O centro de saude como unidade-base do programa de controle da malaria : parte I analise da situacao da malariaLuis Almeida Franco

Endemic malaria continues to be one of the major public health problems in Mozambique; lack of information impedes monitoring of preventive measures and thus an improvement in malaria control. In this article; we suggest the use of health units; in particular health centres; as basis for the information system of the national malaria control programme. Health centres should be selected on the basis of their capacity to carry out certain tasks; principally reliable microscopy; so that the quality of information collected can be guaranteed. The health centre should act as a sentinel site; with the responsibility to collect and organize standardized information about malaria in its catchment area. Together; these sentinel sites will constitute a basis for the future national malaria surveillance system. To test the practicability of this idea; a project was implemented in the Jose Macamo Health Centre in Maputo City. It was designed to obtain more systematic information about the clinical and epidemiological features of malaria that is most important for improving malaria control in Mozambique. The project lasted for two years from July 1991. Through the establishment of a malaria clinic; the clinical and epidemiological features of malaria in the centre's catchment area were studied. The results will be published subsequently. In this article; we present an outline of the features of endemic malaria in Maputo City and the principal factors influencing the disease

Dinamica da malaria numa area de saude da Cidade de Maputo : parte II

The authors present the results of study of the dynamics of endemic malaria in the catchment area of Jose Macamo Health Centre. They established a malaria clinic in this centre; integrated in a pilot project designed to test malaria control using health centres as base. Data was collected in this clinic from July 1993; covering two periods in which the epidemiological characteristics of malaria were determined by different rainfall patterns. In the first year; there was a severe drought; despite this; a focal outbreak occurred in January 1992 in suburbs situated along the drainage system of the influence valley. Through data collected on residence of patients with malaria; we detected a greater incidence in some suburbs and; within these suburbs; areas with differing incidences. An environmental survey in these areas showed numerous breeding sites of the malaria vector. These were small wells; dug by the population to obtain water for their fields. A parasitological survey in February 1992 showed a high prevalence (38) of malaria in the same areas; confirming a relationship between breeding sites and prevalence rates. A new peak occurred later in April-May; coinciding with a period of heavy rainfall. During the first year; 6011 patients with malaria were observed; 1.102 in the period of low transmission (July-December 1991) and 4.909 from January to June; 1992. In the second year; the pattern was very different; above average rainfall gave rise to an epidemic which covered a larger area. 23.028 patients were observed in this period; of whom 17.151 during the higher transmission period. The geographic transmission of the reported cases was higher during the 2 study period; but most patients came from suburbs adjoining the health centre. We analyse the possible causes of this epidemic; principally the relationship between the seasonal characteristics of endemic malaria and the immunity of the population. We consider that the implementation of a similar system of data collection in other health centres with good quality microscopy could; in the future; permit the development of efficient epidemiological surveillance for endemic malaria