Malaria Treatment & Prevention

An important factor responsible for failure of many programs is over reliance on pesticides as a measure of control.Biological means continue to be under used.Besides,adequate attention is not paid to landscaping and environment improvement.
Recently,I had the opportunity to work in some dense forests and was pleasantly surprised that areas with minimal human interference with environment hardly had malaria cases.

As we integrated approach is one of the best approaches. However, it is more on paper is most places than in reality.

As I understand it, malaria transmission depends on three organisms, the
malaria parasite, humans and Anopheles mosquitoes. If there are no humans
(as in some isolated forests) there will be no transmission as the only way
mosquitoes get malaria is from infected humans. The Anopheles responsible
for most human malaria prefer human blood meals, but can get by on other
hosts, which do not serve as hosts for human malaria. So, there have to be
sufficient human hosts with malaria, and Anopheles mosquitoes for
transmission to occur.

To control, and eventually eradicate malaria, we can reduce the vector
(mosquitoes) through larvaciding, and IRS, or separate the human from the
vector, through LLINS (which protect uninfected humans from infected
mosquitoes *and *uninfected mosquitoes from infected humans, and also
reduces the chances for female Anopheles to breed, which may help reduce
the population of mosquitoes), or kill off the parasites through rapid
diagnostics and effective treatment, (which reduces the likelihood of
transmitting malaria to more mosquitoes, as well as saving lives). The
most effective campaigns use all three mechanisms, as what was done in
Zanzibar.

A forth effective mechanism would be to remove all humans, but that is not
very practical.

BTW ...

As I understand it, malaria transmission depends on three organisms, the
malaria parasite, humans and Anopheles mosquitoes. If there are no humans
(as in some isolated forests) there will be no transmission as the only way
mosquitoes get malaria is from infected humans. The Anopheles responsible
for most human malaria prefer human blood meals, but can get by on other
hosts, which do not serve as hosts for human malaria. So, there have to be
sufficient human hosts with malaria, and Anopheles mosquitoes for
transmission to occur.

To control, and eventually eradicate malaria, we can reduce the vector
(mosquitoes) through larvaciding, and IRS, or separate the human from the
vector, through LLINS (which protect uninfected humans from infected
mosquitoes *and *uninfected mosquitoes from infected humans, and also
reduces the chances for female Anopheles to breed, which may help reduce
the population of mosquitoes), or kill off the parasites through rapid
diagnostics and effective treatment, (which reduces the likelihood of
transmitting malaria to more mosquitoes, as well as saving lives). The
most effective campaigns use all three mechanisms, as what was done in
Zanzibar.

A forth effective mechanism would be to remove all humans, but that is not
very practical.

BTW, since Anopheles gambia, at least, requires relatively clean water to
breed, by cleaning up the environment may actually increase malaria
transmission. Most of Bangladesh is malaria free, precisely because all
the surface water is heavily contaminated. Only in the Chittigong Hill
Tract areas and Sylhet region with clean running streams is much malaria
found.

So areas with "minimal human interference with environment" should not have
much malaria transmission.

Best, Charles

The areas I mentioned are definitely inhabited by humans.However,they all live in small huts.No sewage or water supply systems or collections of water.Only free flowing streams.

sandepp
i would like to learn more on it
the data review of last 10 years shows that we have more reported malaria from districts  with more forest - cases mostly near forest and less cases in hihgly populated areas
eg NE , Orrissa , chhatisgarh m, AP
I have personalty seen  hundred of malaria cases FP in orrisssa interior PHCs
malaria is also one of the cause of moralities of maoist insurgents
regrds
anil

Sounds like good Anopheles habitat. Just no parasites.

Each year malaria kills nearly 1 million people worldwide, most of whom are children 5 years or younger in Africa. Significant progress has been made in some sub-Saharan countries e.g. Namibia over the last 10 years due to a combination of ACTs, insecticide treated nets and IRS together as well a the introduction of RDT's for quicker diagnosis in the rural districts in malaria endemic areas.
But somehow there seems to be a resurgence in malaria cases, could the malaria parasite be developing resistance to anti-malarial drugs that are currently being used in treatment protocols? Or maybe the mosquitoes have adapted to the prevailing environment and hence changed their feeding patterns- taking their blood meals during the day or before people go to sleep under the treated nets.

Thank you Violet.

We would expect a rise in cases some years after implementation with
successful malaria control due to decreasing immunity. This is well
explained in a malaria modeling paper by Azra Ghani
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0004383.
Although infection decreases, less people have immunity against
developing symptoms and there is an increase in cases reported. To see if
this is a true resurgence or an artifact of good malaria control, we can
look at the age of the reported cases. As transmission decreases the
average age of a case of malaria increases. This has been seen in many
settings where details of age (not just under 5 and over 5 years) is
taken, such as The Gambia, Senegal, coastal Kenya and Tanzania (Kilifi,
Korogwe and Muheza) as well as numerous countries outside of Africa.

However, as immunity decreases there are real risks of resurgence of
malaria. Resurgence has been seen in many places and is a real danger with
decreasing immunity. Thus, it is paramount that todays successes in
reducing malaria are continued to the end game; elimination and finally
eradication.
--
Dr Roly Gosling MD, PhD

Associate Professor
Lead, Malaria Elimination ...

Thank you Violet.

We would expect a rise in cases some years after implementation with
successful malaria control due to decreasing immunity. This is well
explained in a malaria modeling paper by Azra Ghani
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0004383.
Although infection decreases, less people have immunity against
developing symptoms and there is an increase in cases reported. To see if
this is a true resurgence or an artifact of good malaria control, we can
look at the age of the reported cases. As transmission decreases the
average age of a case of malaria increases. This has been seen in many
settings where details of age (not just under 5 and over 5 years) is
taken, such as The Gambia, Senegal, coastal Kenya and Tanzania (Kilifi,
Korogwe and Muheza) as well as numerous countries outside of Africa.

However, as immunity decreases there are real risks of resurgence of
malaria. Resurgence has been seen in many places and is a real danger with
decreasing immunity. Thus, it is paramount that todays successes in
reducing malaria are continued to the end game; elimination and finally
eradication.
--
Dr Roly Gosling MD, PhD

Associate Professor
Lead, Malaria Elimination Initiative
Global Health Group,
University of California, San Francisco

50 Beale Street, Suite 1200, Box 1224
San Francisco, CA 94105 USA

Tel: (+1) 415 597 8114
Cell: (+1) 415 254 6524
Fax: (+1) 415 597 8299
email:
Skype: Rolygosling
www.malariaeliminationgroup.org <http://www.malariaeliminationgroup.org/>






On 6/1/12 5:56 AM, "GHDonline (Violet Chaka)" <>
wrote:

>Violet Chaka replied to the discussion "Malaria resurgence: a systematic
>review and assessment of its causes" in the Malaria Treatment &
>Prevention community.
>
>Reply contents:
>"Each year malaria kills nearly 1 million people worldwide, most of whom
>are children 5 years or younger in Africa. Significant progress has been
>made in some sub-Saharan countries e.g. Namibia over the last 10 years
>due to a combination of ACTs, insecticide treated nets and IRS together
>as well a the introduction of RDT's for quicker diagnosis in the rural
>districts in malaria endemic areas.
>But somehow there seems to be a resurgence in malaria cases, could the
>malaria parasite be developing resistance to anti-malarial drugs that are
>currently being used in treatment protocols? Or maybe the mosquitoes have
>adapted to the prevailing environment and hence changed their feeding
>patterns- taking their blood meals during the day or before people go to
>sleep under the treated nets."
>
>--
>View this post online:
><http://www.ghdonline.org/malaria/discussion/malaria-resurgence-a-systemat
>ic-review-and-assessm/#reply-4949-2?id=10989067&format=text&type=instant>
>
>Unsubscribe or change your email notification settings:
><http://www.ghdonline.org/users/roly-gosling/edit/>
>
>Contact the GHDonline team:
><http://www.ghdonline.org/contact/>
>
>You can reply to this discussion by responding directly to this e-mail;
>it will be shared with all community members and posted as is. Files
>cannot be added via email attachment and must be uploaded directly to
>GHDonline.

Violet-
it does appear that mosquitoes may be changing their feeding pattern in response to IRS-no suprise that behavior that allows survival is selected for-see attached publication where in parts of Bioko Island, the Anopheles feed outdoors, which was not noted in studies years ago-best johanna

Worth noting is the adaptation of Anopheles mosquitoes to breed in polluted water in puddles around living that serves as reservoir. This has been observed in Lagos, Nigeria. Initial results indicate that Anopheles that breeds in polluted water correlated with those that has kdr resistance.



________________________________
From: GHDonline (Johanna Daily) <>
To: WELLINGTON OYIBO <>
Sent: Saturday, June 2, 2012 2:44 PM
Subject: Re: [Malaria Treatment & Prevention] Malaria resurgence: a systematic review and assessment of its causes

Johanna Daily replied to the discussion "Malaria resurgence: a systematic review and assessment of its causes" in the Malaria Treatment & Prevention community.

Reply contents:
"Violet-
it does appear that mosquitoes may be changing their feeding pattern in response to IRS-no suprise that behavior that allows survival is selected for-see attached publication where in parts of Bioko Island, the Anopheles feed outdoors, which was not noted in studies years ago-best johanna"

Attached resource:
* <http://www.ghdonline.org/malaria/discussion/malaria-resurgence-a-systematic-r... et al MJ 2011.pdf


--
View this post online:
<http://www.ghdonline.org/malaria/discussion/malaria-resurgence-a-systematic-r...>

Unsubscribe or change your email notification settings:
<http://www.ghdonline.org/users/wellington-oyibo/edit/>

Contact the GHDonline team:
<http://www.ghdonline.org/contact ...

Worth noting is the adaptation of Anopheles mosquitoes to breed in polluted water in puddles around living that serves as reservoir. This has been observed in Lagos, Nigeria. Initial results indicate that Anopheles that breeds in polluted water correlated with those that has kdr resistance.



________________________________
From: GHDonline (Johanna Daily) <>
To: WELLINGTON OYIBO <>
Sent: Saturday, June 2, 2012 2:44 PM
Subject: Re: [Malaria Treatment & Prevention] Malaria resurgence: a systematic review and assessment of its causes

Johanna Daily replied to the discussion "Malaria resurgence: a systematic review and assessment of its causes" in the Malaria Treatment & Prevention community.

Reply contents:
"Violet-
it does appear that mosquitoes may be changing their feeding pattern in response to IRS-no suprise that behavior that allows survival is selected for-see attached publication where in parts of Bioko Island, the Anopheles feed outdoors, which was not noted in studies years ago-best johanna"

Attached resource:
* <http://www.ghdonline.org/malaria/discussion/malaria-resurgence-a-systematic-r... et al MJ 2011.pdf


--
View this post online:
<http://www.ghdonline.org/malaria/discussion/malaria-resurgence-a-systematic-r...>

Unsubscribe or change your email notification settings:
<http://www.ghdonline.org/users/wellington-oyibo/edit/>

Contact the GHDonline team:
<http://www.ghdonline.org/contact/>

You can reply to this discussion by responding directly to this e-mail; it will be shared with all community members and posted as is. Files cannot be added via email attachment and must be uploaded directly to GHDonline.

Thank you Dr. Gosling, Johanna an Wellington.

I totally agree that the successes in reducing malaria should be continued especially in Africa by respective Ministries of Health. Political will has proven to be pivotal in ITN's and IRS coverage in endemic areas.

Best,

Violet