Zanzibar malaria control

A new Malaria Control Unit (MCU) within the Ministry of Health and Social Welfare (MHSW) will implement the project"s vector control, chloroquine distribution, health education and training, and operational research activities. Various mosquito control measures will be employed. Engineering interventions such as leveling, draining, and filling will be conducted in Zanzibar Town and other target sites. Mosquito breeding areas which are not susceptible to engineering will be subjected to larviciding. Biological control using larvivorous fish will also be explored. Until engineering and larviciding activities can be implemented, a space spraying program utilizing ultra-low volume Malathion will be conducted to reduce adult populations. Residual DDT and Malathion spraying of households will be performed seasonally in areas between protected urban centers and unprotected rural areas and in rural areas with a high prevalence of malaria. Chloroquine will be distributed for both prophylaxis and therapy. Some 150 paid malaria agents will each distribute biweekly prophylactic doses to 1,500-2,000 high-risk persons (children, expectant mothers). Chloroquine for presumptive treatment of suspect fever cases will be supplied to health centers and local officials. Health education and community motivation activities will include training of health workers and schoolteachers to promote malaria control, reviving MHSW"s Health Education Unit (which will produce printed materials), enlisting the participation of radio and television stations, and holding programs to increase awareness of malaria control among government officials and other groups outside the health sector. A National Malaria Control Committee will be formed to promote intersectoral cooperation. Epidemiologic, parasitologic, entomologic, and other indices will be monitored continuously to permit adaptation of techniques and evaluation of program effectiveness. To create the MCU, an existing malaria unit will be reorganized and its staff increased from 151 to 433. Basic and/or inservice training will be provided in-country to, inter alia, MCU staff, laboratory personnel, entomologists, sprayers, malaria agents, and health assistants. Amendment of 5/23/85 reduces the project"s scope to a level where it can be sustained by the Government of Zanzibar. Residual spraying of houses will be the primary means of combating malaria, and health education, case treatment, entomological work, and MCU strengthening will continue to be important. The active case detection program will be postponed until malarial incidence drops substantially; in the meantime, malariometric surveys will provide the basis for program evaluation. Larviciding and source reduction activities will be much less extensive and more focused, and distribution of chloroquine for prophylaxis, though not for therapy, will be eliminated because of fear of promoting chloroquine resistant malaria. Finally, the malaria control program, to the extent practical, will be integrated into the island"s primary health care system. (PD-ABI-320)