Conquering Malaria

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Conquering Malaria

• Joel G. Breman, MD, DTPH
• Fogarty International Center
• National Institutes of Health
• Improving Population Health Workshop
• Instituto Nacional de Salud Publica (INSP)
• Cuernavaca, Mexico
• 21 22 June 2003

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Conquering Malaria

• Burden
• Ecology and manifestations
• Successes
• Control
• Research and training

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Burden
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The Global Burden of Malaria

• 1.5 2.7 million deaths annually
• Over 1 billion clinical episodes
• 300 500 million people infected
• Every 10 - 30 seconds a child dies of malaria

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Ecology and Manifestations
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Malaria Ecology

• Intrinsic and Extrinsic Factors

EXTRINSIC
Control and prevention measures
Social, behavioral, economic and political
factors
Human
INTRINSIC
Parasite
Mosquito
Environmental conditions
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Malarias Toll Major Intrinsic Components

• Plasmodium falciparum
• Anopheles gambiae

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Malaria Ecology and BurdenClinical Manifestations
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MARA/ARMA Model of Malaria Transmission, 2003
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Successes
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Successes Vector Control

• 1899-1914, multiple demonstrations of control by
  reduction of Anopheline larvae and adults
• 1899, Sierra Leone (antilarval) Cuba
  (large-scale) Malaysia (antilarval)
• 1904-1914, Panama Canal Zone control by
  larviciding, large-scale environmental
  modification
• 1927, elimination of A. albimanus in Barbados
  (first area-wide success with invading species)

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Successes Vector Control (2)

• 1935-1939, use of pyrethrum spraying in South
  Africa, Netherlands and India
• 1939-1957
• 1939-1940, Elimination of A. gambiae from Brazil
  and upper Nile, Egypt, 1942-1945
• 1946-1957, Interruption of transmission by
  anti-mosquito measures in Cyprus, Sandinia,
  Guyana, Venezuela and Greece indoor residual
  spraying with DDT, a new major strategy

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Successes Personal Protection (3)

• 1987-2003
• Multiple projects and programs using
  insecticide-impregnated bed nets demonstrating
  overall mortality reduction and decrease in
  several malaria indices

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Control
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Vector Control

• Drainage and filling urban
• Chemical and biological larvicides
• Indoor residual insecticide spraying
• Outdoor residual insecticide spraying
• costly and effective

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Personal protection (2)

• Insecticideimpregnated materials
• nets, curtains, clothing
• House screening
• House location
• Repellents
• Fumigants
• Cost-effective for low-income countries

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Antiplasmodial (3)

• Patient management early diagnosis, treatment,
  referral, education
• Chemoprophylaxis
• Intermittent treatment (pregnancy)
• Radical therapy for relapses (P. vivax, P. ovale)
• cost effective

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Social Action (4)

• Mobilization of individual, family, community
• Health education
• Management Effectiveness
• Health systems access, use, quality
• Leadership policies, strategies, tactics
• Surveillance of infection and disease
• Monitoring and evaluation of programs

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Research and Training
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Research, Training, and Support Needs According
to Understanding of Diseases and Efficacy of
Control Methods
High
High
Training
Efficacy of Control Methods
Research Needs
Low
Low
Some
High
Moderate
Research Support Needs
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Research, Training, and Support Needs According
to Understanding of Diseases and Efficacy of
Control Methods
High
High
Training
Efficacy of Control Methods
Malaria Dengue HIV/AIDSTuberculosisEbola/Marbur
g InfluenzaCancersAlzheimers
SmallpoxGuinea wormPoliomyelitisH. influenzae
type BMeaslesTetanus
Research Needs
Low
Low
Some
High
Moderate
Research Support Needs
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Research Agenda

• Pathogenesis
• Drug development
• Immunology and vaccine development
• Diagnostics
• Entomology
• Recent genetic breakthroughs

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Conquering Malaria For More Information
MIM http//mim.nih.gov RBM http//www.who.int
DCPP http//www.fic.nih.gov/dcpp/ Joel
Breman jbreman_at_nih.gov