First independent assessment of the intensive malaria control programme anti-malaria campaign : Sri Lanka

First outside special evaluation covers 1982; no methodology is noted. Although compared to 1981 screening increased from 6.0 to 7.5% and positivity decreased by 18.6% (largely due to a decline in P. vivax infections), the incidence of P. falciparum rose 29% and there has been a recent epidemic of P. vivax in the Intermediate Zone. The virtual absence of monitoring makes it impossible to determine whether the former problem indicates decreased parasite sensitivity to malathion, the project"s main control measure; the number of homes fully sprayed with malathion has in any case decreased. Factors contributing to the currently serious situation have included a prolonged drought; inadequate allotments of fuel, new spray pumps, and antimalarials (a large amount of chloroquine obtained for 1982 proved substandard); an unresponsive chain of command; poor training and low staff morale; incorrect reporting; and neglect of health education and safeguards. Understaffing has been a key problem. Of 4,777 positions, only 3,993 were filled, with vacancies affecting field assistants (112), spray machine operators (482), microscopists (66), and regional medical officers (8 of 16). Understaffing in the seven regional labs curtailed surveillance, although the number of smears examined rose 1.13 million in 1982. Field research continued in 11 areas. AMC trained 31 microscopists at the National Malaria Eradication Training Centre (still not meeting need) and 62 health care workers in short courses, while over 1,550 primary health care workers, volunteers, and officials received 1-day training. In other areas, voluntary treatment centers and field health workers supporting AMC were underutilized; poor coordination between health institutions impaired AMC/Health Services integration at the field level; development areas lacked adequate AMC facilities; and construction of the A.I.D.-supported laboratory/insectary was behind schedule. Organizationally, the shift in program emphasis to integrated vector control covering all disease carriers appears valid. A total of 38 recommendations are made.