Malaria Control During Mass Population Movements and Natural Disasters (2003) / Chapter Skim
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7. Preventive Interventions
7. Preventive Interventions
Pages 80-92
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From page 80... ...
Appropriate preventive services for malaria control must be defined based on the specifics of the local malaria situation but might include consideration of cost-effective and sustainable vector control strategies (e.g., insecticide-treated nets) , prevention of malaria during pregnancy, environmental control, or even prophylaxis of high-risk groups.
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From page 81... ...
Although relatively few evaluations have been done, in either stable or displaced populations, prophylaxis strategies for defined groups such as pregnant women, orphans, unaccompanied minors, or laborers who are housed together for prolonged periods of time could be both effective and manageable. Preventive Use of Antimalarial Drugs During Pregnancy Pregnancy is a situation where malaria prevention should be actively encouraged, as pregnant women are at greater risk of malaria infection than nonpregnant women.
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From page 82... ...
Therefore, at least in areas of intense stable malaria transmission, neither case management nor weekly chemoprophylaxis can be relied on to acloquately protect women ancl their fetuses from malaria. In such situations, intermittent protective treatment (IPT)
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From page 83... ...
Prophylaxis of Other High-Risk Populations Anemic children (especially those who received blood transfusions because of severe anemia) , severely malnourished individuals receiving therapeutic feeding, and nonimmune populations newly exposed to malaria transmission would likely benefit from preventive use of antimalarial drugs.
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From page 84... ...
In another study, zinc supplementation reduced clinic attendance due to malaria and dramatically reduced high-density malaria infections (Shankar et al., 20001. Other nutrients that may be important in reducing malaria morbidity or mortality include vitamins A and C, riboflavin, betacarotene, and various antioxidants (Shankar, 20001.
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From page 85... ...
ITN programs for Afghan refugees in Pakistan have also met with considerable success (Rowland et al., 1996; Rowland, 19991. Bed nets are easily installed over beds or floor mats, can be readily moved, protect one or more persons (depending on users' ages and the sizes of the nets available)
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From page 86... ...
ITN programs that achieve low coverage rates or fail to treat (or retreat) nets appropriately with insecticide are likely to accomplish little more than the wasting of valuable resources (Hawley et al., in press)
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From page 87... ...
Using established guidelines, both ITN programs and residual spray programs would be considered cost effective and attractive health investments (cost per disability-adjusted life year averted was less than $150; Goodman et al., 19991. The cost of an ITN program will depend on bed net size, model, type, quality of material, and country (MacCormack et al., 19891.
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From page 88... ...
In Peru and Ecuador in 1997, soap distribution was estimated to cost $4.60 per person per year (Krooger et al., 19971. VECTOR CONTROL USING INSECTICIDES Role of Vector Control in Emergencies The role of insecticidal vector control in an emergency setting will depend, to a great extent, on the local epidemiology of malaria, the feeding
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From page 89... ...
It has been used in epidemic situations in order to get a rapid decrease in adult mosquito populations and as a highly visible intervention. ITNS OR RESIDUAL SPRAYING IN REFUGEE SETTINGS' Studies have shown that in most settings ITNs and residual spraying programs have approximately the same level of efficacy and cost effectiveness for preventing malaria (Goodman et al., 1999; Curtis and Mnzava, 20001.
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From page 90... ...
Therefore, the decision to opt for one over the other for malaria control for a displaced population revolves around local logistical constraints. Provided that either could be used effectively against locally prevalent malaria vectors, they each have their advantages and disadvantages.
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From page 91... ...
In the Tanzanian camps mentioned previously, the nongovernmental organization on the scene stopped campwide ITN distribution in favor of a twice-yearly residual spraying campaign, while community health workers attempted to improve ITN use through health education. ENVIRONMENTAL AND BIOLOGICAL VECTOR CONTROL When vector breeding sites are few in number and easily identified, environmental or biological control may be a viable option.
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From page 92... ...
· Consider ways to integrate malaria prevention for children and pregnant women with nutritional support activities and/or antenatal care. · Design an appropriate community education program to teach proper use of nets and to highlight vulnerable populations who most need this protection (if a net program is deemed the best approach to use)
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