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Malaria Control in Endemic Countries

Malaria Control

The goal of malaria control in malaria-endemic countries is to reduce as much as possible the health impact of malaria on a population, using the resources available, and taking into account other health priorities.

Malaria control does not aim to eliminate malaria totally. Complete elimination of the malaria parasite (and thus the disease) would constitute eradication. While eradication is more desirable, it is not currently a realistic goal for most of the countries where malaria is endemic.

Malaria control is carried out through the following interventions, which are often combined:

• Case management (diagnosis and treatment) of patients suffering from malaria
• Prevention of infection through vector control
• Prevention of disease by administration of antimalarial drugs to particularly vulnerable population groups such as pregnant women and infants.

Case Management

Persons who are sick with malaria should be treated promptly and correctly. Malaria is often a debilitating disease that, when caused by Plasmodium falciparum, can be fatal. In addition, treatment eliminates an essential component of the cycle (the parasite) and thus interrupts the transmission cycle.

The World Health Organization recommends that anyone suspected of having malaria should receive diagnosis and treatment with an effective drug within 24 hours of the onset of symptoms. When the patient cannot have access to a health care provider within that time period (as is the case for most patients in malaria-endemic areas), home treatment is acceptable.

Prevention of Infection

Infection is prevented when malaria-carrying Anopheles mosquitoes are prevented from biting humans.

Vector control aims to reduce contacts between mosquitoes and humans. Some vector control measures (destruction of larval breeding sites, insecticide spraying inside houses) require organized teams (for example, from the Ministry of Health) and resources that are not always available.

An alternate approach, insecticide-treated bed nets (ITNs) combines vector control and personal protection. This intervention can often be conducted by the communities themselves and has become a major intervention in malaria control.

Prevention of Disease

Administration of antimalarial drugs to vulnerable population groups does not prevent infection, which happens through mosquito bites. But drugs can prevent disease by eliminating the parasites that are in the blood, which are the forms that cause disease. Pregnant women are the vulnerable group most frequently targeted. They may receive, for example, "intermittent preventive treatment" (IPT) with antimalarial drugs given most often at antenatal consultations during the second and third trimesters of pregnancy.

Partnerships for Malaria Control

Successful malaria control activities require coordinated actions by:

• National authorities (especially the Ministry of Health)
• International organizations (such as the World Health Organization and UNICEF)
• Governmental and nongovernmental agencies
• The private sector
• The communities.

To enhance coordination, various partnerships have formed, the most prominent being the Roll Back Malaria global partnership.

Activities for Malaria Control

The main activities necessary for carrying out malaria control interventions are:

• Health education (also called Information-Education-Communication, IEC), where the communities are informed of what they can do to prevent and treat malaria.
• Training and supervision of health workers, to ensure that they carry out their tasks correctly.
• Provision of equipment and supplies (e.g., microscopes, drugs, bed nets) to allow the health workers and the communities to carry out the interventions.

Barriers to Malaria Control

A patient ward at Mandla District Hospital, India. Inadequate health infrastructures and resources are often a barrier to malaria control.

Malaria control is made difficult by several technical and administrative problems.

• Drug-resistant malaria parasites hinder case management by decreasing the efficacy of antimalarial drugs and by requiring the use of alternate drugs that are often more costly, less safe and less easy to administer.
• Insecticide resistance decreases the efficacy of interventions that rely on insecticides such as insecticide-treated bed nets and insecticide spraying.
• Inadequate health infrastructures in poor countries are unable to conduct the recommended interventions.
• The people most exposed to malaria are often poor and lack education. They often do not know how to prevent or treat malaria. Even when they do know, they often do not have the financial means to purchase the necessary products, such as drugs or bed nets.