Towards an appropriate malaria control strategy: issues of concern and alternatives for action.

PIP: A resurgence of malaria in India prompted formation of a Malaria Expert Group, which met in 1996 to formulate an appropriate malaria control strategy. An estimated 20-30 million episodes of malaria occur in India each year. Since malaria is an exclusively focal phenomenon, strategies should be responsive to the epidemiologic characteristics of the five ecotypes: tribal, rural, urban, industrial, and border. Also needed are flexible, individualized strategies for development project areas and Triple Insecticide Resistance Areas. Most malaria deaths are attributable to delayed diagnosis and treatment. Recommended are streamlined logistics for laboratory supplies, monitoring of anti-malarial drugs for possible resistance, training of nongovernmental organizations to open peripheral laboratories, rigorous training for laboratory technicians in malaria diagnosis, training of supervisors for laboratory work and cross-checking of findings, and establishment of graded laboratory facilities for different levels of the health care delivery system. Integration of malaria control into India's primary health care system will require community participation, appropriate technology, intersectoral coordination, and social equity.^ieng

Women and AIDS.

PIP: In this article, Dr. P.N. Sehgal, former director of the National Institute of Communicable Diseases in Delhi, explains the steps that women need to take to protect themselves against AIDS and discusses some issues facing women who have already contracted the disease. Because of women's lack of status in the family and society, it is harder for them to ensure their safety. Women based at home often lack information on AIDS, and those women who are informed sometimes depend on their male partner for financial support, which means that they are forced to engage in unsafe sexual practices. Safer sexual practices can reduce the risk for women. Though varying in degree of safety, some safer practices include: monogamous relationships between uninfected partners; the use of condoms for all types of sexual intercourse; non-penetrative sex practices (hugging, kissing, masturbating); reducing the number of sexual partners; avoiding sex when either of the partners has open sores or any STD. Pregnant women should also receive information concerning AIDS, including: a baby born from an HIV-infected mother has a 20-40% of being infected; the risk of transmission is higher when the mother already shows signs of AIDS; and an infected baby may die within the first few years of life. the HIV transmission may occur prepartum or during birth itself, but the risk of transmission from breastfeeding is extremely low. Dr. Sehgal stresses the need for privacy and confidentiality when dealing with carriers of the disease or when carrying out HIV testing. Above all, the rights of HIV-infected people must be protected.^ieng