|Technical notes: Special Considerations for Programming in Unstable Situations (UNICEF, 2000, 490 p.)|
|Chapter 1 - Annex 7: Management, Control and Prevention of the Most Common Communicable Diseases|
Malaria is a major problem in tropical areas, especially during emergencies, when populations from areas of marginal transmission might be moving through or settling in endemic areas.
Malaria kills over 1 million people a year, of which some 750,000 are children under five years of age (Rolling Back Malaria, UNICEF 1999). In sub-Saharan Africa, malaria accounts for one in five of all childhood deaths.
In all cases, the need is for:
· prevention through vector (mosquito) control to reduce transmission and through chemoprophylaxis for pregnant women;
· treatment of individual cases in line with WHO standard guidelines and access to referral centres for severe cases and treatment failures;
· laboratory facilities to diagnose treatment failures and severe disease and, in areas of low transmission, uncomplicated disease.
Vector control measures must be selected according to epidemiological, ecological, social and economic characteristics. Possible measures include:
· personal protection using bednets and curtains, eave strips (strips of cloth covering openings between the roof and walls), screens and other barriers at windows and doors to prevent entry of mosquitoes - all of these impregnated with long-lasting insecticides (this can lower child mortality by about 25 per cent according to WHO); especially young children and pregnant women need to be protected from mosquito bites at all times;
· indoor residual spraying - effective against certain species, but efficacy varies according to house structure and type of sprayable surface;
· larval control and environmental management in areas where breeding sites of mosquitoes are well defined. This involves mobilizing the community to eliminate stagnant water as much as possible and adopting agricultural practices that avoid accumulations of surface water.
In cases of displaced populations, camp sites should be carefully selected, wherever possible. The likelihood of wide-spread malaria is reduced if people live 1 km or more away from the breeding places of anopheles mosquitoes, especially surface water.
Chemoprophylaxis should normally be limited to pregnant women. Exceptionally, more general prophylaxis may be considered for an initial period only for non-immune populations displaced into malarial areas. (More widespread prophylactic use of drugs is not appropriate due to the spread of drug resistance.)
Early diagnosis and prompt treatment will shorten the duration of the disease as well as prevent the development of complications and the majority of deaths from malaria. It should be one of the core functions of primary health care services - and an important component in the (re)training of all health workers - in any area where malaria is endemic.
Drugs should be selected and administered in line with WHO guidelines and established national policy. In many areas, there are high levels of resistance to chloroquine, and treatment with other drugs is recommended. The first step in organizing proper case management for malaria is to acquire the latest information of drug resistence for the specific area (usually from WHO, if not available from the national authorities).