No matter when and where vaccination enters widescale use, it is unlikely to supplant the need for effective treatment of drug-resistant falciparum malaria for several decades (Personal communication, B. Greenwood, London School of Hygiene and Tropical Medicine, March 2004).

INTEGRATED CONTROL PROGRAMS AND SPECIAL SETTINGS

Past and Present Models

Over recent years, several historical examples have been cited as evidence that malaria control could be achieved in endemic areas by combining environmental and human interventions. In the 1930s and 1940s, successful multipronged approaches to control transmission by A. gambiae operated in Brazil, Egypt, and Zambia (Utzinger et al., 2001; Killeen et al., 2002). In the Zambian copper mines, clearing vegetation, modifying river boundaries, draining swamps, and applying oil to open bodies of water coupled with house screening, mosquito nets, and quinine treatment reduced the local incidence of malaria by 70 to 95 percent for over 30 years (Utzinger et al., 2001). Today, contemporary versions of such programs are run by Exxon-Mobil in Cameroon and Chad, British Petroleum in Angola, and Konkola copper mine in Zambia.

In addition to commercial operations with a financial incentive to protect workers or residents from malaria using various combinations of environmental and vector control measures plus chemotherapy, local health authorities in endemic and epidemic settings have sometimes mounted integrated malaria programs within the normal health structure incorporating some or all of these elements (Shiff, 2002). Needless to say, such programs require coordination and planning, cooperation of local communities, and sustainable financing. A campaign that combined IRS plus artemisinin-containing combination therapy in KwaZulu Natal province, South Africa (in response to a local epidemic of multidrug resistant Plasmodium falciparum) is the most recent example of a successful government-sponsored integrated control program (Muheki et al, 2003). In recent years, research studies in Sierra Leone (Marbiah et al., 1998) and The Gambia (Alonso et al., 1993) have also supported the packaging of ITNs plus targeted chemoprophylaxis as a successful control package. On the other hand, the systematic deployment of ACTs in refugee camps on the northwest border of Thailand (population 120,000) produced a sustained reduction of more than 90 percent in the incidence of falciparum malaria without any additional control intervention (Nosten et al., 2000).



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement