Epidemiology and control of malaria (with a focus on … .ppt

epidemiologyandcontrolofmalaria withafocusonsub saharanafrica grantdorsey md phddivisionofinfectiousdiseasesuniversityofcalifornia sanfrancisco burdenofdisease over40 oftheworld spopulationliveinendemicareasestimated500millionclinicalcasesand1 2milliondeaths year3rdmostcommoncauseofdeathduetoacommunicableagent annualmalariamortalityratesper100 000populationsince1900 burdenofmalariainafrica oneafricanchilddiesofmalariaevery30secondshigherinpoorandruralareasinallmalaria endemiccountriesinafrica malariaaccountsfor25 40 ofoutpatientvisitsand20 50 ofhospitaladmissions malariamortalityinafricanchildren uniqueepidemiologicalaspectsofmalariainafrica infectionisincrediblycommonandheterogeneoushighdensityofmosquitoesmosquitoesliketobitehumansandliveindoorsverylittlevectorcontrolinafricagoldstandardformeasuringthefrequencyofinfectionistermedtheentomologicalinoculationrate eir eir numberofbitesbyanophelesmosquitopernightxproportionofmosquitoescarryingmalariaparasitesintheirsalivaryglandsx365daysperyear uniqueepidemiologicalaspectsofmalariainafricacont clinicalconsequencesofinfectionvarygreatlydiseasemanifestationsrangefromasymptomaticparasitemiatolife threateningillnessriskofillnessanddeathstronglyinfluencedbydevelopmentof semi immunity overone slifetimehighriskgroupsincludeyoungchildren pregnantwomen hiv infectedpatients andnon immuneadults i e travelers estimatingriskofinfection disease anddeath 50billioninfectionswithmalariaparasiteseachyearinafrica 1 100infectionsleadstoclinicalillness 500millioncasesofmalariaeachyear 1 50casesofmalariaresultsinthesevereformofdisease 10millioncasesofseveremalariaeachyear 1 5casesofseveremalarialeadstodeath 1 2milliondeathsduetomalariaeachyear transmissionintensity incidence andage dielmo senegal 200infections year ndiop senegal 20infections year inthe20thcentury theboundaryofmalariatransmissionwasprogressivelyrolledbackfromthenorth elimination 1960 elimination1960 1975 elimination1975 2007 eliminationprogramongoing eliminationnewlytargeted fundingsource 0 19 international2 domestic 1estimatedbasedonmappingmalariariskinafricaprojectupdatedfor2007populationlevels2includesfundingallocationsbytheglobalfund worldbank anduspresident smalariainitiative drcongo southafrica swaziland tanzania mainland botswana zambia 0 91 2 41 2 53 3 17 4 43 uae 22 estimatedannualmalariafinancingperpopulationatrisk1 countriestargetingeliminationdonotcurrentlyspendmoreperpopulationatriskthansomecontrolprograms 0 36 1includesbothreportedandunconfirmedcasesasestimatedbythenationalprogramand orpartners2basedon2003estimates drcongo southafrica uae2 tanzania mainland botswana zambia 5 76 10 74 40 800 200 000 oman2 10m estimatedannualmalariafinancingpercase1 butdospendsignificantlymorepercase whichwillcontinuetoincreaseasincidencedeclinesfurther availabletoolsforthecontrolandeliminationofmalaria 1 effectivecasemanagement2 insecticidetreatedbednets itns 3 vectorcontrol4 chemoprevention5 vaccine effectivecasemanagementintheeraofacts act shavenowbecomethestandardofcarethroughouttheworldartesunate mefloquineartemether lumefantrineartesunate amodiaquinedihydroartemisinin piperaquineexcellentefficacyunlessresistancetopartnerdrugearlyreportsofartemisininresistanceinthai cambodiabordermaydecreasetransmissionthroughanti gametocyteeffectsconcernaboutdrugavailabilityandcost effectivecasemanagementissuesinresourcepoorsettings governmentrecommendsonefirst linetherapyforthewholecountrypolicybasedonclinicalsurveillancestudiesdrugsubsidizedforthepublicsectoractscurrentlytooexpensiveintheprivatesectormostfeversaretreatedempiricallyasmalariaathomeurgentneedtopromoterationaleuseofacts jointmalariatrainingprogram objective toevaluatetheimpactofintegratedteam basedtrainingofhealthcareworkersonmalariacasemanagement designandparticipants malariasurveillancedata120daysbeforeandaftertrainingwerecomparedforallpatientspresentingtoeightgovernment runhealthcenters setting theeightsitesrepresentthediversityofmalariatransmissioninuganda datawerecollectedoneyearafterartemether lumefantrinewasintroducedastherecommendedfirst linetreatmentforuncomplicatedmalaria intervention sixdayintegratedteam basedtrainingcoursetargetingclinical laboratoryandrecordsstaffwithsitevisitsapproximately6and12weeksposttraining proportionofpatientssuspectedofhavingmalariareferredforabloodsmear proportionofpatientswithapositivebloodsmeartreatedformalaria proportionofpatientswithanegativebloodsmeartreatedformalaria proportionofpatientprescribedantimalarialtherapywhoweregivenacorrectregimen insecticidetreatedbednets itns severalrandomizedtrialsinarangeofendemicsettingshavedocumentedtheefficacyofitnsinterventionsdoneatthepopulationlevel 10foldreductionintransmission 2folddecreaseinincidenceofclinicalmalaria 20 reductioninallcausechildhoodmortalityoneofthemostcosteffectiveinterventionsavailablebednetscostonlyafewdollarslonglastingitnsinsecticideimpregnatedintonetslast5yearsremainingissuesarecoverageanddistribution vectorcontrol primarytoolindoorresidualspraying irs veryeffectiveinlowtransmissionareasstartingtobeusedinhighertransmissionsettingsinafricalimiteddataonwhatisthebestinsecticideandhowoftentosprayveryexpensiveothervectorcontrolmeasureslarvicidegeneticallymodifiedmosquitoes irsinmoderateendemicsettinginuganda irs chemoprevention twomainstrategieschemoprophylaxisintermittentpreventativetherapytargetgroupspregnantwomenhivinfectedpatientsdailytrimethoprim sulfamethoxazoleinfantsandyoungchildrenactiveareaofresearch summaryofstudiesevaluatingiptiwithspgivenatthetimeofroutineimmunizations controlofmalariainafricacont vaccines1973vaccinemadefromwholemalariaparasiteskilledbyirradiationcouldprotecthealthypersonsfrominfectionnotaviableoptionforlargescalep