Malaria control (383-0043)

Evaluation covered the period 1984-4/86. No methodology is given. Excellent progress has been made in training personnel at the headquarters and regional levels, and progress has been made in intersectoral coordination. Progress in the use of additional vector control methods, however, has been limited; the time needed for the transition from conventional malaria methodology to the integrated system was underestimated. There is still a dependence on malathion residual house spraying and drug treatments (chloroquine) as the main tools in the anti-malaria campaign. The two chemical interventions are still potent, but the number of cases continues to exceed the level established by the project as acceptable, and there is concern about the long-term sustainability of these methods: loss of susceptibility to malathion has been demonstrated, and chloroquine-resistant Plasmodium falciparum have been detected. The potential for both types of resistance in the near future - coupled with increasing opposition to house spraying, resulting in reduced coverage - confirm the importance of the project"s objective to develop an integrated control program. The primary recommendation is to plan and implement a regional trial and demonstration of the integrated malaria control program; a plan for such a program is a major priority but does not yet exist. Action decisions, responding directly to this and other recommendations, are to: (1) develop a plan for regional trial and demonstration of integrated malaria control; (2) select a region in which to implement this plan; (3) select a regional malaria officer to undergo 3 months of U.S. vector control study, and select a U.S. counterpart to fill in for this period; (4) develop a standardized regional-level entomological surveillance system; (5) integrate epidemiological and entomological surveillance systems; (6) extend the project for up to two years, using current resources, if the above are accomplished; and (7) contract locally for design of information/education materials.