PUBLIC HEALTH PUBLIC HEALTH IMPORTANCE AND IMPORTANCE AND

CONTROL MEASURES CONTROL MEASURES IN MALARIAIN MALARIA

APPROACHES TO MALARIA APPROACHES TO MALARIA CONTROLCONTROL

• A. MANAGEMENT OF MALARIA A. MANAGEMENT OF MALARIA CASES IN THE COMMUNITYCASES IN THE COMMUNITY

• B.ACTIVE INTERVENTION TO B.ACTIVE INTERVENTION TO CONTROL MALARIA CONTROL MALARIA TRANSMISSION IN THE TRANSMISSION IN THE COMMUNITYCOMMUNITY

A. MANAGEMENT OF A. MANAGEMENT OF MALARIA CASESMALARIA CASES

• 1. CASE DETECTION1. CASE DETECTION

• 2.TREATMENT2.TREATMENT

• 3.MASS DRUG ADMINISTRATION3.MASS DRUG ADMINISTRATION

CASE DETECTIONCASE DETECTION

• ALL FEVER CASE ATTENDING TO ALL FEVER CASE ATTENDING TO PHC/DISPENSARIES /HOSPITALS PHC/DISPENSARIES /HOSPITALS SHOULD BE PRESUMED TO BE SHOULD BE PRESUMED TO BE SUFFERING FROM MALARIASUFFERING FROM MALARIA

TREATMENTTREATMENT

• CHLOROQUINECHLOROQUINE-1-1STST LINE OF DRUG LINE OF DRUG

1.VIVAX - CHL - 25 MG/KG 1.VIVAX - CHL - 25 MG/KG BW(3 BW(3 DAYS)DAYS)

PRIM -0.2 MG/KG BW PRIM -0.2 MG/KG BW (14 (14 DAYS)DAYS)

• 2.FALCIPARUM2.FALCIPARUM

-25MG/KG BW(3 DAYS)-25MG/KG BW(3 DAYS)

-PRIMAQUINE 0.7 -PRIMAQUINE 0.7 MG/KG(1MG/KG(1STST

DAY)DAY)

3.CHL- RESISTANT FALCIPARUM 3.CHL- RESISTANT FALCIPARUM MALARIAMALARIA - ARTESUNATE - ARTESUNATE COMBINATION COMBINATION THERAPYTHERAPY

-QUININE-QUININE

UNCOMPLICATED UNCOMPLICATED MALARIAMALARIA

• 1 .CHLOROQUINE1 .CHLOROQUINE DAYDAY CHILCHILDRENDREN

ADULADULTSTS

11 10MG10MG/KG/KG

600M600MGG

22 10MG10MG/KG/KG

600M600MGG

33 5MG/5MG/KGKG

300 300 MGMG

• 2. PRIMAQUINE -P.FALCIPARUM2. PRIMAQUINE -P.FALCIPARUM

ABOVE 15 YEARS - 45 MG ABOVE 15 YEARS - 45 MG SINGLE SINGLE

DOSE ON DOSE ON DAY 1DAY 1 LESS THAN 15 LESS THAN 15 YEARS-7.5 -30 MGYEARS-7.5 -30 MG

P.VIVAX-P.VIVAX-

ABOVE 15 YEARS-15MG ABOVE 15 YEARS-15MG DAILY DAILY DOSE DOSE FOR 14 DAYSFOR 14 DAYS

LESS THAN 15 YEARS -2.5-10 LESS THAN 15 YEARS -2.5-10 MGMG

• 3.ARTSUNATE 3.ARTSUNATE +SULPHADOXINE+PYRIMETHAMINE+SULPHADOXINE+PYRIMETHAMINE

ADULTS (ABOVE15 YRS)ADULTS (ABOVE15 YRS)

AS-4 TABS ON 1,2,3 DAYSAS-4 TABS ON 1,2,3 DAYS

SP-3 TABS ON DAY 1SP-3 TABS ON DAY 1CONTRAINDICATION-PREGNANCYCONTRAINDICATION-PREGNANCY

SEVERE AND SEVERE AND COMPLICATED MALARIACOMPLICATED MALARIA

• 1 . QUININE INJ –1 . QUININE INJ –-10MG/KG I.V DRIP IN 5% -10MG/KG I.V DRIP IN 5% DEXTROSE SALINE TO BE DEXTROSE SALINE TO BE

RUN RUN OVR 4 HRSOVR 4 HRS

2.ARTESUNATE -2.ARTESUNATE --2.4 MG/KG BW I.M OR I.V -2.4 MG/KG BW I.M OR I.V

FOLLOWED BY 1.2 MG/KG BW AFTER FOLLOWED BY 1.2 MG/KG BW AFTER 12 HRS, THEN 1.2 MG/KG BW ONCE 12 HRS, THEN 1.2 MG/KG BW ONCE DAILY FOR 4 DAYSDAILY FOR 4 DAYS

• 3.ARTEMETHER3.ARTEMETHER

-1.6MG/KG BW I.M -1.6MG/KG BW I.M FOLLOWED BY 1.6MG/ KG BW FOLLOWED BY 1.6MG/ KG BW DAILY FOR 4 DAYS DAILY FOR 4 DAYS

4.ARTETHER4.ARTETHER

-150MG DAILY I.M FOR 3 -150MG DAILY I.M FOR 3 DAYS DAYS

• 5.ARTEMISININ5.ARTEMISININ

-10MG/KG BW AT 0 & 4 -10MG/KG BW AT 0 & 4 HRS FOLLOWED BY 7 MG/KG BW HRS FOLLOWED BY 7 MG/KG BW AT 24,36,48,60 HRSAT 24,36,48,60 HRS

SIDE EFFECTSSIDE EFFECTS

• CNS -BLURRING OF CNS -BLURRING OF VISION,HEADACHE,RETINAL VISION,HEADACHE,RETINAL

DAMAGEDAMAGE• GIT -CRAMPS, NAUSEA, GIT -CRAMPS, NAUSEA,

VOMITINGVOMITING

• CVS –CYANOSISCVS –CYANOSIS

MASS DRUG MASS DRUG ADMINISTRATIONADMINISTRATION

• RECOMMENDE IN HIGHLY RECOMMENDE IN HIGHLY ENDEMIC AREASENDEMIC AREAS

• ANTI MOSQUITO MEASURES TO ANTI MOSQUITO MEASURES TO FOLLOWFOLLOW

• NOT RECOMMENDED IN NOT RECOMMENDED IN CHILDREN BELOW 5 YEARS -CHILDREN BELOW 5 YEARS -INTERFERE WITH INTERFERE WITH

DEVT. OF DEVT. OF PROTECTIVE PROTECTIVE

IMMUNITYIMMUNITY

-ACCELERATE DEVT -ACCELERATE DEVT OF DRUG RESISTANCEOF DRUG RESISTANCE

- INCREACE RISK - INCREACE RISK OF RETINOPATHYOF RETINOPATHY

CHEMOPROPHYLAXISCHEMOPROPHYLAXIS

• RECOMMENDE FORRECOMMENDE FORTRAVELLORS,SOLDIERS.POLICE,PREGTRAVELLORS,SOLDIERS.POLICE,PREGNANCYNANCY

• CHOLOQUINE -300MG ONCE A WEEKCHOLOQUINE -300MG ONCE A WEEK• PROGUANIL -200MG ONCE A DAYPROGUANIL -200MG ONCE A DAY

MEFLOQUINE ,QUINE, DOXY CYCLINEMEFLOQUINE ,QUINE, DOXY CYCLINE

ACTIVE INTERVENTION ACTIVE INTERVENTION MEASURESMEASURES

MOSQUITO CONTROL MEASURESMOSQUITO CONTROL MEASURES• ANTI LARVAL MEASURESANTI LARVAL MEASURES

-ENVIRONMENTAL -ENVIRONMENTAL CONTROLCONTROL

-CHEMICAL CONTROL-CHEMICAL CONTROL-BIOLOGICAL CONTROL-BIOLOGICAL CONTROL

• ANTI ADULT MEASURESANTI ADULT MEASURES-RESIDUAL SPRAYS-RESIDUAL SPRAYS-SPACE SPRAYS-SPACE SPRAYS-GENETIC CONTROL-GENETIC CONTROL

• PROTECTION AGAINST PROTECTION AGAINST MOSQUITO BITESMOSQUITO BITES

--MOSQUITO NETSMOSQUITO NETS

-SCREENING-SCREENING-REPELLENTS-REPELLENTS

ANTI LARVAL ANTI LARVAL MEASURESMEASURES

• ENVIRONMENTAL CONTROLENVIRONMENTAL CONTROL

-SOURCE REDUCTION-SOURCE REDUCTION-FILLING, LEVELLING AND -FILLING, LEVELLING AND

DRAINAGE OF DRAINAGE OF BREEDING BREEDING PLACESPLACES

-WATER MANAGEMENT-WATER MANAGEMENT

-FOR ANOPHELES-FILLING AND -FOR ANOPHELES-FILLING AND DRAINAGEDRAINAGE

• CHEMICAL CONTROLCHEMICAL CONTROL

MINERAL OILSMINERAL OILS

PARIS GREENPARIS GREEN

SYNTHETIC INSECTICIDESSYNTHETIC INSECTICIDES

--

• MINERAL OILSMINERAL OILS-ADDITION OF OIL TO WATER-ADDITION OF OIL TO WATER

-DIESEL OIL, FUEL OIL, -DIESEL OIL, FUEL OIL, KEROSENE OIL ETC.KEROSENE OIL ETC.

-FORMS A THIN FILM AND -FORMS A THIN FILM AND CUTS CUTS OF AIR SUPPLYOF AIR SUPPLY

-40 TO 90 LITRES PER -40 TO 90 LITRES PER HECTAREHECTARE

-KILLS LARVA AND PUPA-KILLS LARVA AND PUPA

- APPLIED ONCE IN A WEEK- APPLIED ONCE IN A WEEK

-MAKES WATER UNFIT FOR -MAKES WATER UNFIT FOR DRINKING AND KILLS FISHDRINKING AND KILLS FISH

PARIS GREEN –COPPER ACETO ARSENITEPARIS GREEN –COPPER ACETO ARSENITE-STOMACH POISON-STOMACH POISON

-KILLS SURFACE FEEDERS-KILLS SURFACE FEEDERS

-I KG PER HECTARE-I KG PER HECTARE

-DOES NOT HARM -DOES NOT HARM FISH ,MAN, FISH ,MAN, AND DOMESTIC AND DOMESTIC ANIMALSANIMALS

SYNTHETIC INSECTICIDES -SYNTHETIC INSECTICIDES -

FENTHION,CHLORPYRIFOS AND FENTHION,CHLORPYRIFOS AND ABATEABATE

-ORGANOPHOSPHORUS COMPOUNDS-ORGANOPHOSPHORUS COMPOUNDS -HYDROLYSE IN WATER-HYDROLYSE IN WATER

-WATER CONTAMINATION & RISK OF -WATER CONTAMINATION & RISK OF RESISTANCERESISTANCE

• BIOLOGICAL CONTROLBIOLOGICAL CONTROL

-GAMBUSIA & -GAMBUSIA & LEBISTER LEBISTER RETICULATUSRETICULATUS

-EFFECTIVE ONLY -EFFECTIVE ONLY WHEN WHEN USED IN USED IN CONJUNCTION CONJUNCTION WITH WITH OTHER METHODSOTHER METHODS

ANTI ADULT MEASURESANTI ADULT MEASURES

• RESIDUAL SPRAYS RESIDUAL SPRAYS

DDT,MALATHION,PROPOXURDDT,MALATHION,PROPOXUR

-DDT -1-2 GMS/MTRE SQ-DDT -1-2 GMS/MTRE SQ

-MALATHION -2 GMS /MTRE SQ-MALATHION -2 GMS /MTRE SQ

-LINDANE -0.5 GMS/MTRE SQ-LINDANE -0.5 GMS/MTRE SQ

- RESISTANCE IS THE MAIN - RESISTANCE IS THE MAIN PROBLEMPROBLEM

• SPACE SPRAYS SPACE SPRAYS -SPRAYED INTO -SPRAYED INTO

ATMOSPHERE ATMOSPHERE IN THE FORM IN THE FORM OF MIST OR FOGOF MIST OR FOG

-PYRETHRUM EXTRACTS IS -PYRETHRUM EXTRACTS IS NERVE POISON AND KILLS NERVE POISON AND KILLS INSTANTLYINSTANTLY-O.I%PYRETHRIN-O.I%PYRETHRIN

-DOORS AND WINDOWS -DOORS AND WINDOWS CLOSED CLOSED FOR HALF AN HOURFOR HALF AN HOUR

-NO RESIDUAL ACTION-NO RESIDUAL ACTION

-RESIDUAL INSECTICIDES ARE -RESIDUAL INSECTICIDES ARE ALSO USEDALSO USED

GENETIC CONTROLGENETIC CONTROL

-STERILE MALE -STERILE MALE TECHNIQUETECHNIQUE

-CYTOPLASMIC -CYTOPLASMIC INCOMPATABILITYINCOMPATABILITY

-SEX DISTORTION-SEX DISTORTION

-GENE REPLACEMENT-GENE REPLACEMENT

-THEY ARE MORE -THEY ARE MORE EFFICIENT AND EFFICIENT AND

CHEAPERCHEAPER

PROTECTION AGAINST PROTECTION AGAINST MOSQUITO BITESMOSQUITO BITES

• MOSQUITO NETS -MATERIAL USED MOSQUITO NETS -MATERIAL USED SHOULD BE WHITE TO SHOULD BE WHITE TO ALLOW EASY DETECTION ALLOW EASY DETECTION OF MOSQUITOSOF MOSQUITOS

-TOP AND SIDES -TOP AND SIDES SHOULD SHOULD BE OF NETTINGBE OF NETTING

-NO HOLES OR RENTS-NO HOLES OR RENTS

-HOLE SIZE-0.0475 -HOLE SIZE-0.0475 INCHESINCHES

-150 HOLES PER SQUARE -150 HOLES PER SQUARE INCHINCH

SCREENING -COPPER OR BRONZE SCREENING -COPPER OR BRONZE GUAZEGUAZE

-16 MESHES PER INCH-16 MESHES PER INCH

-APERTURE -0.0475 INCH-APERTURE -0.0475 INCH

-COSTLY BUT EFFECTIVE-COSTLY BUT EFFECTIVE

• REPELLANTSREPELLANTS

-DIETHYLTOLUAMIDE-DIETHYLTOLUAMIDE

-INDALONE-INDALONE

-DIETHYL PHTHALATE-DIETHYL PHTHALATE

- MAINLY ACTIVE - MAINLY ACTIVE AGAINST AGAINST CULEX MOSQUITOSCULEX MOSQUITOS

-SHORT DURATION OF -SHORT DURATION OF PROTECTIONPROTECTION