Malaria Epidemiology & Prevention

8/13/2019 Malaria Epidemiology & Prevention

1/92


2/92

Malaria Epidemiology,

Surveillance and Prevention Guided by

Dr. S. B. Bansal

Dr. Amit Gharia

Group 22

Sunil Chawrasia

Sushila Chouhan

Susheel Soni Shoubhik Banerjee

Surrendra Singh

Sunil Desai


3/92

INTRODUCTION

A protozoal disease.

Caused by infection of parasite of genus plasmodium

Transmitted to man by certain species of infected

Anopheles Mosquito

Typical attack- cold stagehot stage

sweating stage

Clinical Feature depends on-sp. Of parasite

-pt. state of immunity

-intensity of infection

-presence of concomitant condition


4/92

BURDEN OF MALARIA IN INDIA

YEAR CASES(million)

Deaths

2005 1.82 963

2006 1.76 1703

2007 (up toNovember)

1.29 996

STATES/UTs POPULATION % MALARIA % Pf % Death %

N.E State 3.79 12.55 18.31 55.08

Jharkhand 2.60 11.36 6.23 0.27

Chhattisgarh 2.16 6.59 10.29 0.13

Orissa 3.61 22.52 43.34 17.01

TOTAL 12.16 53.02 78.60 72.49


5/92

PREVALENT MAJOR

EPIDEMOLOGICAL TYPES OFMALARIA

Tribal malaria

Rural malaria

Urban malaria

Malaria in projected areas

Border malaria


6/92

TRIBAL MALARIA

In tribal areas of Andhra Pradesh, MadhyaPradesh, Chhattisgarh, Gujarat, Maharashtra,Bihar, Jharkhand, Rajasthan & North eastern states

Contributes to about 50% cases of P.falciparum High risk to infants, young children ,pregnant

women

Factor responsible:-Limited health infrastructureLack of drugs at village level


7/92

RURAL MALARIA

Irrigated areas of arid and semiarid areas ofHaryana, Punjab, West U.P, parts of M.P &Rajasthan, plains of Orissa, Andhra Pradesh, Tamil

Nadu Malaria is moderate to low endemicity

An.culicifacies is the main vector

P.vivax is predominant during lean period &P.falciparum during periodic exacerbation

In this areas health infrastructure is moderatelydeveloped


8/92

URBAN MALARIA

In major cities:-Delhi ,Mumbai ,Chennai, Kolkata,Hyderabad, Bangalore

, Ahmadabad, Bhopal, Jaipur, Lucknow, Chandigarh,Kanpur.

An.stephansi is main vector

P.vivax is predominant &P.falciparum in focal

transmission


9/92

MALARIA IN PROJECTED AREAS

Areas where construction & development activities aretaken up and temporary aggregation of labourers takeplace.

This bring different strains of malaria parasite in thenon immune population.

More than one vector is usually involved


10/92

BORDER MALARIA

These are high malaria transmission belts along theinternational and national border.

Problem in regard to malaria control due to mixing ofpopulation and poor administrative control.


11/92

EPIDEMIOLOGICAL DETERMINANTS1. AGENT FACTOR

2. HOST FACTOR

3. ENVIROMENTAL FACTORa. Climate

b. Vector


12/92

1. Agent

2. Reservoir of infection

3. Period of communicability


13/92

AGENT

4 species of plasmodiumP.vivax :-70% cases in India

P.falciparum :-25-30% cases

P.malariae :-< 1% cases

P.ovale :- very rare (Tumkur & Hassan districtin Karnataka


14/92

LIFE CYCLE OF AGENT

2 developmental cycles1. Human cycle (asexual phase)

2. Mosquito cycle (sexual phase)

-Definitive host :- Mosquito

-Intermediate host :- Man


15/92

ASEXUAL CYCLE

/ENDOGENOUS/SCHIZOGNY

Infective stage to man :--sporozoite

4 phases;-1. Pre-erythrocytic phase

2. Erythrocytic phase

3. Gamatogony

4. Exo-erythocyic phase


16/92

PRE-ERYTHROCYTIC PHASE

Sporozoite infect liver cell forms hepatic schizonts

In P.falciparum-1 sporozoite-40,000 merozoiteOthers -1 sporozoite -2,000-15,000 merozoite

merozoite


17/92

Merozoite specific receptors of RBC Ringtropozoite

schizonts immature schizonts maturetropozoite

Cycle is repeated again and again.

Duration of erythrocytic cycle

P .malariae- 72.hours

others- 48 hours


18/92

-In all species of malaria some of erythrocytic formsdo not divide but forms male & female gamatocyte.

-This are sexual form of parasite.

-They are infective form to mosquito.

Ring tropozoite microgamatocyte infective to

macrogamatocyte mosquito


19/92

Infective form gametocyte stage

Microgametocyte exflagellation 4-8microgamete

Macrogametocyte macrogamete

zygote

ookinete

oocyst

sporozoite

-Time period from gametocyte to sporozoite formation

10-20 days(Extrinsic incubation period)


20/92

Resemble Pre-erythrocytic cycle.

Some sporozoite does not undergo multiplication but

enter a stage of resting (dormant) phase.These resting parasite are called HYPNOZOITE.

After a period they get activated and releasemerozoite.

Cause relapse of fever.

Not found in P .falciparum , so no relapse infalciparum malaria.


21/92


22/92

RESERVIOR OF INFECTION

Animal reservoir ;- chimpanzees in tropicalAfrica

Human reservoir ;- one who harbours thesexual form of parasite

Condition for reservoir

1. Person must harbour both sex of gametocyte in blood.

2. Gametocyte must be mature

3. Gametocyte must be viable4. Gametocyte must be present in sufficient density to

infect mosquito at least ;-12 /cu.mm of blood


23/92

PERIOD OF COMMUNICABILTY

Malaria is communicable as long as mature viablegametocyte exist in circulating blood in sufficientdensity to infect mosquito.


24/92

RELAPSE

In P.vivax & P.ovale infection the parasite may survivefor long periods in dormant exo-erythrocytic stage ashypnozoites in liver cells.

Reactivation of hypnozoites leads to initiation of fresherythrocytic cycle and new attack of fever.

Usually from 24 weeks to 5 years after the primaryattack .

P vivax & ovale - 2-3 years


25/92

RECRUDESCENCE

After a number of paroxyms the primary attacksubsides due to partial immunity.

The parasite however is not eliminated but persistin some erythrocyte though the level ofparasitaemia is below the threshold level.

Erythrocytic schizogony continues in body at lowlevel and gradually the number of parasite buildup to cross threshold level

This causes new attack after a period of latency.

Occurs in P.falciparum & P.malariae


26/92

HOST FACTORS

1. Age2. Sex3. Race4. Pregnancy5. Socio-economic development6. Housing

7. Population mobility8. Occupation9. Human habits10. Immunity


27/92

1. AGEAffects all age group

New born infants have considerable resistanceto infection with falciparum due to highconcentration of foetal Hb during few months oflife

2. SEX

Male > Female

Males are more exposed to out door activityFemales in India are better clothed


28/92

3. RACE

Sickle cell trait ;- mild illness with falciparumDuffy negative ;-resistant to vivax infection

4. PREGNANCY

Increase the risk of malaria

May cause intrauterine death of foetusCause premature labour or abortion


29/92

5. POPULATION MOBILITY

Labours connected with engineering ,irrigation

,agricultural & other project and migration ofnomads may import malaria parasite in theirblood & reintroduce malaria in areas wheremalaria have been controlled or eliminated.

6.OCCUPATION

Malaria is predominantly a rural disease and is

closely related to agriculture practices


30/92

7. SOCIO ECONOMIC DEVELOPMENT

A disease of low socio economic areas

Malaria disappeared from developed country as a resultof socio economic development.

8. HOUSING

The ill ventilated and ill-lighted houses provide ideal indoor resting place for mosquito

So, proper housing is major control measure


31/92

9. HUMAN HABITSSleeping outside doors.

Nomadism.Refusal to accept spraying of housing.Replastering of walls after spraying .Not using measures of personal protection.

All the above factors increase the risk of malaria.

10. IMMUNITYImmunity is accquired after repeated exposure for several years.

In endemic areas a state of collective immunity is established slowly. So, infants and travellers from non-endemic areas are main suffers. Immune mother transfer IgG antibody that infants for 3-5 months. Active immunity is species specific. Immunity usually declines after leaving endemic areas.

Both humoral &cellular factors play a role in protection


32/92


33/92

ENVIRONMENTAL FACTORS It is divided into parts:-

a. Climate

b. Vector

A. Climate :- This include

1. Season2. Temperature

3. Humidity

4. Rainfall5. Altitude

6. Man made malaria


34/92


35/92

3.Humidity:

-Direct effect on the life of the mosquito.

-It has no effect on the parasite.-A relative humidity of 60% is necessary formosquitoes to live their normal lifespan.

-When the relative humidity is high, mosquitoes aremore active & feed more voraciously.

-If the humidity is low mosquitoes do not live long.

4.Rainfall:-

-It provides opportunities for the breeding ofmosquitoes and may give rise to epidemics ofmalaria.

-It also increases humidity which is necessary for thesurvival of mosquitoes.


36/92

5.Altitude:-

High altitudes unfavourable for mosquitoes.

6.Man Made Malaria:-

These are:-

-Burrow Pits

-Garden Pools

-Irrigation Channels

-Engineering Projects


37/92

VECTOROut of 51 species of Anopheles only 9 causes malaria

-An. Culicifacies:- rural areas

-An. Stephensi:- urban areas

-An. Fluvitalis:- Hills & Foot hills areas

-An. Minimus:- Hills & Foot hills areas-An. Philippinensis:- Planes of West Bengal &

North East India

-An. Sundaic:- Eastern costal areas

-An. Annularis:- Andman & Nicobar-An. Varuna:- Hills & Foot hills of eastern ghat

-An. B balabacensis:- Forest area of North East India


38/92

IMPORTANT VECTOR FACTORS

1.Density

2.Life span

3.Breeding habits

4.Resting habits5.Resistant to insecticide

6.Choice of host

7.Biting time

8.Vectoral capacity


39/92

1.Density-

- Critical density:- density below which the effectivetransmission not occur.

-It is vary from species to species.

-High density required- An. culicifacies

- Low density required- An. fluviatilis

2.Life Span-

It is the key factor in the transmission of malaria.

-The vector mosquitoes must live at least 10-12daysafter an infective blood meal.

-The strategy in malaria eradication is to shorten thelife span of mosquitoes to


40/92

3.Breeding habits:-

It varies from species to species.

-Moving water An. Fluvitalis-Brackish water - An.Sundaicus

-Wells & overhead tanks-An.stephensi

It is required for conducting anti-larval operation.

4.Resting habits:-

Endophily-those mosquito resting indoor.

Exophily- those mosquito resting outdoor.

These forms the basis the of Anti-adult measures.

R i t t i ti id


41/92

5.Resistance to insecticides:-It is necessary for the choice of insecticide to beused.

6.Choice of host:-Some mosquitoes prefer human blood, some animal blood &

some show great variation in their feeding habits.

7.Biting time:-Majority of Indian mosquitoes bite after eveningthroughout the night.

8.Vectoral capacity:-

It refers to the combine effect of :--Density of vector population-Susceptibility to infection-Probability to feed on man

-Life span


42/92

MODE OF TRANSMISSION

Two types-A)VectoralB)Non-Vectoral

A. Vectoral Transmission-

Malaria is transmitted by certain infected species ofAn.mosquitoes.

Important factors for transmission are--Adequate life span-Preference to human host

-Tendency to reside around human population-Should be in sufficient density to maketransmission chain-Environmental factors like temp., humidity, rainfall


43/92

B) Non-Vectoral Transmission-

-Blood transfusion

-Sharing infected needles

-Transplacental or vertical


44/92

INCUBATION PERIOD

This is the length of time between the infective mosquito

bite and the first appearance of clinical sign of whichfever is most common.

P.Falciparum-9-14 days

P.Vivax- 12-17 days

P.Ovale- 16-18 daysP.Malariae- 18-40 days


45/92

PRE-PATENT INCUBATION PERIOD:-

It is the time between the inoculation of parasiteinto human being & appearance of 1st parasite in blood .

PROTRACTED INCUBATION PERIOD:-In some strains of P.vivax a period of latencyis observed when incubation period isprolonged to 8 -10 months


46/92

CLINICAL FEATURES

-The primary fever corresponds to the development ofparasites in the RBC.

-The peaks of fever coincide with the release ofmerozoites into the blood stream.

The typical attacks comprises three stages-

1.Cold stage-

-The onset with lassitude, headache, nausea, chillysensation associated with rigors.-This stage lasts for about an hour.


47/92

2.Hot stage-

Patient feels burning hot & casts off his clothes.The skin is hot and dry to touch.

Headache is intense but nausea diminishes.

This stage lasts for 2-6 hours.

3.Sweating stage-

Fever comes down with profuse sweating.

Temp. drops rapidly to normal & skin become cool & moist.This stage lasts for 2-4 hours.


48/92

COMPLICATIONS

1.P.Falciparum--Cerebral malaria-Acute renal failure

-Liver damage-GIT symptoms

2.P.Vivex, Ovale & Malariae--Anaemia

-Splenomegaly-Herpes


49/92


50/92

WHAT IS SURVEILLANCE ?

Surveillance means to watch over with greatattention ,authority & often with suspicion.

DEFINITION

The surveillance can be defined as continuousscrutiny of the factor that determine the occurrence

and distribution of disease and other condition ofill health.


51/92

OBJECTIVE OF SURVEILLANCE

1. To provide information regarding new andchanging trends in the health status of apopulation.

2. To provide feedback regarding on going controlprogram.

3. To provide timely warning of health disaster.

The ultimate objective of surveillance isprevention.


52/92

WHY NEED SURVEILANCE

The surveillance is needed for :-

1.Effective control and prevention.

2.For collection, analysis, interpretation

& distribution of relevant data foraction.

The main purpose of surveillance is to detectchanges in trends and distribution in order toinitiate investigative and control measure.


53/92

SURVEILLANCE OF MALARIA- IN

MPO The Modified plan of operation (MPO) under the

NMEP came into force from 1st April 1977. Surveillance is an integral part of MPO.

For better control and stabilise the malariasituation in the country, endemic area arereclassified again according to API.

- area with API >2

-area with API 10 or


54/92

SURVEILLANCE IN MALARIA

Surveillance of malaria is aimed at case detectionthrough laboratory services and providing facilities forproper treatment.

Collection and examination of blood smear is a key

element in MPO.

If all the detected cases are given radical treatment, itwill lead to depletion of the human reservoir.


55/92

TYPES OF MALARIA SURVEILLANCE

It is of two types

Active surveillance

Passive surveillance


56/92

ACTIVE SURVEILLANCE Carried by-surveillance workers (or MPW )

Norms -

-For normal area10,000 population / 2000 houses

-1 surv.worker /MPW

For 4 surv. Worker/MPW -1surv.Inspecter (health assistant)

-For terrain area8000 population-1 surv. Worker/MPW

For 4 surv.workers /MPW -1surv.Inspecter(health assistant)

FORTNIGHTLY DOMICILIARY


57/92

FORTNIGHTLY DOMICILIARYVISITS

The surv.worker/MPW will visit each house in his area once a fortnight& enquire whether-

1.there is a fever case in house .2.there was a fever case in the house between his previous visit

and present visit.

If the answer to either of these question is yes

-MPW collects a blood film (thick & thin) on same slide &

presumptive treatment .-Make entries in house card about his visit.

-Dispatch the blood slides at least twice a week to the unit


58/92

-Dispatch the blood slides at least twice a week to the unitlaboratory (PHC) for microscopic examination.

-He also collects blood slide from the sub-centre and FTD &send to laboratory (PHC)

-Take report from laboratory (at least twice aweek).

-If report is positive for malaria parasite .

-MPWreturns to patientand administer a full course ofradical treatment for malaria.


59/92

PASSIVE SURVEILLANCE

The search for malaria cases by local agencies such as PHC ,sub-centre ,hospitals , dispensaries and local medical practioners.

In this patients voluntary report to the health agencies.

Those cases that escape by active search (MPW) are caught by theseagencies.

They collect blood smear from all fever cases and also from those withhistory of recent fever and give presumptive dose of malaria.

These collected slides are ,collected by MPW and send to unitlaboratory (PHC).

In next turn to laboratory the MPW collects report, if the report ispositive ,he goes to patient and give radical treatment.

PARAMETERS FOR MALARIA


60/92

PARAMETERS FOR MALARIASURVEILLANCE

By definition surveillance also implys thecontinuing scrutiny of all aspects of occurrenceand spread of disease that are pertinent to effective

control .

So ,in these also include the systematic collectionof data and evaluation of field investigations etc.

For epidemiological surveillance of malaria thefollowing parameters are used -

IN PRE ERADICATION ERA


61/92

IN PRE-ERADICATION ERA

1. Spleen rate-

- defined as %of children between 2-10 year ofage showing enlarged spleen.-it is a measure of endemicity of malaria in acommunity.

2. Infant parasite rate-

-% of infant showing malarial parasite in theirblood film.

-Most sensitive index of recent transmission ofmalaria in locality.

3.Parasite rate

-% of children between 2-10 years showingmalaria parasite in their blood films

4.Average enlarged spleen5.Proportional case rate


62/92

ERADICATION ERA

1.Annual parasite incidence (API)API= confirmed cases during 1 year 1000

population under surveillance

-It is based on active & passive surveillance.

-It measure malaria incidence in acommunity

2. Annual blood examination rate (ABER)

ABER- No. of slides examined 100population

-It is an index of operational efficiency.3.Annual falciparum incidence (AFI)

4.Slide positivity rate (SPR)

5.Slide falciparum rate (SFR)


63/92


64/92


65/92

Reduce vector mosquito population

Repel the vector mosquitoes

Form a barrier between vector andpotential host (personal protection)

Reduce the lifespan of vector mosquitoes

Reduce the lifespan ofpotentially infectedvector mosquitoes


66/92

Epidemiological situation and risk factors Appropriate for controlling the specificvector species, given its breeding , flight and

resting, behavior Simple to understand and apply Affordable and based on locally availableresources (equipment , consumable supplies,

and technical skills) Acceptable and compatible with localcustoms and practices (postemergency phase) Safe for the user and the environment


67/92

VECTOR CONTROL

CHALLENGES

Resources and infrastructure

Insecticide resistance

Inadequate surveillance

Mosquito species complexes


68/92

ANTI-LARVALMEASURES

oSOURCE REDUCTIONoCHEMICAL CONTROLBIOLOGICAL CONTROL

ANTI -ADULT MEASURES

oRESIDUAL SPRAYSoSPACE SPRAYS

oGENETIC CONTROL


69/92

PROTECTION AGAINST MOSQUITOBITES

oMOSQUITO NET

oSCREENING

oREPELLENTS


70/92

SOURCE REDUCTION :-COMPRISES

FILLING DITCHES, AREAS, PITS, LOW LYING AREAS,

STREAMLINING,

CHANNELISING,DESILTING,

DEWEEDING,

TRIMMING OF DRAINS,

WATER DISPOSAL AND SANITATION,EMPTY WATER CONTAINER ONCE IN A WEEK, ETC.


71/92

CHEMICAL CONTROL :-COMMONLY USED LARVICIDES ARE

I. Mineral oils

II. Paris green

III. Synthetic insecticides

Toxicants employed as larvicides

Toxicant Doses (g/ha)

Abate 56-112

Malathion 224-672

Fenthion 22-112

Chloropyrifos 11-16


72/92

Biological Control :-

Bilogical control of mosquito breeding through biologicalagents specially larvivorous fish and by larvicides.

The best known are:-

GAMBUSIA AFFINIS

LEBISTER RETICULATUS


73/92

2.ANTI-ADULT MEASURES

INDOOR RESIDUAL SPRAYING:-

Residual spraying with DDT was a major reason

for successes in malaria control of 1950s & 60s

Malaria eradicated or nearly eradicated from

many parts of the world at that timeHouse spraying remains a valuable tool for

malaria control under the right circumstances

However, large-scale ongoing application of

insecticides in this manner is not sustainable

due to financial and operational constraints and

development of insecticide resistance


74/92

INDOOR RESIDUAL SPRAYING ISAPPROPRIATE

WHEN...

A high percentage of structures in an operational

area have adequate sprayable surfaces, and can be

expected to be well sprayed The majority of the vector population in endophilic,

i.e. rests indoors

The vector is susceptible to the insecticide in use

In a given area, residual spraying can be targeted at

selected houses where the risk of transmission is

highest, e.g. those near important breeding sites


75/92

FACTORS TO CONSIDER IN SELECTION

OF RESIDUAL INSECTICIDES Residual effectiveness

Safety (LD50, environmental persistence,

bioaccumulation)

Vector susceptibility/Management of resistance Impact on disease

Excito-repellency

Costs

Acceptance (odor, visibility)


76/92

AEROSOL SPACE SPRAY :-

Space spraying of Pyrethrum extract(2%) in 50 houses inand around every malaria positive case to kill the infectivemosquitoes.

Involve the application of pesticides in the form of fog ormist using special equipment:-

ULV SPR YER THERM L FOG SPR YER


77/92

GENETIC CONTROL:-

GENETIC METHODS SUCH AS

STERILE MALE TECHNIQUE CYTOPLASMIC INCOMPATIBILITY

CHROMOSOMAL TRANSLOCATION

SEX DISTORTION

GENE REPLACEMENT

BEING CHEAPER AND POTENTIALLY MORE

EFFICIENT THAN CHEMICAL METHODS .


78/92


79/92


80/92

Many types of potential vaccine for controlling malariaare under are development.

TYPES OF MALARIA VACCINES

1)PRE-ERYTHROCYTIC VACCINES

2)ASEXUAL BLOOD STAGES VACCINES3)SEXUAL STAGES VACCINES


81/92

1. PRE-ERYTHROCYTIC VACCINE

They are developed to prevent infection and

impact of disease

2. ASEXUAL BLOOD STAGE VACCINE

-Based on antigens derived from the bloodstages of P.falciparum present in man

o -Designed to reduce severe and complicated

manifestation of disease

o

-They could lower morbidity and mortality,aparticularly high risk group


82/92

3. SEXUAL STAGE /TRANSMISSION BLOCKINGVACCINE

oThus Designed to arrest the development of the

parasite in mosquito.

oReduce or eliminate transmission of the disease


83/92

Stage ofPlasmodium Antigens Salient features

Pre-erythnocytic Circum Sporozoite Protein (CSP)

, Liver stage Antigens -1 (LSA-1)

-Stage/species specific;-antibody blocks infection of

liver;

- large immunising dose required;can abort an infection

Merozoite andErythrocytes

Erythrocyte Binding Antigen,Merozoite Surface Antigen 1&2 (MSA-

1&2);Ring Infected Erythrocyte Surfacentigen (RESA)

Serine Repeat Antigen (SERA) ApicalMembrane Antigen-1 (APM-1)

-Specific for species and stage; --

Cannot abort an infection;Prevents invasion of erythrocytes,-thus reducing severity oinfection


84/92

Gametocytes & gametesPfs 25,,Pfs 230

-Prevents infection ofmosquitoes;

-antibody to this antigenprevents either fertilizationor maturation ofgametocytes,zygotes orookinetes-antibody blockstransmission cycle

Combined vaccine (cocktail)

SPf 66 (based on pre-

erythrocytic and asexual bloodstage proteins of Pf)

-Based on incorporation ofantigens from different stagesinto one vaccine to produce an

immune response,- blocking all stages of theparasite development


85/92

Recombinant Vaccine:

Against P. vivaxblood stage infection .Combination of malarial antigens with immune boostingadjuvant and hepatitis B surface antigens have been reported.

Gamete Vaccine:When the antibodies are taken up by the mosquitoes, gametesescaping the RBCs will be neutralized, thus preventingfertilization and reducing transmission.

DNA Vaccine:Based on a synthetic gene, made by adding 21 epitopes of 9different antigens present in P. faciparum.Example - Pf 155/RESA (Ring Infected Erythrocyte Surface

Antigen).


86/92

Problems in vaccine production including not beingable to grow the parasite in large quantities.

Difficulty of evaluation.

Complexity of conducting clinical and field trials.

Mutation of the parasites.

Multiple antigens, specific to species and stage.

CONCLUSION


87/92

CONCLUSION-Sporozoite vaccines generated by recombinantDNA technology, combined with potent T-cellepitopes for higher immunogenecity seem toinhibit early liver-stages of the parasite .

Blood stage antigens combined with Freund's adjuvant or

other immunoboosters may generate effects resemblingchloroquine chemoprophylaxis.

Merozoite vaccines get longer time to interact with theirtarget than the transiently appearing sporozoites in case

of sporozoite vaccines.

Gamete vaccines hold promise for future where in antibodieswhen taken up by the mosquitoes will neutralise the gametes

escaping RBCs, thus preventing fertilization.

.


88/92

Can be motivated at 2 levels

1. Individual /Family level2.Community level


89/92

INDIVIDUAL PROTECTION AGAINSTMOSQUITO BITES:-

By preventive measures such as the use of-

Repllents

Protective clothing

Bed nets

Mosquito coils

Screening of house


90/92

1. HEALTH EDUCATION-Educate the people to wear full sleave cloths.

-Avoid outdoor sleeping.

-Do not allow water to collect in the

sourroundings eg. In tyresin coconut shells

2.COMMUNITY PARTICIPATION

- There is no standing wastewater around water pointsor elsewhere in the settlement.

- Promotion for insecticidal spray in community.


91/92


92/92

Thank You

Malaria Epidemiology & Prevention

Documents

Transcript of Malaria Epidemiology & Prevention