SRI LANKA - MALARIA CONTROL.

The MOH"s Anti-Malaria Campaign (AMC) will implement the project"s MC, training, research, and health education activities with assistance from the World Health Organization. MC activities will comprise three phases: (1) intensive spraying; (2) selective spraying with surveillance; and (3) surveillance with phased integration of AMC into the General Health Services. For the first 4-5 years, the project will focus on intensive spraying of rural homes with malathion, a residual insecticide. (Use of malathion as an agricultural insecticide will be banned in order to help prolong its effectiveness.) When the annual parasite incidence is less than one per 1,000 persons, AMC will move to selective spraying or no spraying. Surveillance operations will include both active and passive case detection, focused initially on highly endemic and neighboring zones and gradually expanded to cover the entire malaria-affected rural population. In addition, parasitological assessments will be conducted to identify area-specific responses to spraying, along with entomological surveys of selected "indicator" areas. To allow processing of an expected 1.3-1.5 million blood samples a year, 7 new field laboratories have been set up and additional staff hired. All clinical and suspected malaria cases will receive radical treatment with antimalarial drugs and follow-up blood filming; presumptive treatment of fever cases, focal spraying, and/or mass drug administration will be used as needed in areas of high or persistent malaria transmission. Short-term training will be provided to medical officers, entomological assistants, field assistants, microscopists, and spraymen at AMC"s 17 regional offices and at the Malaria Eradication Training Center; the latter will also offer courses to other interested personnel. Limited short-term participant training will be offered. The AMC will also conduct basic and applied research on, e.g., vector and parasite resistance to, respectively, malathion and antimalarials; treatment procedures and dosages; and biological MC measures. Finally, a mass media, public health education program will be conducted.