[Malaria in the central highlands of Madagascar: control strategies]. / Paludisme sur les hautes terres centrales de Madagascar: stratégies de lutte.

The purpose of this article is to present data on malaria in the central highland plateaux of Madagascar and strategies to improve the national malaria control program. Use of rapid diagnosis strips, early home-based fever management with pre-packaged chloroquine treatment kits and proposed new therapeutic combination based on artemisinine are discussed for management of patients with high suspicion of malaria attack. Preventive measures including alternated targeted and full-house indoor spraying for vector control, use of insecticide-impregnated bednets, implementation of intermittent preventive treatment in risk groups, optimization of the epidemic early detection and warning system using the Lot Quality Assurance Sampling method for epidemiological investigation if the alert threshold is exceeded, and provision of rapid diagnosis strips are presented.

Paludisme sur les Hautes Terres Centrales de Madagascar : strategies de lutte

Le present article presente le paludisme sur les Hautes Terres Centrales de Madagascar et les strategies pour ameliorer les composantes du programme national de lutte contre le paludisme. Pour la prise en charge du patient suspect d'acces palustre; l'utilisation des bandelettes de diagnostic rapide; la prise en charge precoce a domicile par la chloroquine pre-emballee et les reflexions sur les nouvelles combinaisons therapeutiques a base d'artemisinine sont discutees. Pour les mesures de prevention; l'alternance des pulverisations intra domiciliaires ciblees et generalisees dans la lutte antivectorielle; l' utilisation de moustiquaires impregnees d'insecticides; le passage au traitement preventif intermittent pour les groupes a risque; l'amelioration du systeme de surveillance et d'alerte epidemique par l'utilisation de la methode de Lot Quality Assurance Sampling pour l'investigation epidemiologique en cas de depassement du seuil d'alerte et la mise a disposition des bandelettes de diagnostic rapide sont etudies

[Recent observations on the sensitivity to pyrethroids and DDT of Anopheles arabiensis and Anopheles funestus in the central Highlands of Madagascar; preliminary results on the absence of the kdr mutation in An. arabiensis]. / Données récentes sur la sensibilité d'Anopheles arabiensis et d'Anopheles funestus aux pyréthrinoïdes et au DDT sur les Hautes Terres Centrales de Madagascar--résultats préliminaires montrant une absence de la mutation kdr chez An. arabiensis.

Anopheles arabiensis and Anopheles funestus are the principal vectors of malaria on the central highlands of Madagascar. These two species of mosquito are directly or indirectly the targets of indoor insecticide spread. The survey of the susceptibility of these two vectors to insecticides is essential specifying for the anti-vectorial current directives and for the future programs. This paper describes: --the recent tests of susceptibility and the study of the knock-down effect of four pyrethroids (deltamethrin 0.50%, permethrin 0.250%, alpha-cypermethrin 0.025%, cyfluthrin 0.150%) and DDT 4% on An. arabiensis collected from December 2002 to May 2003 in three villages on the district of Tsiroanomandidy and in Alasora, a rural area near the capital, Antananarivo. --the susceptibility tests of An. funestus realised in Morafeno, against cyfluthrin 0.150%, deltaméthrin 0.050%, lambda-cyhalothrin 0.050% and DDT 4%. --the preliminary study of the kdr gene mutation, which might account for the pyrethrinoid and DDT resistance, of An. arabiensis in Alasora. The data indicate a decrease in the efficiency of alpha-cypermethrin 0.025% (Tkd99 = 21 mn) and of DDT 4% (Tkd99 = 191.5 mn) on An. arabiensis in Analamiranga. Nevertheless, the effectiveness of permethrin 0.250% has been notified. In Soanierana, alpha-cypermethrin 0.025% was effective against An. arabiensis, whilst the ineffectiveness of the DDT 4% (Tkd99 = 116 mn) in Andranonahoatra was observed. In Alasora, a fall in the effectiveness of alpha-cypermethrin 0.025% (Tkd99 = 21 mn) and the resistance to DDT 4% (Tkd99 = 6894 mn) was noted. No kdr mutation was detected on the kd gene of An. arabiensis resistant to the alpha-cypermethrin 0.025% and to DDT 4%, collected in Alasora. An. funestus collected in the district of Miandrivazo is susceptible to pyrethroids and to DDT. To conclude, in the Malagasy Central Highlands, An. arabiensis is ordinary sensitive to pyrethroid and poorly sensitive, or even resistant to DDT (as observed in Antananarivo plain). However, An. funestus remains sensitive to all tested insecticides; this observation is crucial because this anopheles vector is the first target of the campaigns of indoor spraying insecticides.

Impact of the malaria control campaign (1993-1998) in the highlands of Madagascar: parasitological and entomological data.

Malaria transmission in the central highlands of Madagascar was interrupted in the 1960s by a national control program that used DDT indoor spraying and mass treatment with chloroquine. At the end of the 1980s in this region, epidemic malaria reappeared. Italian health authorities provided technical assistance to the National Malaria Control Program since the beginning of the resurgence of malaria in the central highlands. Yearly residual house spraying performed for 5 years (1993-1998) and the availability of antimalarial drugs reduced malaria transmission to very low levels, with improvement in parasitologic and entomologic indexes. A significant reduction of malaria prevalence was observed in the villages located at altitudes of 1,000-1,500 m, corresponding to the stratum of unstable malaria that was the main target of the antivector interventions. A significant reduction of malaria prevalence was also observed in the villages located at altitudes of 900-1,000 m, where malaria transmission is stable. The main vector Anopheles funestus was dramatically reduced in abundance and distribution in the sprayed areas.