CSU 39/2010: TOWARDS MALARIA ELIMINATION/ READER FEEDBACK

Sunday, 4th of April 2010

CHILD SURVIVAL UPDATE 39/2010: TOWARDS MALARIA ELIMINATION/ READER FEEDBACK

1) TOWARDS MALARIA ELIMINATION

Most malaria specialists are comfortable with the idea of 'shrinking the map,' i.e. using currently available tools to clear malaria from countries with low burdens of morbidity and mortality, while simultaneously using preventive and clinical interventions to reduce the burden of morbidity and mortality in countries of high endemicity.

The thematic series 'Towards Malaria Elimination, ' available at http://www.malariajournal.com/series/elimination raises the bar. Below you will find summarized the views of the authors, Tanner and Hommel. Full text is at http://www.malariajournal.com/content/9/1/24

A year from now, we shall have a good view of the extent to which the high burden countries of subsaharan Africa have reached the 2010 Abuja targets, especially 80 percent coverage with mosquito nets. Those coverage data, which are getting better, will only translate into durable reductions in morbidity and mortality if utilization can be brought into line with coverage, and insecticide resistance properly detected and managed. Those are two big ifs.

2) READER FEEDBACK

From Nigeria and Kenya come reader reactions to recent malaria postings.

Chioma Amajoh points to the need for country level entomological expertise, without which the national malaria programme does not know when and where insecticide resistance will rear its ugly head.

Augustine Ngindu asks the question of when and where the joint application of IRS and LLINs is indicated.

Good reading.

FROM NIGERIA

Dear Robert,

Thanks for your mail. I am delighted that you pointed out that apart from 80%coverage and use, effective vector monitoring is also key for malaria elimination.

The issue of Country Access to Susceptibility/Bioassay Test kits and Capacity Development for effective deployment of the Tests must be addressed now in the various endemic countries.

Regards,

Chioma Amajoh,

Head, IVM Branch, NMCP, FMOH,

Coordinator, National LLIN Campaign, Nigeria

FROM KENYA

Hi Robert

It is good to share such information. The debate on use of combined ITN and IRS needs to be viewed from two perspectives i.e. whether the intervention is used as a mitigation measure for malaria epidemics or whether it is used as a malaria control measure using IRS. Using data from some malaria epidemiological zones with multiple vectors, it becomes clear that both interventions give values that are suggestive of complementarity in reducing vectorial capacities up to level < 0.5 when extrapolations with mathematical modeling are done. The values are different in different malaria epidemiological zones and where only one vector is involved. The studies would be very useful if they could be guided by these factors otherwise they may appear true in one scenario but that may not be the case in a different area.

Augustine Ngindu

NPO/Malaria, WHO Kenya

ACK Garden House

1st Ngong Avenue, Off Bishops road

P.O. Box 45335-00100

Nairobi, Kenya

Good reading.