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Strategic Orientation Paper on Prevention and Control of Malaria

for National and International Programme Officers Involved in Malaria Control at Country Level (1^st ed.)

Full Text (84 pp, PDF)
Foreword   |   Provisional schedule |
Acknowledgements | Introduction 
Unit 1: Preventive intervention strategies
1.1 Approaches for scaling up insecticide-treated nets
1.2 Other vector control options
1.3 Malaria during pregnancy
Unit 2: Access to prompt and effective treatment
2.1 Malaria diagnosis
2.2 Drug resistance and process for drug policy changes
2.3 Scaling up effective treatment (home management of malaria)
Unit 3: Prevention and control of malaria epidemics in complex emergencies
3.1 Estimating the population at risk for malaria epidemics
3.2 Long-range forecasting, early warning and early detection systems
3.3 Case management and the effective use of drugs in epidemics
3.4 Vector control in epidemics
3.5 Monitoring and improving preparedness plans
Unit 4: Monitoring and evaluation
4.1 Monitoring and evaluation of health programmes
4.2 Key malaria targets/goals and regional differences
4.3 Measurement topics (mortality, morbidity, coverage)
4.4 Measurement tools
4.5 Routine health information systems and other systems
Annexes
Annex 1: The Millennium Development Goals
Annex 2: 10 things you need to know about DDT use
Annex 3: WHO position on prevention and control of HIV/malaria co-infection
Annex 4: A note on stratification
Annex 5: Combinations of antimalarial drugs and their applications
Annex 6: Exercises and answers

- More Roll Back Malaria Publications
- WHO Roll Back Malaria Department
- WHO Malaria Page

- PAHO Malaria Page

Introduction to Training Program

Objectives

1. To orient participants on the global and regional Roll Back Malaria (RBM) goals, objectives and targets.
2. To equip and direct participants with up-to-date intervention strategies and tools for malaria control under different epidemiological settings.

Goals and strategies of Roll Back Malaria

The RBM Initiative aims to reduce the global malaria burden through the use of evidence-based interventions and to strengthen health systems. Current malaria control strategies are based on:

• early diagnosis and effective treatment of malaria cases;
• prevention through vector control measures and, in some particular situations, chemotherapeutic measures;
• prevention and control of epidemics.

In most areas of Africa where malaria transmission is rated from moderate to intense, control strategies are based on a combination of three core interventions:

1. Access to prompt and effective treatment.
2. Universal use of insecticide-treated nets (ITNs), with priority to young children and pregnant women.
3. Intermittent preventive treatment (IPT) with at least two full doses of an effective, safe antimalarial drug in the second and third trimesters of pregnancy.

The Abuja Malaria Summit in 2000 aimed to strengthen national health systems, with the following goals and targets by the year 2005:

• 60% of malaria patients have access to appropriate treatment within 24 hours of onset of symptoms;
• 60% of children and pregnant women are protected from malaria using ITNs;
• 60% of pregnant women have access to appropriate malaria chemoprophylaxis/ intermittent preventive treatment.

The Millennium Development Goals (MDGs) were agreed in 2000. The goals and targets specific to malaria are:

• Goal 6: Combat HIV/AIDS, malaria and other diseases.
  • Target 7: Have halted by 2015 and begun to reverse the spread of HIV/AIDS.
  • Target 8: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases.

In spite if all these well defined goals and targets, most countries could not attain the RBM, Abuja targets and MDGs targets may within the expected time unless the magnitude and rate of antimalarial interventions are significantly enhanced, with coverage reaching all vulnerable populations. Some countries may benefit from intensification of interventions using existing systems and outlets to accelerate scaleup and ensure achievements in the intended period of time.

In Africa, south of the Sahara, both Expanded Programme on Immunization (EPI) and Antenatal Care (ANC) services routinely and continuously reach substantial proportion of their target populations (infants, young children and pregnant women; DPT3 61%, 2003¹; 70% of pregnant women²). Both traditionally provide free services, and both aim for high population coverage. In addition, EPI has long advocated a dual-track approach through supplementary immunization activities (SIAs), where applicable, to rapidly achieve high population coverage while maintaining and strengthening routine immunization activities to sustain that coverage.

For example, in Madagascar, using the expanded programme on immunization (46% dtp3 coverage) to distribute free or subsidized ITNs would maximize ITNs coverage within a few years.

Using the antenatal care (ANC) programme, the provision of Intermittent Prophylactic Therapies (IPT) country could reach up to 63% of the pregnant women at risk of acquiring malaria during pregnancy within one year. Using the measles campaign to distribute ITNs to children aged under 5 years of age would ensure significant coverage among young children (who constitute 18% of the population).

¹ WHO Immunization Assessment and Monitoring, Global and regional data and statistics. Geneva. (based in data for 2003 available on this site)
² WHO/UNICEF. The Africa malaria report, 2003. Geneva. français   |   português