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New strategies urged to control malaria
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Changing patterns of malaria infection in low-transmission settings highlight the need for continuing changes in malaria control strategies, according to a review paper published in The Lancet.
“The malaria control strategies implemented over the last decade have been highly successful in reducing malaria worldwide,” Sir Richard Feachem, DSc, PhD, director of the Global Health Group at the University of California, San Francisco, said in a press release. “However, these strategies must evolve to respond effectively to the changing patterns of infection in low transmission areas. More sophisticated and targeted approaches to identifying those people who are infected, and responding promptly and effectively, must be put in place.”
Sir Richard Feachem
According to the report by Feachem and colleagues, when malaria levels in a country are reduced to low levels, the disease becomes concentrated in particular groups of people in particular communities. In Sri Lanka, for example, the overall malaria incidence decreased by 99.9% from 1999 to 2011. However, the proportion of infections in adult men increased from 54% to 93%.
Migrant workers are at heightened risk for malaria, the researchers wrote, and most malaria cases seen in low-transmission countries are imported from high-transmission countries, via international travelers, migrant workers and others,. In addition, many of the groups exposed to malaria infection in low-transmission settings do not use health services for a variety of reasons.
Because of the changing epidemiology of malaria, typical malaria control methods must be tailored and targeted to the highest-risk groups. Previously, home-based interventions such as bed nets and indoor insecticides have been the focus of malaria control, when the greatest burden of malaria was found in women and children. Occupation-based methods, such as insecticide-treated clothing or hammocks, could be used for this increased malaria burden in adult men.
Previously, Plasmodium falciparum was responsible for most of the malaria burden and has been the focus of control. However, there has been an increasing number of infections resulting from P. vivax, which is harder to detect and treat and more difficult to control and eliminate. In the Solomon Islands, for example, there was a 90% reduction in total malaria cases from 2001 to 2011. However, the proportion of P. vivax infections more than doubled.
The researchers concluded that funding for malaria control will play a critical role.
Disclosure: Feachem reports no relevant financial disclosures.
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