Malaria is an acute infectious disease caused by the parasites called
Plasmodia and spread by the the vector, the female anopheles mosquito. Control of this
dreaded menace would therefore involve three living beings: Man (The host), Plasmodia (The agent), and Anopheles mosquito (The vector). And due to this reason alone, control of
malaria is a formidable task. The international efforts on malaria control were highly
successful in the late 50's and early 60's. However, due to various reasons, the malaria
control programmes received setbacks all over the world and today it has come back with a
vengeance. Control of malaria is possible only by concerted community efforts. Relying
only on the government machinery for the control of this problem will only heighten the
Malaria control measures:
Conference held in October, 1992 at Amsterdam evolved a Global Strategy for Malaria
Control. The strategy broadly suggests de-emphasis on vector control and renewed emphasis
on treatment. Early diagnosis and treatment; prevention of deaths; promotion of personal
protection measures like use of ITMs; epidemic forecasting, early detection and control;
monitoring, evaluation and operative research and integration of activity in Primary
Health Centres are the salient aspects of this strategy.
The control of malaria involves control
of 3 living beings and their environment. Man, the host is a moving target and can take
the disease with him to far and wide. Mosquitoes are moving, highly adaptable and have
shown resistance to insecticides. It is therefore important to target non-flying eggs and
larvae. The parasite also is highly adaptable, hides in humans and mosquitoes and has also
developed resistance to drugs. Therefore, for effective malaria control, target man first,
control mosquitoes next and keep trying to tackle the parasite with development of
effective drugs and vaccines.
Control of malaria is a complex chain of measures that often complement
one another. The diagram on the left depicts this control chain: For example, by taking
personal protective measures, three things can be achieved - prevention of malaria in the
given individual, thus reduced parasite load and reduction in spread, and by denying blood
meal to the mosquito the egg laying is also hampered! In the recent years, more emphasis
is being laid on early diagnosis and treatment, on personal protection especially with
insecticide treated bednets and on biological vector control. By these means, it is
intended to minimise use of potentially harmful chemical insecticides.
Treat the affected
Protect the unaffected
Kill the asexual forms
Prevent the progression of disease
Kill the sexual forms
Prevent the spread to mosquitoes
Ensure full treatment
Problem: Drug resistance
Problems: Resistance to insecticides;
Man's Role in Malaria
Control: Man is the most important link in the malaria control chain. He can be made
to understand the problem and he can help in breaking the chain at multiple points.
Therefore great emphasis should be laid on educating the people about malaria and its
control, so that common people can effectively contribute in controlling this disease.
This includes education of doctors about the need for early diagnosis and prompt treatment
Early diagnosis and
treatment - treat early to reduce parasite load, hence spread; prevent deaths
Treat completely to
prevent spread and relapse
Ensure compliance with
prevent malaria by using bed nets, insecticide sprays etc., and by chemoprophylaxis.
Seek his help in mosquito
1. Early diagnosis and
treatment: This is a very important aspect of malaria control. In fact, early
detection and treatment of the disease itself is enough to control this epidemic in its
early stages. By this, the parasite load in the community is reduced, thereby reducing the
transmission of the disease.
of all cases of fever is very important. Tests for malarial parasite should be done in all
cases of fever, and presumptive treatment with first full dose of chloroquine should be
administered. Chloroquine is highly effective as schizonticidal against all species of
malaria and is also gametocytocidal against all except P. falciparum. Thus, by
administering chloroquine to all cases of fever, it is possible to sterilize the
gametocytes and thus prevent the spread to mosquitoes.
Whenever resistance to
chloroquine is known or suspected, second line anti malarials should be used to treat
P. falciparum malaria.
2. Radical treatment:
All confirmed cases of fever should be administered radical treatment with primaquine. A
single dose of primaquine must be administered in P. falciparum malaria to sterilize the
gametocytes. A 14 days course of primaquine should be administered in P. vivax infection
to destroy the hypnozoites in the liver and thus to prevent relapse.
3. Ensure compliance: Complete
treatment should be ensured. If the patient vomits the drugs within an hour of ingestion,
the same should be repeated. Incomplete treatment fails to clear the parasitemia and
thereby aids spread. Many patients fail to complete the treatment due to either
negligence, lack of proper education or sometimes due to adverse effects.
4. Personal protection:
Man should be encouraged to protect himself against malaria. Personal protection measures
include protection against mosquito bites and chemoprophylaxis against malaria.
mosquito bites: People living in endemic areas as well as travelers to such areas
should be educated and encouraged to use protective measures against mosquito bites. These
include closing the doors and windows in the evenings to prevent entry of mosquitoes into
human dwellings; using mosquito repellant lotions, creams, mats or coils and regular use
of bednets. Using bednets is one of the safest methods of preventing and controlling
malaria. Now Insecticide Treated Bednets are available and it has been found in various
studies that use of these ITMs leads to a 19% reduction in child mortality and 40-60%
reduction in infection.
As mentioned above,
protection against mosquito bites, especially the use of mosquito nets, has a spiraling
effect on malaria control. By this measure, blood meal is denied for the female mosquito
and this prevents development of eggs and hence a reduction in mosquito population and
For more details See Mosquito Control
to endemic areas and high risk individuals living in endemic areas (pregnant, elderly,
patients with end organ failure) should be started on chemoprophylaxis against malaria.
This involves taking antimalarial drugs every week (some drugs may have to be taken
everyday) so as to suppress malaria.
For details See Chemoprophylaxis