Scale-up of integrated malaria vector control: lessons from Malawi.

Abstract:

PROBLEM:Indoor residual spraying and long-lasting insecticidal nets (LLINs) are key tools for malaria vector control. Malawi has struggled to scale up indoor residual spraying and to improve LLIN coverage and usage. APPROACH:In 2002, the Malawian National Malaria Control Programme developed guidelines for insecticide treated net distribution to reach the strategic target of at least 60% coverage of households with an LLIN. By 2005, the target coverage was 80% of households and the Global Fund financed the scale-up. The US President's Malaria Initiative funded the indoor residual spraying intervention. LOCAL SETTING:Malawi's entire population is considered to be at risk of malaria. Poor vector control, insecticide resistance in malaria vectors and insufficient technical and financial support have exacerbated the malaria burden. RELEVANT CHANGES:Between 2002 and 2012, 18 248 206 LLINs had been distributed. The coverage of at least one LLIN per household increased from 27% (3689/13 664) to 58% (1974/3404). Indoor residual spraying coverage increased from 28 227 to 653 592 structures between 2007 and 2011. However, vector resistance prompted a switch from pyrethroids to organophosphates for indoor residual spraying, which increased the cost and operations needed to be cut back from seven to one district. Malaria cases increased from 2 853 315 in 2002 to 6 748 535 in 2010, and thereafter dropped to 4 922 596 in 2012. LESSONS LEARNT:A single intervention-based approach for vector control may have suboptimal impact. Well-coordinated integrated vector management may offer greater benefits. A resistance management plan is essential for effective and sustainable vector control. PROBLÈME:La pulvérisation d’insecticides à effet rémanent à l’intérieur des habitations et l'utilisation de moustiquaires à imprégnation durable (MID) sont des mesures clés dans la lutte antivectorielle contre le paludisme. Mais le Malawi a eu du mal à intensifier les interventions de pulvérisation intradomiciliaire d'insecticides et à améliorer la protection par des MID et leur utilisation. APPROCHE:En 2002, le programme national de lutte contre le paludisme au Malawi a conçu des directives pour distribuer des moustiquaires imprégnées d'insecticides en vue d'atteindre l'objectif stratégique d'au moins 60% des ménages utilisant une MID. En 2005, la couverture ciblée est passée à 80% des ménages, et le Fonds mondial a financé l'intensification de la campagne. Les interventions de pulvérisation intradomiciliaire d'insecticides à effet rémanent ont été financées par l'Initiative du Président des États-Unis contre le paludisme. ENVIRONNEMENT LOCAL:On considère que l'intégralité de la population du Malawi est exposée au risque palustre. Mais une lutte antivectorielle déficiente, le développement d'une résistance aux insecticides chez les vecteurs du paludisme et un soutien technique et financier insuffisant ont aggravé la charge du paludisme. CHANGEMENTS SIGNIFICATIFS:Entre 2002 et 2012, 18 248 206 MID ont été distribuées. L'utilisation d'au moins une MID dans chaque ménage est passée de 27% (3 689/13 664) à 58% (1 974/3 404). La couverture par pulvérisation intradomiciliaire à effet rémanent est passée de 28 227 à 653 592 structures entre 2007 et 2011. Néanmoins, la résistance des vecteurs aux insecticides a nécessité d'abandonner les pyréthrinoïdes au profit des organophosphorés pour les pulvérisations intradomiciliaires, ce qui a majoré les coûts et nécessité de limiter les interventions à un seul district, sur les sept initialement prévus. Les cas de paludisme ont augmenté de 2 853 315 en 2002 à 6 748 535 en 2010 avant de chuter à 4 922 596 en 2012. LEÇONS TIRÉES:En matière de lutte antivectorielle, une approche fondée sur un seul type d'intervention peut avoir des effets sous-optimaux. Une gestion antivectorielle intégrée correctement coordonnée pourrait être plus bénéfique. Un plan de gestion de la résistance est essentiel pour une lutte antivectorielle efficace et durable. SITUACIÓN:La fumigación de interiores con acción residual y los mosquiteros tratados con insecticidas de larga duración (LLIN, por sus siglas en inglés) son herramientas importantes para el control de vectores de la malaria. Malawi ha luchado por aumentar la fumigación de interiores con acción residual y por mejorar la cobertura y uso de los LLIN. ENFOQUE:En 2002, el Programa de Control Nacional contra la Malaria de Malawi desarrolló directrices para la distribución de mosquiteros tratados con insecticidas con el fin de alcanzar el objetivo estratégico de que como mínimo el 60% de los hogares dispusieran de un LLIN. En 2005, la cobertura objetivo era un 80% de los hogares y el Fondo Mundial financió la ampliación. La Iniciativa del Presidente de los Estados Unidos de América contra la Malaria financió la intervención de la fumigación de interiores con acción residual. MARCO REGIONAL:Se considera que toda la población de Malawi corre el riesgo de sufrir malaria. Los escasos controles de vectores, la resistencia de los insecticidas en los vectores de la malaria y el apoyo técnico y financiero insuficiente han multiplicado las tasas de malaria. CAMBIOS IMPORTANTES:Entre 2002 y 2012, se han distribuido 18 248 206 LLIN. La cobertura de al menos un LLIN por hogar ha aumentado de un 27% (3 689/13 664) a un 58% (1 974/3 404). La cobertura de fumigación de interiores con acción residual ha aumentado de 28 227 a 653 592 estructuras entre 2007 y 2011. No obstante, la resistencia de vectores ha acelerado un cambio de piretroides a organofosfatos para la fumigación de interiores con acción residual, lo que ha aumentado el coste y las operaciones necesarias para reducir de siete distritos a uno. Los casos de malaria aumentaron de 2 853 315 en 2002 a 6 748 535 en 2010, y luego cayeron a 4 922 596 en 2012. LECCIONES APRENDIDAS:Un enfoque basado en una única intervención para el control de vectores puede tener un impacto subóptimo. Una gestión integrada de vectores bien coordinada puede ofrecer mayores beneficios. Es fundamental desarrollar un plan de gestión de resistencia para lograr un control de vectores eficaz y sostenible. المشكلة:تتمثل الوسائل الرئيسية لمكافحة ناقلات مرض الملاريا في رش الأماكن المغلقة بمبيدات حشرية تدوم طويلاً واستعمال الناموسيات المعالجة بمبيدات حشرية مديدة المفعول (LLIN). ناضلت ملاوي من أجل زيادة معدل رش الأماكن المغلقة بمبيدات حشرية تدوم طويلاً لتحسين مدى توفير الناموسيات من نوع LLIN واستعمالها. الأسلوب:تم العمل في عام 2002 بالبرنامج الوطني لمكافحة الملاريا في ملاوي على وضع مبادئ توجيهية لتوزيع الناموسية المعالجة بمبيد حشري سعيًا إلى تحقيق الهدف الاستراتيجي الرامي إلى توفير الناموسيات بما يغطي 60‏% على الأقل من الدور. وبلغت نسبة التغطية 80% من الدُور مع حلول عام 2005، وقد قدّم الصندوق العالمي التمويل اللازم لرفع تلك النسبة. ووفرت مبادرة الرئيس الأمريكي لمكافحة الملاريا التمويل اللازم لتنفيذ التدخل المتعلق برش الأماكن المغلقة بمبيدات حشرية تدوم طويلاً. المواقع المحلية:تم اعتبار سكان ملاوي بأكملهم من المعرضين لخطر الإصابة بمرض الملاريا، فقد أدى انخفاض مستوى مكافحة ناقلات المرض، ومقاومة ناقلات مرض الملاريا للمبيدات الحشرية، ونقص الدعم المالي والتقني إلى تفاقم عبء مرض الملاريا. التغيرات ذات الصلة:تم توزيع 18,248,206 من الناموسيات من نوع LLIN في الفترة بين عامي 2002 و2012. وقد ارتفع مستوى التغطية التي تهدف إلى توفير ناموسية واحدة على الأقل من نوع LLIN لكل منزل من 27‏% (3689/13,664) ليصل 58‏% (1974/3404). كما ارتفع مستوى التغطية التي تهدف إلى رش الأماكن المغلقة بمبيدات حشرية تدوم طويلاً من 28,227 منشأة ليصل إلى 653,592 منشأة في الفترة بين عامي 2007 و2011. وبالرغم من ذلك، كانت مقاومة ناقلات المرض للمبيدات دافعًا للتحول من استخدام مادة بيريثرويد إلى المركبات الفوسفاتية العضوية فيما يتعلق برش الأماكن المغلقة بمبيدات حشرية تدوم طويلاً، مما أدى إلى ارتفاع التكلفة وزيادة الإجراءات الواجب تقليلها من سبع مناطق ليقتصر على منطقة واحدة. وزادت حالات الإصابة بمرض الملاريا من 2,853,315 حالة في عام 2002 لتصل إلى 6,748,535 حالة في عام 2010، ومنذ ذلك الحين انخفض عدد الحالات ليصل إلى 4,922,596 حالة في عام 2012. الدروس المستفادة:إن اتباع أسلوب يعتمد على تدخل واحد لمكافحة ناقلات المرض قد يكون أثره دون الحد الأمثل. وقد تحقق الإدارة المتعلقة بناقلات المرض والتي تتسم بالتكامل وحسن التنسيق المزيد من المنافع. كما أن توفر خطة لإدارة مقاومة المبيدات أمر ضروري لتحقيق المكافحة الفعالة والمستمرة لناقلات المرض. 问题:室内滞留喷剂和长效驱虫蚊帐 (LLIN) 是控制疟疾媒介的重要工具。马拉维在推广室内滞留喷剂和提高长效驱虫蚊帐 (LLIN) 覆盖面和使用率方面困难重重。. 方法:2002 年,马拉维全国疟疾防治方案制定了一份指南,指导分发经过杀虫剂处理的蚊帐,以实现至少 60% 的住户拥有长效驱虫蚊帐 (LLIN) 的战略目标。到 2005 年,覆盖率目标为 80% 的住户,并且推广资金由全球基金会出资。 室内滞留喷剂干预由美国总统防治疟疾行动计划出资。. 当地状况:马拉维全体人口均面临疟疾的威胁。媒介控制水平差、疟疾媒介的抗药性以及技术和财政支持不足使得疟疾问题雪上加霜。. 相关变化:2002 年到 2012 之间,共分发了 18,248,206 件长效驱虫蚊帐 (LLIN)。每户至少一件长效驱虫蚊帐 (LLIN) 的覆盖率从 27% (3689/13 664) 增加到 58% (1974/3404)。2007 年到 2011 年之间,室内滞留喷剂覆盖率从 28, 227 户增加到 653, 592 户。但是,由于媒介的抗药性,必须使用有机磷酸酯类杀虫剂代替拟除虫菊酯进行室内滞留喷洒,这使得原计划用于 7 个地区的成本和运营减少至只能用于 1 个地区。从 2002 年到 2010 年,疟疾病例从 2,853,315 例增加到 6,748,535 例,然后,在 2012 年,降至 4,922,596 例。. 经验教训:单一的干预式媒介控制方法效果可能并不理想。相互协调的综合性媒介管理可能会取得更好的效果。抗药性管理计划是有效且可持续媒介控制的重中之重。. Проблема:Остаточное распыление инсектицидов в помещении и инсектицидные сетки длительного действия (ИСДД) являются основными способами борьбы с переносчиками малярии. В Малави были предприняты упорные попытки расширить масштаб применения остаточного распыления инсектицидов и улучшить охват населения ИССД и показатели их использования. Подход:В 2002 году Национальной программой Малави по борьбе с малярией были разработаны рекомендации по распространению сеток, обработанных инсектицидами, для достижения стратегической цели — как минимум 60%-го охвата домашних хозяйств ИСДД. К 2005 году программа ставила целью уже 80%-й охват и Глобальный фонд профинансировал такое расширение. Инициатива президента США по борьбе с малярией выделила средства на остаточное распыление инсектицидов в помещениях. Местные условия:Считается, что все население Малави входит в группу риска в отношении заболевания малярией. По причине неудовлетворительных результатов борьбы с переносчиками, устойчивости переносчиков малярии к инсектицидам и недостаточной технической и финансовой поддержки бремя малярии усилилось. Осуществленные перемены:В период с 2002 по 2012 год было распространено 18 248 206 ИСДД. Охват населения (по меньшей мере одной ИСДД на домашнее хозяйство) вырос с 27% (3689 из 13 664 домохозяйств) до 58% (1974 из 3404 домохозяйств). Число опрыскиваемых помещений возросло с 28 227 до 653 592 в период с 2007 по 2011 год. Однако устойчивость, выработанная переносчиками, обусловила необходимость использовать для остаточного распыления органофосфаты вместо пиретроидов, из-за чего увеличилась стоимость обработки и охват соответствующими операциями пришлось сократить с семи округов до одного. Число случаев заболевания малярией выросло с 2 853 315 в 2002 году до 6 748 535 в 2010 году. Затем это количество сократилось до 4 922 596 случаев в 2012 году. Выводы:Подход к борьбе с переносчиками заболевания, основанный на одном способе вмешательства, возможно, не позволил добиться оптимального эффекта. Большую пользу могут принести качественно скоординированные мероприятия по комплексной борьбе с переносчиками заболевания. Для эффективной и устойчивой борьбы с переносчиками заболевания необходим план противодействия устойчивости к инсектицидам.

authors

Chanda E,Mzilahowa T,Chipwanya J,Ali D,Troell P,Dodoli W,Mnzava AP,Ameneshewa B,Gimnig J

doi

10.2471/BLT.15.154245

subject

Has Abstract

pub_date

2016-06-01 00:00:00

pages

475-80

issue

6

eissn

0042-9686

issn

1564-0604

pii

BLT.15.154245

journal_volume

94

pub_type

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    authors: Yugoslav Typhoid Commission.

    更新日期:1962-01-01 00:00:00

  • Suppressant effect of human or equine rabies immunoglobulins on the immunogenicity of post-exposure rabies vaccination under the 2-1-1 regimen: a field trial in Indonesia. MAS054 Clinical Investigator Group.

    abstract::WHO's reference protocol for post-exposure rabies vaccination advises five intramuscular injections on days 0, 3, 7, 14, and 30; in addition, rabies immunoglobulins (RIG) must be given to serious cases of exposure (grade III severity). Some studies indicate that these immunoglobulins suppress the immunogenicity of rab...

    journal_title:Bulletin of the World Health Organization

    pub_type: 临床试验,杂志文章,多中心研究

    doi:

    authors: Lang J,Simanjuntak GH,Soerjosembodo S,Koesharyono C

    更新日期:1998-01-01 00:00:00

  • The effect of metrifonate on Brugia pahangi infections in domestic cats.

    abstract::Metrifonate, an organophosphorus compound, caused a decline in the number of microfilariae in domestic cats experimentally infected with Brugia pahangi. It was found that the drug was active against both microfilariae and macrofilariae, but probably its greatest effect was on the macrofilarial stages. It is suggested ...

    journal_title:Bulletin of the World Health Organization

    pub_type: 杂志文章

    doi:

    authors: Denham DA,Ponnudurai T,Nelson GS,Guy F,Rogers R

    更新日期:1971-01-01 00:00:00

  • Development of vaccines against cholera and diarrhoea due to enterotoxigenic Escherichia coli: memorandum from a WHO meeting.

    abstract::This Memorandum summarizes current knowledge on the epidemiology of cholera and diarrhoea due to enterotoxigenic Escherichia coli (ETEC) and outlines the results of recent research to develop an effective oral vaccine against cholera. The meeting reviewed current research on the protective antigens of ETEC and made a ...

    journal_title:Bulletin of the World Health Organization

    pub_type: 杂志文章

    doi:

    authors:

    更新日期:1990-01-01 00:00:00

  • Users of rehabilitation services in 14 countries and territories affected by conflict, 1988-2018.

    abstract:Objective:To analyse the demographic and clinical characteristics of people attending physical rehabilitation centres run or supported by the International Committee of the Red Cross in countries and territories affected by conflict. Methods:Of 150 such rehabilitation centres worldwide, 38 use an electronic patient ma...

    journal_title:Bulletin of the World Health Organization

    pub_type: 杂志文章

    doi:10.2471/BLT.19.249060

    authors: Barth CA,Wladis A,Blake C,Bhandarkar P,O'Sullivan C

    更新日期:2020-09-01 00:00:00

  • A cross-sectional community study of post-traumatic stress disorder and social support in Lao People's Democratic Republic.

    abstract:OBJECTIVE:To estimate post-traumatic stress disorder (PTSD) symptoms in those injured and not injured by landmines or unexploded ordnance (UXO) in rural Lao People's Democratic Republic and to determine whether the perception of social support was associated with PTSD symptom severity. METHODS:A community survey was c...

    journal_title:Bulletin of the World Health Organization

    pub_type: 杂志文章

    doi:10.2471/BLT.12.115311

    authors: Southivong B,Ichikawa M,Nakahara S,Southivong C

    更新日期:2013-10-01 00:00:00

  • Providing family planning services to women in Africa.

    abstract::Access to contraceptives in Africa has not increased at the same pace as elsewhere in the world. Some African nations are investing in family planning services to reduce fertility rates, improve economic development and their population's health. Tatum Anderson reports. ...

    journal_title:Bulletin of the World Health Organization

    pub_type: 新闻

    doi:10.2471/BLT.17.020917

    authors:

    更新日期:2017-09-01 00:00:00

  • Antileptospiral agglutinins produced in rabbits.

    abstract::Agglutinating antibodies produced in an adult rabbit in response to intravenous injections of live Leptospira sp. (serotype biflexa, strain Waz), consisted of a 19S component (present at day 6 after inoculation) and a 7S component (present at day 6 after inoculation). Both 19S and 7S antibodies persisted in the serum ...

    journal_title:Bulletin of the World Health Organization

    pub_type: 杂志文章

    doi:

    authors: Graves S,Faine S

    更新日期:1970-01-01 00:00:00

  • International corporate tax avoidance and domestic government health expenditure.

    abstract:Objective:To compare estimated losses from international corporate tax avoidance in individual countries and domestic government health expenditure, with reference to the annual threshold of 86 United States dollars (US$) per capita required to achieve universal health coverage. Methods:I obtained and compared estimat...

    journal_title:Bulletin of the World Health Organization

    pub_type: 杂志文章

    doi:10.2471/BLT.18.220897

    authors: O'Hare BA

    更新日期:2019-11-01 00:00:00

  • Chronic arsenic toxicity from drinking tubewell water in rural West Bengal.

    abstract::Hepatic damage caused by chronic exposure to arsenic has been frequently described. Here we report on 13 patients from West Bengal, India, who consumed large amounts of arsenic in drinking water. An epidemiological investigation of the study area showed evidence of chronic arsenical dermatosis and hepatomegaly in 62 (...

    journal_title:Bulletin of the World Health Organization

    pub_type: 杂志文章

    doi:

    authors: Guha Mazumder DN,Chakraborty AK,Ghose A,Gupta JD,Chakraborty DP,Dey SB,Chattopadhyay N

    更新日期:1988-01-01 00:00:00

  • Mortality from neglected tropical diseases in Brazil, 2000-2011.

    abstract:OBJECTIVE:To describe mortality from neglected tropical diseases (NTDs) in Brazil, 2000-2011. METHODS:We extracted information on cause of death, age, sex, ethnicity and place of residence from the nationwide mortality information system at the Brazilian Ministry of Health. We selected deaths in which the underlying c...

    journal_title:Bulletin of the World Health Organization

    pub_type: 杂志文章

    doi:10.2471/BLT.15.152363

    authors: Martins-Melo FR,Ramos AN Jr,Alencar CH,Heukelbach J

    更新日期:2016-02-01 00:00:00

  • Active surveillance for congenital rubella syndrome in Yangon, Myanmar.

    abstract:OBJECTIVE:Rubella vaccine is not included in the immunization schedule in Myanmar. Although surveillance for outbreaks of measles and rubella is conducted nationwide, there is no routine surveillance for congenital rubella syndrome (CRS). Therefore, we organized a study to assess the burden of CRS. METHODS:From 1 Dece...

    journal_title:Bulletin of the World Health Organization

    pub_type: 杂志文章

    doi:10.2471/blt.05.022814

    authors: Thant KZ,Oo WM,Myint TT,Shwe TN,Han AM,Aye KM,Aye KT,Moe K,Thein S,Robertson SE

    更新日期:2006-01-01 00:00:00

  • Medico-legal aspects of medical certification of cause of death.

    abstract::This paper deals with the medico-legal aspects of death certification, the inadequate attention accorded to these aspects in most of the present death certificate forms, and the consequences resulting from this circumstance. A description is also given of the revision of the national system of medical certification of...

    journal_title:Bulletin of the World Health Organization

    pub_type: 杂志文章

    doi:

    authors: ISOTALO A

    更新日期:1960-01-01 00:00:00

  • The yellow fever situation in Africa.

    abstract::WHILE THE TWENTIETH CENTURY HAS PRODUCED GREAT DEVELOPMENTS IN THE EPIDEMIOLOGY OF YELLOW FEVER AND IN TECHNIQUES FOR ITS CONTROL IN URBAN AREAS, THE ESSENTIAL METHOD OF CONTROL HAS NOT CHANGED: it is still the elimination of the urban vector, Aëdes aegypti. The aim of those responsible for yellow fever control in Afr...

    journal_title:Bulletin of the World Health Organization

    pub_type: 杂志文章

    doi:

    authors: MAHAFFY AF

    更新日期:1954-01-01 00:00:00