Vector control interventions for visceral leishmaniasis elimination initiative in South Asia, 2005-2010.

The Visceral Leishmaniasis (VL) Elimination Initiative in the Indian subcontinent was launched in 2005 as a joint effort between the governments in the Region (India, Nepal and Bangladesh) and the World Health Organization (WHO). The objective is to reduce the annual VL incidence below 1/10,000 inhabitants by 2015 based on detection and treatment of VL cases and vector control. We present here a review of studies published in the period 2005-2010 on the efficacy of different tools to control Phlebotomus argentipes. The review indicates that the current indoor residual spraying (IRS) and novel vector control methods mainly insecticide treated nets (ITN) have low effectiveness for several reasons. Efforts to improve quality of IRS operations and further research on alternative and integrated vector control methods need to be promoted to reach the VL elimination target by 2015.

Use and Effects of Malaria Control Measures in Pregnancy in Lagos, Nigeria

In Nigeria, malaria causes up to 11% of maternal mortality. Our main aim was to find out the most common mosquito control measures employed by the pregnant women in Lagos and their effects on malaria infection. The study was carried out over a period of 6 months during which trained interviewers administered questionnaires to 400 pregnant women. The prevalence of malaria was 8.4%. There was no significant association between the prevalence of malaria and age, level of education, or occupation of the participants. Pregnant women in the age range 26-30 had the mean parasite density (409.9+/-196.80). Insecticide spray (32.8%), mosquito coil (27.5%), and insecticide-treated nets (ITN) (15.5%) were the major mosquito control measures employed by the participants while the prevalence of infection among them were 2.3%, 6.2%, and 3.2%, respectively (P<0.05). Only 18.3% of the women had taken more than one dose of intermittent preventive treatment (IPT), while another 11.8% had taken a single dose. The infection rate among them was 4.1% and 6.4%, respectively. Malaria prevalence was highest among those who had not received any dose of IPT (10%). This study showed that the use of ITN and IPT among the pregnant women were still unacceptably low. It also showed that the use of insecticide spray which was the most common malaria control measure adopted by the participants was effective despite the fact that it is not a National Malaria Control Policy. We recommend that a sustained integrated mosquito management and public education should be strengthened in Nigeria.

Knowledge, attitudes and practices about malaria in an urban community in south-western Nigeria.

Background & objectives: Oyo is an urban community in Oyo state of south-western Nigeria and it is holoendemic for malaria. Information was collected on the knowledge, attitudes and practices (KAP) of inhabitants of Oyo town in relation to malaria. Methods: A cross-sectional survey of 192 households with the aid of self- or researcher-administered questionnaires was carried out to identify factors associated with the disease in the area. Results: About 93.2% (n=192) of respondents recognized mosquito bites as the cause of malaria. A small proportion of children (13.7%) and adults (5.3%) received prompt treatment; however, more adults (65.8%) got correct dosage of antimalarials than children (38.7%). About 90% of suspected malaria cases in children and adults were first treated at home with local herbs or drugs, purchased from medicine stores. The use of insecticide-treated nets (ITNs) was scarce as only 16.7% of households used them for their children. Other reported malaria prevention methods include the use of insecticides (79.7%) and herbs (44.3%). In all, 17 (8.9%) of households did not have screening nets on their windows and 6.3% of 175 households with screening nets on their windows had rusty and torn nets. The level of education of heads of households was a strong predictor of positive malaria-related KAP. Window types and environmental hygiene were associated with prevalence of malaria in households. Interpretation & conclusion: The control of malaria cannot be achieved without full involvement of the affected communities; the available tools for control can only be effective and sustainable if the local communities are mobilized and empowered with knowledge. It is suggested that health education campaigns be intensified; chemist shop-keepers and mothers being important target groups.

Insecticide treated nets, antimalarials and child survival in India.

Malaria has been a complex public health problem affecting mainly the poor and the rural communities in India. Insecticide treated nets (ITN) and antimalarials are the two proven interventions for prevention and control of malaria. ITN has been amply demonstrated to be an effective intervention to protect children from malaria, and in preventing deaths due to falciparum malaria. Antimalarials are a therapeutic intervention for management of malaria, and prevention of complications due to Plasmodium falciparum infection. However, implementation of these interventions is fraught with problems of complex and multidimensional nature at the periphery. These can be addressed by optimizing the use of the 2 interventions, the insecticide treated nets and antimalarials, for area specific application and country specific needs, determined by the eco-epidemiological diversity of malaria in India. This article reviews the significant role of ITN in reducing child mortality, and the judicious use of antimalarials in the management of malaria patient, and the problems associated with the use of these interventions in protecting children against malaria in India.

Community practices of using bed nets & acceptance & prospects of scaling up insecticide treated nets in north-east India.

Background & objectives: The National Vector Borne Disease Control Programme (NVBDCP), India has been promoting and scaling up the use of insecticide-treated nets (ITNs) in the tribal dominated malarious areas of north-east India. But, information on sleeping habits, bed net ownership and use practices, and feedback of communities in ITN - targeted areas is needed for formulating a strategic framework for upscaling the coverage of ITNs. We carried out a community-based cross-sectional survey in select areas of Nagaland and Mizoram (where ITNs were introduced) along with Assam (where ITNs were not introduced) to know the response of community. Methods: Following large scale introduction of ITNs during 2001-2002 in the north-eastern States of Nagaland and Mizoram by NVBDCP, India, a cross-sectional community-based survey was undertaken in April-May, 2003 covering 435 households of Nagaland and 464 households in Mizoram, using a structured questionnaire, to assess the demographic variables relevant to bed net use, bed net washing practices and acceptability of ITNs etc., for upscaling the coverage of ITNs in the surveyed communities. A total of 448 households in 8 villages in a non-ITN PHC area of Assam were served as the control area. Results: The average bet net usage per family (2.01 to 2.65). Bed net use was mostly seasonal in Nagaland where a majority (65.1-78.7%) used bed nets only during summers and monsoon as compared to the year round use in Mizoram (83.5%) and Assam (78.9%). Frequent washing of nets was most common in Assamese communities with 77 per cent households washing their nets at least once in a month. More than two third users favoured use of ITNs over the conventional indoor residual spray of DDT for malaria control. Interpretation & conclusion: ITNs are widely acceptable in the user communities and a demand for ITNs is evident in the non-user communities of north-east India. Approach of treating community owned nets through an efficient service delivery mechanism will be a viable option for upscaling the ITN coverage.

BEDNET USE AND INFLUENTIAL FACTORS OF TWO ETHNICAL MINORITIES AT CHINA-MYANMAR BORDER / 中国血吸虫病防治杂志

Objectives To learn the bednet use and influential factors among Wa and Lahu ethnics,and further to explore feasible ways of promoting the use of bednets and insecticide-treated nets (ITNs). Methods Questionnaire surveys and statistical analysis with EpiInfo 2000 software package were carried out. Results Only did 2.8% [95% confidence intervals(95%CI):1.2%-5.4%] of Wa and 4.8 % (95%CI:2.8%-8.1%) of Lahu ethnic members use bednets frequently or sometimes. Bednets were not available for 67.7% (95% CI:62.0%-73.1%) of Wa and 59.7% (95% CI:53.1%- 66.1%) of Lahu ethnic peoples. Most people who had bednets did not often use them for anti-mosquitoes. Results of multivariate logistic regression confirmed significant correlation between bednet use and knowledge of malaria prevention. Conclusion The coverage and use rates are very low in the two ethnical minorities. Health education, communication and social marketing are the strategies for promoting the usage of bednet and ITNs.

Malaria Situation and Evaluation on the Control Effect in Henan Province during 1990-2005 / 中国寄生虫学与寄生虫病杂志

Objective To analyze malaria situation and evaluate the effect of control program in Henan Province during 1990-2005. Methods Data were collected and analyzed on the measures and effects of malaria control, vector surveillance, blood examination for cases with fever and serological surveillance in the province during 1990-2005. Results In the 16 years, a total of 802 700 people were given pre-transmission season treatment with chloroquine and primaquine for a radical cure of vivax malaria, chemoprophylaxis was given to 764 300 people at high risk during the transmission season, treatment or presumptive treatment was given to 43 891 cases. 11 216 100 cases with fever were tested and 11 213 (0.10%) were found positive accounting for 29.01% (11 213/338 654) of all malaria cases. A total of 1 332 800 bed nets were treated with insecticide and 1 999 300 people were protected in 1990-1992 and 1996-1999. 34 846 residents including pupils were tested with IFAT in 1990-2000 and 1149 (3.30%) were positive. The parasite rate amongst 71 234 local residents including pupils was 0.40% (286/71 234). The principal transmitting vectors were Anopheles sinensis and An.anthropophagus. The man-biting habit for An. sinensis and An.anthropophagus was 0.060 8 and 0.314 3 respectively, and the vectorial capacity of An.anthropophagus was 22.4 times higher than that of An.sinensis. In this period, 38 654 malaria cases were reported in the province and the annual malaria incidence was 2.62 per hundred thousand, the lowest annual incidence was in 1992 (0.37 per hundred thousand). 70.05% (27 076/38 654) of these malaria cases were from areas where An. anthropophagus was present. Conclusions In general, the malaria control activities have been effective and the epidemiological situation kept stable in Henan Province, although in some areas the situation is unstable and outbreak spots or focal epidemics occur.