Malaria Treatment & Prevention

The need for sustained and increased funding for malaria is urgent from this analyses or else the gains recorded in the last few years could be wiped out. This is clearly a critical inflection point for malaria control! The resources, tools and strategies to eliminate malaria in most African settings will require increased funding, for example, diagnosis to strengthen malaria case management, monitor resurgence, evaluate impact of other interventions such as the use of long lasting insecticide treated nets, indoor residual spraying, vaccines, intermittent preventive treatment of malaria in pregnancy etc. Newer and superior tools that are field adaptable are urgently needed!


It is interesting to note that as the malaria cases come down more resources and efforts will have to be committed to maintain the elimination level. We have seen now and interesting possibility that malaria can be eliminated and all efforts required at all levels should be deployed so that we can celebrate yet another "monster" disease stamped out/rolled away successfully!

Wellington Oyibo
University of Lagos
Lagos, Nigeria

Hello friends in the struggle,I do appreciate all the avenues being tried to prevent/reduce malaria in LDCs but it has yield tangible results in areas where practical approaches have been used,e,g mosquito nets and self hiegine have greatly reduced malaria spread and breeding. In case of any free or affordable  mosquito nets emphasis must be increased.
Joseph Nsubuga

Dear Kileken,i do appreciate your contribution to the effect and i want to augement by saying provision of mosquito nets to LDCs is of paramount importance due to the fact that environmental and climatic condition fevour the parasite responsilbe for malaria  transmission and breeding.
Joseph Nsubuga

It is good to know that increased resources (especially financial) and new strategies led to the decline in new malaria casesand fatalities by 50%! I think more can still be done in terms of prevention. There is need to educate the communities in rural areas on how to correctly and effectively use the mosquito nets; and also residual spraying. The assumption that I have noticed is that when malaria nets are being distributed is that everyone knows how to use them. Community health workers can be trained to help educate people in this regard.
Violet Chaka

Dear all:
No one seems to remember that the bed nets really do NOT prevent mosquito bites, they are vehicles for the insecticide that kills them when they try to feed and hence stop transmission. But the insecticide only lasts on to 2 years (even DDT known for long life only lasts 12 months for IRS). So far no one has talked about replacing the nets when the killing power is gone, but the news will become less and less effective and we will get back to where we were before. That is why progress is so fragile!

Clive Shiff

Dear friends,

This recrudescence may also indicate the limitations of vertical/disease-specific approaches to malaria control/elimination. Sustaining advances in malaria control will likely require strengthening the accessibility and quality of healthcare delivery systems--enabling those systems to continue to effectively deploy integrated malaria prevention, diagnosis, and treatment strategies on an ongoing basis beyond one-off national campaigns.
Best Wishes,
Ari

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~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Ari Johnson, MD
University of California, San Francisco
Co-Executive Director
Project Muso Ladamunen
1380 Monroe St NW Box 309 Washington DC 20010
Rue 104 Porte 155 Daoudabougou, Bamako, Mali
US Cell: +1.301.908.7262
Office: +1.202.657.MUSO

www.projectmuso.org
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Dear all,
I want to clarify that mosquito nets do not stop bites BUT they prevent direct attack of mosquitos and if you want to kill too you need to treat them  [treated mosquito nets] but this treatment is a cost to most people in LDCs.I would advocate for nets as a burrier  for direct contacts with human beings

dear colleagues - if I could take this opportunity to address some of the above comments with a brief history of insecticides in bednets.

In the past, polyester bed nets used to be dipped in insecticide. This proved to be a very effective means of enhancing the efficacy of untreated polyester bed nets, which while presenting a physical barrier tended to hole and tear easily and allow ready access to malaria transmitting mosquitoes. The addition of an insecticide treatment applied after net manufacture significantly enhanced the performance by repelling approaching mosquitoes. Those that were able to get through holes typically collected enough insecticide to prevent biting and were usually killed. The problem was the insecticide soon washed out, so nets needed retreatment by dipping every 6 months. This proved to be a logistical nightmare considering the millions of people using bed nets.

To overcome the problem of insecticide not lasting, that was rightly mentioned below, much longer lasting bed nets were then developed by either factory coating or impregnating the net fibers with insecticide. Impregnated nets are made of polyethylene, which is far more durable than polyester. Impregnation also allows the insecticide to be protected during washing and to leach out ...

dear colleagues - if I could take this opportunity to address some of the above comments with a brief history of insecticides in bednets.

In the past, polyester bed nets used to be dipped in insecticide. This proved to be a very effective means of enhancing the efficacy of untreated polyester bed nets, which while presenting a physical barrier tended to hole and tear easily and allow ready access to malaria transmitting mosquitoes. The addition of an insecticide treatment applied after net manufacture significantly enhanced the performance by repelling approaching mosquitoes. Those that were able to get through holes typically collected enough insecticide to prevent biting and were usually killed. The problem was the insecticide soon washed out, so nets needed retreatment by dipping every 6 months. This proved to be a logistical nightmare considering the millions of people using bed nets.

To overcome the problem of insecticide not lasting, that was rightly mentioned below, much longer lasting bed nets were then developed by either factory coating or impregnating the net fibers with insecticide. Impregnated nets are made of polyethylene, which is far more durable than polyester. Impregnation also allows the insecticide to be protected during washing and to leach out slowly over time. With coated nets the insecticide is on the outside so is more vulnerable to loss through washing, abrasion and chemical breakdown. coated polyester nets typically last up to 3 years. Polyethylene nets in contrast can last over 5 years - and there is data showing that under some conditions impregnated nets last 7 or even more years.

With donor funding for bednet replacement campaigns constrained, these material differences in bed nets are critical to recognize so that value for money can be obtained appropriately for each situation.

best regards,
Lisa Goldman-Van Nostrand -
Strategic Advisor, Sumitomo Chemical

How about providing insectsides in wall paints is it feasible/ safe
Dr Anil Varshney


IMMUNIZE EVERY CHILD FOR HEALTHY FUTURE
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Dear all,

Malaria has remained a major killer despite the introduction of insecticide treated bed nets.
Its high time we focused on a number of preventive strategies like larviciding, vector control by clearing mosquito breeding areas and the like, one member who proposed mixing of this insectcide with paint, this sounds a good strategy as well, let us continue sharing innovative ideas we shall turn malaria down.

Roger Paul Kamugasha
WEDNET-AFRICA

Dear all, Mosquito nets do provide personal protection to those sleeping under them as Anopheles (as opposed to other "nuisance" mosquitoes) generally bite indoors, late at night and prefer their meals to be asleep. Treated nets make it harder for mosquitoes to get through the net and may provide a general deterrent to mosquitoes even coming into a room with a treated net.

If everyone sleeps under a treated net every night, the female Anopheles mosquitoes either do not feed, or feeds on other mammals such as cows, which do not host the malaria parasite. This will help reduce the population of Anopheles which can help break the malaria transmission cycle. Mosquitoes (like malaria parasites) adapt quickly to develop resistance to the insecticides (or medicine) used to control them. Anopheles in the Copper Belt of Zambia ahave developed resistance to both DDT and pyrethroids used in IRS and on nets. Additionally, Anopheles have changed their behavior in some areas with heavy net use such as biting earlier, or outdoors, which makes both IRS and Treated nets ineffective. Bottom line is we have tools such as treated nets, IRS and treatments which work well now, but for how long? Our progress ...

Dear all, Mosquito nets do provide personal protection to those sleeping under them as Anopheles (as opposed to other "nuisance" mosquitoes) generally bite indoors, late at night and prefer their meals to be asleep. Treated nets make it harder for mosquitoes to get through the net and may provide a general deterrent to mosquitoes even coming into a room with a treated net.

If everyone sleeps under a treated net every night, the female Anopheles mosquitoes either do not feed, or feeds on other mammals such as cows, which do not host the malaria parasite. This will help reduce the population of Anopheles which can help break the malaria transmission cycle. Mosquitoes (like malaria parasites) adapt quickly to develop resistance to the insecticides (or medicine) used to control them. Anopheles in the Copper Belt of Zambia ahave developed resistance to both DDT and pyrethroids used in IRS and on nets. Additionally, Anopheles have changed their behavior in some areas with heavy net use such as biting earlier, or outdoors, which makes both IRS and Treated nets ineffective. Bottom line is we have tools such as treated nets, IRS and treatments which work well now, but for how long? Our progress, as impressive as it is, truly is fragile.

--
Charles Llewellyn
114 Marsh Street
Beaufort, NC 28516

Cell 919 599-2147

Dear all, i believe education on the fact that the net needs to be impregnated with medicine at regular periods should be ongoing.  Most people feel the need to sleep out of the net on account of heat.  This is because the people that need these nets most are in deprived areas who live in small poorly ventilated rooms

 
Your perception shapes your experience

In response to the question regarding the fragility of progress as noted by the 2009/10 increase in malaria incidence in Zambia, Rwanda, or Sao Tomé and Principe, Ari mentioned the significance of “Strengthening health care delivery systems to effectively deploy integrated malaria prevention, diagnosis, and treatment strategies on an on-going basis....”

The significance of bed nets has so far been emphasized in this discussion; thank you Lisa and others for addressing and clarifying some points in the discussion. As mentioned, we are at a stage in many areas where there is a need for net replacement campaigns for nets that have exceeded their insecticidal effectiveness (3 to 5 years depending on brand). Charles also raised interesting points regarding the development of insecticide resistance.

If interested, here are three recent publications on this subject.
Benin: http://www.malariajournal.com/content/pdf/1475-2875-10-261.pdf

Zambia: http://www.malariajournal.com/content/pdf/1475-2875-10-254.pdf

Senegal: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(11)70194-3/abs...

Other issues of note include the need for improved case management through the widespread implementation of diagnostics, improved education and awareness, and strengthened disease monitoring and evaluation of key interventions.

The Global Malaria Action Plan underscores ...

In response to the question regarding the fragility of progress as noted by the 2009/10 increase in malaria incidence in Zambia, Rwanda, or Sao Tomé and Principe, Ari mentioned the significance of “Strengthening health care delivery systems to effectively deploy integrated malaria prevention, diagnosis, and treatment strategies on an on-going basis....”

The significance of bed nets has so far been emphasized in this discussion; thank you Lisa and others for addressing and clarifying some points in the discussion. As mentioned, we are at a stage in many areas where there is a need for net replacement campaigns for nets that have exceeded their insecticidal effectiveness (3 to 5 years depending on brand). Charles also raised interesting points regarding the development of insecticide resistance.

If interested, here are three recent publications on this subject.
Benin: http://www.malariajournal.com/content/pdf/1475-2875-10-261.pdf

Zambia: http://www.malariajournal.com/content/pdf/1475-2875-10-254.pdf

Senegal: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(11)70194-3/abs...

Other issues of note include the need for improved case management through the widespread implementation of diagnostics, improved education and awareness, and strengthened disease monitoring and evaluation of key interventions.

The Global Malaria Action Plan underscores communication and advocacy as crucial to ensuring that progress is not undermined by prematurely pausing to pat oneself on the back. Just as patient adherence to treatment is essential, the malaria community cannot afford to scale back interventions or efforts in light of progress. Are there other ideas from experiences in Zambia, Rwanda, or Sao Tomé?

Greetings to you,
This is my first posting , I may repeat some of what you already said .
I lived in SSA , mostly Rwanda , my country but I am now located in Pittsburgh/Pa with some short trips to SSA.
If we need to make a difference, we should change our procedures based on characteristics of diseases.
1.Mosquitoes can bite anytime in SSA, people do get up early in morning and go to bed late,they work in valleys close to river and lakes with higher presence of mosquitoes. Even during break inside the house or outside in bushes/under trees,chance of being bitten by mosquitoes are high.
2.We need to differenciate seasons and regions, in Rwanda for eg. I remember that Eastern , Central and Southwestern regions experienced higher endemicity .
3.We need to recognize the SES divide within developing countries, i.e. poverty can cause or exacerbate disease. So with this, we should focus on alleviation of poverty,yes combat diseases but mostly focus on what works, jobs, education, infrastructures, water, roads, communication,... and empowering the "little people".

Thank you.
Laurien

Hello, I'm Corine Karema, the National Malaria Control Program manager in Rwanda since 2006, i would like to give explanation on why Rwanda has résurgence of malaria in 2009. The main cause was failure to replace discounted LLINs in 2008 which led to decline in effective Universal ITN coverage from 51% in 2007 to 24% in 2009 resulting in the 2009 nationwide upsurge in malaria cases. The upsurge occire although we exapnded IRS in some sectors in 7 districts and expansés ACTs availability at all level of health care with increase of Districts implementing community case management to 21 districts out of 30. Following the massive distribution in Déc. 2009 and 2010, extraordinary progress progress in the fight against Malaria hile comparing 2005 to 2010, malaria incidence has déclined by 70% with 60% decline of OPDs, 54% deline

(following previous msg)54% decline In malaria in patient deaths and 66% decline of malaria test positivity rate. Currently the Rwanda MoH is working with partners to develop a malaria financial sustainability plan and develop innovative financing mechanisms. Thank you. Twitter:@ckarema