Protozoal disease caused by infection with

parasites of the genus plasmodium

And transmitted to man by certain species of

infected female anopheline mosquito.

RBC Clinical feautures if malaria vary from mild to

WITH Severe and complicated according to the,
MALARIAL Species of parasite present
PARASITE pts state of immunity
Intensity of the infection
Presence of concomitant
conditions like malnutrition and
others.
Febrile paroxysms occur with definite
intermittent periodicity depending upon the
species of the parasite.

Most of the deaths due to malaria caused by

anaemia & cerebral malaria.
Malaria Control Measures
 History of Malaria Control Programs in India

NMCP 53 NMEP 58 UMS 71 MAP 95 EMCP 97 NAMP 99

MPO 77
National Malaria Control Program RBM 98

National Malaria Eradication Program

Urban Malaria Scheme

Modified Plan of Operation

Malaria Action Plan

Enhanced Malaria Control Program

National Anti-malaria Program NAMP

Roll Back Malaria
 ROLLBACK MALARIA
WHO PROJECT TO CO –
ORDINATE GLOBAL ACTION

MAIN OBJECTIVE

TO REDUCE THE GLOBAL

MALARIA BURDEN
SIGNIFICANTLY THROUGH
INTERVENTION ADAPTED TO
LOCAL NEEDS

TIME LIMITED PROJECT – 5YEARS

 NAMP CONTROL STATEGIES
API>2 API<2
SPRAYING FOCAL SPRAYING
ENTOMOLOGICAL SURVEILLANCE
ASSESSMENT (active & passive )
SURVEILLANCE TREATMENT
(active & passive) FOLOW UP
TREATMENT EPIDEMIOLOGICAL
INVESTIGATION
 PARAMETERS OF MALARIA
SURVEILLANCE
API = CONFIRMED CASES DURING THE YR
POPULATION UNDER X 1000 INDEX OF ENDEMICITY
SURVEILLANCE

X 100 1NDEX OF OPERATIONAL

ABER= NO OF SLIDES EXAMINED
EFFICIENCY
POPULATION UNDER
SURVEILLANCE

ANNUAL FALCIPARUM RATE

SLIDE POSITIVITY RATE
SLIDE FALCIPARUM RATE
PF PROPORTION
SPLEEN RATE
(MEASURES OF ENDEMICITY OF MALARIA)
 APPROACHES TO MALARIA
CONTROL
A ) THE MANAGEMEN T OF
MALARIA CASES IN THE
COMMUNITY

B) ACTIVE INTERVENTION TO
CONTROL/ INTERRUPT
MALARIA TRANSMISSION
WITH COMMUNITY
PARTICIPATION
A.MANAGEMENT OF MALARIA
CASES IN THE COMMUNITY
CASE DETECTION * ACTIVE * PASSIVE

TREATMENT
*PRESUMPTIVE
*RADICAL

SURVEILLANCE

MASS DRUG ADMINISTRATION &

CHEMOPROPHYLAXIS
MANAGEMENT OF MALARIAL
CASES
Recognition of signs & symptoms which
could be caused by malaria.

Diagnosis of malaria and other febrile

conditions

Referral to higher level of care if necessary

Prescription of correct treatment

Education of the patient or carrier on how

to take or administer the drugs.

The expected result of treatment

 CONTD….
When to return to the health facilities

Danger signs

Side effects

Prevention of malaria

Dispensing or selling the the correct drugs of assured

QUALITY WITH THE 1st DOSE ALWAYS BEING TAKEN UNDER
SUPERVISION.

Patient compliance with prescription instructions.

Follow up to check whether the expected therapeutic effect has

been achieved.
 TREATMENT
PRESUMPTIVE TREATMENT

TAB PRIMAQUINE
0.75mg/Kgbody weight+ tab
CHLOROQUINE 10mg/kg
body weight on day 1

TAB CHLOROQUINE 10
mg/kg body weight & 5 mg/kg
body weight on DAY 2 &DAY
3 respectively
 TREATMENT CONTD….
RADICAL TREATMENT
TAB PRIMAQUINE 0.25mg/kg body
weight daily for 5 days
SEVERE AND COMPLICATED MALARIA
QUININE 10mg/kg body weight IV drip in
5% dextrose saline to be run over 4
hours ( 8th hourly )7 days then switch
over to oral dose
ARTIMISINE or ARTESUNATE or
ARTETHER at appropriate doses also
prescribed
TAB MEFLOQUININE is to be
used only in pf cases having
proven resistance to chloroquine.

PROGUANIL 200mg 2 tab /day can

be used as a chemoprophylaxis
for those who are travelling to
endemic areas
 CONTRAINDICATIONS AND TOXICITY
PRIMAQUINE is contraindicated
in G6-PD deficient patients,

AND in pregnant women.

PRIMAQUINE is cardiotoxic
even a single dose produced
cyanosis in some patients,

SO Mulipurpose workers should

check for conditions like that for
pts who are taking these drugs.
B) ACTIVE INTERVENTION
TO CONTROL / INTERRUPT
MALARIA TRANSMISSION

 
 

BEFORE IMPLEMENTING VECTOR CONTROL

STRATEGIES……….
Preliminary malaria surveys about
* Which anopheline species are present
* Which of them are vectors of malaria.

The biology and behaviour of adult vector

mosquitos * including their resting habits *indoor
and outdoor * feeding habits *seasonal changes in
the no biting the humans * duration of adult life and
Areas in which they are present.

The breeding habits of the mosquitos .

Which are the vector susceptible to the insecticide.

 BEFORE USING INSECTICIDES…..

Susceptibility of the target species to the

insecticides available for use.

The acceptability of the pesticide and method

of application to local community

Safety of the insecticide formulation for the

human and non target organisms.

The stability and residual activity of the

insecticide.

Skill and competence of the personnel

applying the insecticides.
ANTI LARVAL MEASURES
LARVICIDES

ENVIRONMENTAL
CONTROL

BIOLOGICAL
CONTROL
LARVICIDES
MINERAL OILS
Petroleum hydrocarbon
on the surface of a water
will prevent mosquito
larvae from breathing
SYNTHETIC INSECTICIDES
FENTHION ,CHLORPYRITOS,
ABATE, Are least toxic
and commonly used.
ANTI ADULT MEASURES
SPACE SPRAYING APPLICATION
Sprayed into the atmosphere
In the form of a mist or fog

Pyrethrum extract malathion,

Fenitrothion through ulv
Fogging is used.

RESIDUAL SPRAYING
DDT is most commonly used

now resistance arise to it

so periodic testing for the

susceptibility is needed
INDIVIDUAL PROTECTION
PERSONAL PROTECTION METHOD
USING UNTREATED OR INSETICIDE

IMPREGNATED BEDNIGHTS AT NIGHT.

FIXING OF SCREENS ON WINDOWS TO

PREVENT MOSQUITO FROM ENTERING

THE HOUSES.

USING INSECTICIDE IMPREGNATED

CURTAINS ON WINDOWS OR DOORWAYS

AND OR IN GAPS BETWEEN THE ROOF

AND WALLS
 PERSONAL
PROTECTION
METHODS
VAPOURS PRODUCED BY THEM
CAUSE DISORIENTATING
EFFECTS IN MOSQUITO AND
PREVENT FROM BITING .

.
The environmental management is the
most appropriate and cost effective
course of action for eliminating
and controlling vectors in urban areas.

Main aim of this method

IS SOURCE REDUCTION
SOURCE REDUCTION IS
DONE BY

Eliminate the breeding place

Intermittent irrigation of
the rice fields

Minor engineering methods

like filling , levelling and
drainage if the breeding
places

Modifying the preffered

areas of breeding places of
vectors

Drainage and filling of the

areas whwre the water
collects
 BIOLOGICAL CONTROL
COST EFFECTIVE

RELATIVELY SAFETY

AMONG THEM ARE

PREDATORY MOSQUITOS
TOXORHYNICITES -Effective for those in
tree holes

LARVIVOROUS FISH

GAMBUSIA –EFFECTIVE In controlling

mosquitos that breed in under storm
drains

They have high tolerance to pollution

 …..CONTD
Several species of fungi are
pathogenic to larvae in clear water

EX; LAGENIDIUM GIGANTEUM

Procedures should be developed

to breed larvivorous fish at the
Local level so that it can be
distributed tothe community to
introduction at the breeding
places
 ….CONTD bacillus thuringiensis

MICROBIAL CONTROL AGENTS SUCH

AS BACTERIA SHOULD BE EMPLOYED

IN PREFERENCE TO CHEMICAL

CONTROL AGENTS BECAUSE OF

THEIR PROVEN ACTIVITY AGAINST

VECTOR

MOST PROMISING AMONG THEM ARE

BACILLUS THURINGIENSIES H-14

BACILLUS SPHAERICUS
Good activity against broad
Spectrum of mosquito species

New trend in mosquito control

Is the use of bacterial
agents in combination with
natural y occuring predatory
insects and fish
 GENETIC CONTROL
STERILE MALE TECHNIQUE.

CYTOPLASMIC INCOMPATIBILITY.

CHROMOSOMAL TRANSLOCATION.

SEX DISTORTION

They are cheaper potentially more efficient

above all not subjected to Vector
resistance
MALARIA A vaccine could provide a much
needed adjunt to the generally
VACCINES inadequate resources currently
Available for malaria control

Canditate antigens for malaria

vaccines

Sporozoite anigens—prevent the

Host from being infected

Asexual blood stage antigens–

restrict parasite multiplication

Sexual stage antigens—serum with

the antidodies ingested by the
Mosquito & block parasite
development in the mosquito midgut
A vaccine could provide a
much needed adjunt to the
generally inadequate resources
currently available for malaria
control

The most effective vaccine

might prove to be one
incorparating antigen from
more than one stage of the
parasite “s lifecycle .
PREVENTION AND CONTROL IN
PREGNANCY
In the view of the high maternal
and infant morbidty and
mortality associated with
malaria in pregnancy
• Intermittent preventive
treatment (IPT) with antimalarial
drugs
• Insecticide-treated bed nets (ITN)
• Febrile malaria case management

SHOULD BE IN THE PART OF

ANTENATAL CARE
OBSTACLES TO CONTROL
Cost & ecological unacceptability
in certain areas
Vector resistance to insecticides
Cost and toxicity
Exophilic behaviour of certain vector
species
Parasite resistance to & rising cost of
antimalarial drugs
 CONTD,,,,,
Inaccessibility of large population

Population movements

Peoples inadequate knowledge about health &

diseases

Paucity of basic health facilities & well

trained health service staff

Inadequate epidemiological information

about the disease
C) INVOLEMENT OF THE NONGOVERNMENTAL
ORGANISATION AND THE PRIVATE SECTOR

D) COMMUNITY PARTICIPATION

E) INTERSECTORAL COLLABARATION

F) TRAINING OF VECTOR CONTROL STAFF AND PERSONNEL ,

INSPECTORS AND FIELD STAFF ,COMMUNITY WORKERS.
F) TRAINING OF VECTOR CONTROL STAFF AND PERSONNEL ,

INSPECTORS AND FIELD STAFF ,COMMUNITY WORKERS

- Data gathering , analysis , interpretation

-Practical aspects of vector biology and

control

-surveillance

-use and maintenance of the equipment

- Pesticides their formulations and their safe

use

- Biological control agents

G) HEALTH EDUCATION
As a regular part of
the programme

to popularize
control measures

To motivate and sustain

community participation .
H) COLLECTIVE RESPONSIBILITY AND
GOOD TEAMWORK ARE INDESPENSIBLE
FOR EFFECTIVE URBAN VECTOR
CONTROL
Mosquito Genome Sequenced !!
 MOSQUITO GENOME
Genomic sequence of plasmodium

falciparum most lethal parasite

causing malaria and parasite

transmitting mosquito anophles

gambiae are completed.

This will be essential for

understanding plasmodium biology

And malaria pathogenesis in

molecular terms
These datasets can greatly help us

For identification of canditate

Targets for drugs vaccines,and

Diagnostic development in addition to

enhancing our basic understanding of

MALARIA
 WEB SITES
http://mrcindia.org/

http://tnhealth.org/

health .allrefer.com

http;//www.pon.nic.in/vcrc

http://tropicaldiseaseswebring.org/
 REFERENCES
PARKS TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE
17th EDITION;2003
WHO MODEL PRESCRIBING INFORMATION; DRUGS USED IN
PARASITIC DISEASES 2nd EDITION WHO 1988
Entomological field techniques for malaria control part i
learners guide 2000
TROPICAL DISEASE RESEARCH A GLOBAL PARTNERSHIP
8th PROGRAMME REPORT RESEARCH AND TRAINING IN
TROPICAL DIDEASES1987
WHO EXPERT COMMITTEE ON MALARIA ; who technical
research series 892 REPORT WHO;1999
URBAN VECTOR AND PEST CONTROL 11th REPORT ON
VECTOR BIOLOGY &CONTROL BY WHO 1988