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Conquering Malaria

Conquering Malaria

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Conquering Malaria

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  1. Conquering Malaria Joel G. Breman, MD, DTPH Fogarty International Center National Institutes of Health Improving Population Health Workshop Instituto Nacional de Salud Publica (INSP) Cuernavaca, Mexico 21 – 22 June 2003

  2. Conquering Malaria • Burden • Ecology and manifestations • Successes • Control • Research and training

  3. Burden

  4. The Global Burden of Malaria • 1.5 – 2.7 million deaths annually • Over 1 billion clinical episodes • 300 – 500 million people infected • Every 10 - 30 seconds a child dies of malaria

  5. Ecology and Manifestations

  6. Malaria Ecology EXTRINSIC Control and prevention measures Social, behavioral, economic and political factors Human Intrinsic and Extrinsic Factors INTRINSIC Parasite Mosquito Environmental conditions

  7. Malaria’s Toll: Major Intrinsic Components Plasmodium falciparum Anopheles gambiae

  8. Hypoglycemia Anemia Acute febrile illness Severe illness Death Respiratory distress Cerebral malaria Infected Mosquito Anemia Chronic effects Impaired growth and development Neurologic/ cognitive Malnutrition Infected Human Developmental Low birth weight Infantmortality Fetus Pregnancy Acute illness Maternal Impaired productivity Anemia Malaria Ecology and BurdenClinical Manifestations

  9. MARA/ARMA Model of Malaria Transmission, 2003

  10. Successes

  11. Successes: Vector Control • 1899-1914, multiple demonstrations of control by reduction of Anopheline larvae and adults • 1899, Sierra Leone (antilarval); Cuba (large-scale); Malaysia (antilarval) • 1904-1914, Panama Canal Zone; control by larviciding, large-scale environmental modification • 1927, elimination of A. albimanus in Barbados (first area-wide success with invading species)

  12. Successes: Vector Control (2) • 1935-1939, use of pyrethrum spraying in South Africa, Netherlands and India • 1939-1957 • 1939-1940, Elimination of A. gambiae from Brazil and upper Nile, Egypt, 1942-1945 • 1946-1957, Interruption of transmission by anti-mosquito measures in Cyprus, Sandinia, Guyana, Venezuela and Greece; indoor residual spraying with DDT, a new major strategy

  13. Successes: Personal Protection (3) • 1987-2003 • Multiple projects and programs using insecticide-impregnated bed nets demonstrating overall mortality reduction and decrease in several malaria indices

  14. Control

  15. Vector Control • Drainage and filling: urban* • Chemical and biological larvicides* • Indoor residual insecticide spraying* • Outdoor residual insecticide spraying *costly and effective

  16. Personal protection (2) • Insecticide–impregnated materials: nets, curtains, clothing* • House screening • House location • Repellents • Fumigants * Cost-effective for low-income countries

  17. Antiplasmodial (3) • Patient management: early diagnosis, treatment, referral, education • Chemoprophylaxis • Intermittent treatment (pregnancy)* • Radical therapy for relapses (P. vivax, P. ovale) * cost effective

  18. Social Action (4) • Mobilization of individual, family, community • Health education Management Effectiveness • Health systems: access, use, quality • Leadership: policies, strategies, tactics • Surveillance of infection and disease • Monitoring and evaluation of programs

  19. Research and Training

  20. Research, Training, and Support Needs According to Understanding of Diseases andEfficacy of Control Methods High High Training Efficacy of Control Methods Research Needs Low Low Some Moderate High Research Support Needs

  21. Research, Training, and Support Needs According to Understanding of Diseases andEfficacy of Control Methods High High Training Efficacy of Control Methods Malaria Dengue HIV/AIDSTuberculosisEbola/Marburg InfluenzaCancersAlzheimer’s SmallpoxGuinea wormPoliomyelitisH. influenzae type BMeaslesTetanus Research Needs Low Low Some Moderate High Research Support Needs

  22. Research Agenda • Pathogenesis • Drug development • Immunology and vaccine development • Diagnostics • Entomology • Recent genetic breakthroughs

  23. Conquering Malaria For More Information MIM http://mim.nih.gov RBM http://www.who.int DCPP http://www.fic.nih.gov/dcpp/ Joel Breman jbreman@nih.gov