity and Its Implications for Transitional Complexities in a Routine Surveillance Network in Western Cambodia.

Due to the associated and substantial efforts of many stakeholders involved in malaria containment, the disease burden of malaria has dramatically decreased in many malaria-endemic countries in recent years. Some decades after the past efforts of the global malaria eradication program, malaria elimination has again featured on the global health agenda. While risk distribution modeling and a mapping approach are effective tools to assist with the efficient allocation of limited health-care resources, these methods need some adjustment and reexamination in accordance with changes occurring in relation to malaria elimination. Limited available data, fine-scale data inaccessibility (for example, household or individual case data), and the lack of reliable data due to inefficiencies within the routine surveillance system, make it difficult to create reliable risk maps for decision-makers or health-care practitioners in the field. Furthermore, the risk of malaria may dynamically change due to various factors such as the progress of containment interventions and environmental changes. To address the complex and dynamic nature of situations in low-to-moderate malaria transmission settings, we built a spatiotemporal model of a standardized morbidity ratio (SMR) of malaria incidence, calculated through annual parasite incidence, using routinely reported surveillance data in combination with environmental indices such as remote sensing data, and the non-environmental regional containment status, to create fine-scale risk maps. A hierarchical Bayesian frame was employed to fit the transitioning malaria risk data onto the map. The model was set to estimate the SMRs of every study location at specific time intervals within its uncertainty range. Using the spatial interpolation of estimated SMRs at village level, we created fine-scale maps of two provinces in western Cambodia at specific time intervals. The maps presented different patterns of malaria risk distribution at specific time intervals. Moreover, the visualized weights estimated using the risk model, and the structure of the routine surveillance network, represent the transitional complexities emerging from ever-changing regional endemic situations.

Migration and HIV in Nepal

Nepal has been experiencing an increasing volume of internal and international migration as well as an increasing incidence of the reported statistics of Human Immuno-deficiency Virus (HIV). There was a well established migration stream from western to eastern along the hills before 1950s.Thereafter, the migration stream changed from the highlands to the lowlands after 1950s with a success of malaria eradication programme in tarai (lowlands) region. In contrast, the recent migration stream seems a reverse direction from the lowlands to the highlands in accordance with the census figure of 2011. The flow of migration direction (south-north) is generally figured out to political disorder/strike in the tarai region, however, further research is needed to find out reasons of directional change in inter-regional migration. Likewise, proportion of people emigrating to India has remarkably declined to 37 percent in the 2011 census while comparing the former 2001 census in which more than 75 percent of emigrants had made their destination to India. Nepalese emigrants are more likely to have greater economic opportunities in other countries rather than in India these days. Prevalence of HIV and AIDS [Acquired Immunodeficiency Syndrome] has been increasing over the years, irrespective of migration direction and destination at both internal and international levels.Janapriya Journal of Interdisciplinary Studies, Vol. 5 (December 2016), page: 102-113

In vitro sensitivity to antimalarial drugs and polymorphisms in Pfg377 gene in Plasmodium falciparum field isolates from Mewat, India

The malaria infection is the interplay of several complex factors, among which drug resistance and gametocyte biology are the crucial ones. Measurements of the drug sensitivity assays and prevalence of gametocyte genes play a major role in malaria eradication programmes. The purpose of this study was to assess the current drug sensitivity profile in the field isolates and type the Pfg377 gene. In vitro drug sensitivity assay was used to assess the susceptibility of Plasmodium falciparum field isolates collected from Mewat (Haryana), located in Northern region of India to four anti-malarial drugs. The inhibitory concentrations (IC50) for the four drugs viz Chloroquine (CQ), Artesunate (AS), Sulphadoxine (SD) and Pyrimethamine (PYR) were in the range of 10.11–113.2, 2.26–4.08, 13.31–43.91 and 0.76–4.91 nM respectively in the evaluated 25 field isolates. The Pfg377 allele typing in the 26 field isolates revealed different types of haplotypes (A, B, C and D) varying by the size and number of repeats and deletions. The Pfg377 allelic types in the cryopreserved and adapted isolates of P. falciparum were compared to determine the parasite lines in them. The allele types or presence of different clones in the same sample could not be correlated significantly with resistance to any of the four drugs tested in the study. Our study revealed different drug sensitivity profiles of field isolates from Mewat region and allele typing of Pfg377 gene revealed different haplotypes of field isolates were circulating in parasite population.

The Hitchhiking Parasite: Why Human Movement Matters to Malaria Transmission and What We Can Do About It

The failure of the Global Malaria Eradication Program (GMEP) during the 1960s highlighted the relevance of human movement to both re-introducing parasites in elimination settings and spreading drug-resistant parasites widely. Today, given the sophisticated surveillance of human movement patterns and key traveler groups, it is hoped that interventions can be implemented to protect and treat travelers, prevent onward transmission in low transmission settings, and eliminate sources of transmission, including sources of drug-resistant parasites.

Malaria Vector Based VIMTS: Challenges and Future

Malaria, AIDS and tuberculosis are considered as the important infectious diseases in the world. Malaria has a close relationship with the climate and life style of the human. Therefore, malaria is known as the disease of the poor countries. With regards to its importance, WHO invited scientists with different specialties for programming the second global malaria eradication program? The recommendation of the vaccine consultative group was development of the vaccines that interrupt malaria transmission (VIMTs). VIMTs are composed of different type of vaccines which vector based TBVs are one of them. Vector based TBVs have advantages in compare other type VIMTs such as impact on the parasite life cycle and mosquito fitness simultaneously. Therefore, targeting the vector and parasite antigens simultaneously can be considered as a robust tool to reach the aim of global malaria eradication program.

Cost Analysis of Insecticide Spraying For Malaria Control In A Terai District Of Eastern Nepal

Background: Malaria is one of the public health problems in Nepal. It is estimated that 25% of population of Nepal are infected by malaria at any time. Malaria control program was first initiated in 1954 with support of USAID through the Insect Born Disease Control Program. This program was changed into Malaria Eradication Program in 1958. The program was reverted to control program in 1978.Objective: The objective of this study was to estimate the cost of insecticide spraying from the provider’s perspective in a Terai district of eastern Nepal.Methods: Morang District of eastern Terai was purposively selected. A pre-tested interview was used to collect data from program managers and government officers in the Malaria Control Program. The main categories of variables were manpower, insecticide, pump and others.Results: The cost for indoor residual spraying per person protected was calculated as Rs.24.70 (US$0.31). This cost was for one cycle and there were two cycles in a year. So the cost per year was Rs.49.40 (US$0.62). The cost per household was calculated as Rs. 129.56 (US$1.65) per cycle and Rs.259.12 and US$3.30 per year for residual spraying.Conclusion: In this cost analysis of indoor residual spraying, the cost per household per year was found Rs. 259.12 and US$3.30. The cost calculated per person protected per year was Rs. 49.40 and US$0.62. This analysis would be more complete if a comparative study of both costs and effectiveness of various vector control measures are undertaken in Nepal.Health Renaissance 2014;12(3): 175-179

Trends in US President's Malaria Initiative-funded indoor residual spray coverage and insecticide choice in sub-Saharan Africa (2008-2015): urgent need for affordable, long-lasting insecticides.

This article reports the changing pattern of US President’s Malaria Initiative-funded IRS in sub-Saharan Africa between 2008 and 2015. IRS coverage in sub-Saharan Africa increased from <2 % of the at-risk population in 2005, to 11 % or 78 million people in 2010, mainly as a result of increased funding from PMI. The scaling up of IRS coverage in sub-Saharan Africa has been successful in several epidemiological settings and contributed to reduced malaria transmission rates. However, the spread and intensification of pyrethroid resistance in malaria vectors led many control programmes to spray alternative insecticides. Between 2009 and 2013, pyrethroid spraying decreased from 87 % (13/15) of PMI-funded countries conducting IRS to 44 % (7/16), while bendiocarb use increased from 7 % (1/15) to 56 % (9/16). Long-lasting pirimiphos-methyl CS received WHOPES recommendation in 2013 and was scheduled to be sprayed in 85 % (11/13) of PMI-funded countries conducting IRS in 2015. The gradual replacement of relatively inexpensive pyrethroids, firstly with bendiocarb (carbamate) and subsequently with pirimiphos methyl CS (organophosphate), has contributed to the downscaling of most PMI-funded IRS programmes. Overall, there was a 53 % decrease in the number of structures sprayed between years of peak coverage and 2015, down from 9.04 million to 4.26 million structures. Sizeable reductions in the number of structures sprayed were reported in Madagascar (56 %, 576,320–254,986), Senegal (64 %, 306,916–111,201), Tanzania (68 %, 1,224,095–389,714) and Zambia (63 %, 1,300,000–482,077), while in Angola, Liberia and Malawi PMI-funded spraying was suspended. The most commonly cited reason was increased cost of pesticides, as vector resistance necessitated switching from pyrethroids to organophosphates. There are worrying preliminary reports of malaria resurgence following IRS withdrawal in parts of Benin, Tanzania and Uganda. The increase in malaria cases following the end of the Global Malaria Eradication Programme in 1969 highlights the fragility of such gains when control efforts are weakened. At present there are several countries reliant on organophosphates and carbamates for IRS, and increasing incipient resistance is a serious threat that could result in IRS no longer being viable. A portfolio of new cost-effective insecticides with different modes of action is urgently needed.

Health Inequalities, Public Sector Involvement and Malaria Control in Cambodia

Cambodia is constructing a broad partnership to guide the delivery of public health services in a context of historical anarchy in the health sector and of contemporary political obstacles. Ironically, the conditions of this partnership undermine the sovereignty of the national programme and hinder the ability of the government to provide comprehensive services. National authorities have given in to the pressure of international funding agencies to adopt approaches characterized by verticalization, multicentred interventions, volunteerism and private partnership. The malaria eradication programme is an example of how the disjointed strategy of combining various interventions can lead to increasing spatial and social health inequalities. In addition, the Cambodian government is often overburdened in trying to manage a multitude of frequently incoherent external interventions. The criteria for efficient delivery reveal an unsustainable national public health vision. Local planners should reconsider the parameters under which they engage with external parties and shore up the autonomy of their decision-making.

Current implications of past DDT indoor spraying in Oman

In Oman, DDT was sprayed indoors during an intensive malaria eradication program between 1976 and 1992. DDT can remain for years after spraying and is associated with potential health risk. This raises the concern for human exposure in areas where DDT was used for indoor spraying. Twelve houses in three regions with a different history of DDT indoor spraying were chosen for a sampling campaign in 2005 to determine p,p′-dichlorodiphenyltrichloroethane (p,p′-DDT), p,p′-dichlorodiphenyldichloroethylene (p,p′-DDE) and p,p′-dichlorodiphenyldichloroethane (p,p′-DDD) levels in indoor air, dust, and outdoor soil. Although DDT was only sprayed indoor, p,p′-DDT, p,p′-DDE and p,p′-DDD were also found in outdoor soil. The results indicate that release and exposure continue for years after cessation of spraying. The predicted cancer risk based on concentrations determined in 2005, indicate that there was still a significant cancer risk up to 13 to 16years after indoor DDT spraying. A novel approach, based on region-specific half-lives, was used to predict concentrations in 2015 and showed that more than 21years after spraying, cancer risk for exposure to indoor air, dust, and outdoor soil are acceptable in Oman for adults and young children. The model can be used for other locations and countries to predict prospective exposure of contaminants based on indoor experimental measurements and knowledge about the spraying time-schedule to extrapolate region-specific half-lives and predict effects on the human population years after spraying.

2015: The beginning of the end of the war against malaria

In May 2015 the 62th World Health Assembly formulated a global malaria strategy for 2016-2030 aiming to “reduce the global disease burden by 40% by 2020, and by at least 90% by 2030. It also aims to eliminate malaria in at least 35 new countries by 2030”.(1) As a reminder, it was 60 years ago that the Eighth World Health Assembly decided in 1955 to shift from malaria control to malaria eradication, with the aim to make many areas of free of malaria “within 10 to 15 years”.(2) This has yet to be accomplished in many malaria endemic countries such as Indonesia, where the earliest program was the malaria eradication program of 1959, evolving into the malaria control program, the roll-back malaria program, and finally in 2012 into the malaria elimination program.(3) In view of the ever-present insecticideresistance

Insight into Malaria Transmission and Control in Endemic Areas

The global effort of malaria control is in line with the one world one health concept, but then a globally defined (one-size-fits-all) malaria control strategy would be inefficient. A model was used to examine the likely impact of malaria parasite interventions for a steady state regional control program in endemic areas. Assumptions varied about two targeted epidemiologic control points on the basic reproductive number, Ro, which is affected by different factors and upon which the status of malaria in any community will depend. For any effective malaria control and eradication program, environmental and socio-economic factors should also be considered.