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Baltimore, Maryland, Jhpiego, 2018. 92 p. (USAID Award No. HRN-A-00-98-00043-00; USAID Leader with Associates Cooperative Agreement No.GHS-A-00-04-00002-00)The Malaria in Pregnancy reference manual and clinical learning materials are intended for skilled providers who provide antenatal care, including midwives, nurses, clinical officers, and medical assistants. The clinical learning materials can be used to conduct a 2-day workshop designed to provide learners with the knowledge and skills needed to prevent, recognize, and treat malaria in pregnancy as they provide focused antenatal care services.
Larval source management: a supplementary measure for malaria vector control. An operational manual.
Geneva, Switzerland, WHO, 2013.  p.Larval source management (LSM) refers to the targeted management of mosquito breeding sites, with the objective to reduce the number of mosquito larvae and pupae. When appropriately used, LSM can contribute to reducing the numbers of both indoor and out-door biting mosquitoes, and -- in malaria elimination phase -- it can be a useful addition to programme tools to reduce the mosquito population in remaining malaria ‘hotspots’. This operational manual has been designed primarily for National Malaria Control Programmes as well as field personnel. It will also be of practical use to specialists working on public health vector control, and malaria programme specialists working with bilateral donors, funders and implementation partners. It has been written by senior public health experts of the malaria vector control community under the guidance of the WHO Global Malaria Programme. The manual’s three main chapters provide guidance on: the selection of larval control interventions, the planning and management of larval control programmes, and detailed guidance on conducting these programmes. The manual also contains a list of WHOPES-recommended formulations, standard operating procedures for larviciding, as well as a number of country case studies.
Indoor residual spraying: an operational manual for indoor residual spraying (IRS) for malaria transmission control and elimination.
Geneva, Switzerland, WHO, 2013.  p.This manual has been created to enhance existing knowledge and skills, and to assist malaria programme managers, entomologists and vector control and public health officers to design, implement and sustain high quality IRS programmes. Though comprehensive, this manual is not intended to replace field expertise in IRS. The manual is divided into three chapters: IRS policy, strategy and standards for national policy makers and programme managers; IRS management, including stewardship and safe use of insecticides, for both national programme managers and district IRS coordinators; IRS spray application guidelines, primarily for district IRS coordinators, supervisors and team leaders. This manual will enable national programmes to: develop or refine national policies and strategies on vector control; develop or update existing national guidelines; develop or update existing national training materials; review access and coverage of IRS programmes; review the quality and impact of IRS programmes.
Geneva, Switzerland, WHO, 2013.  p. (WHO/HTM/NTD/WHOPES/2013.3)Guidelines for testing long-lasting insecticidal nets (LNs) were first published by WHO in 2005. The revised guidelines were reviewed by a WHOPES informal consultation on innovative public health pesticide products, held at WHO headquarters on 22-26 October 2012. Industry was invited to attend the first 2 days of the meeting to exchange information and provide their views, after which their comments were further reviewed by a group of WHO-appointed experts, who finalized the guidelines by consensus. The purpose of this document is to provide specific, standardized procedures and guidelines for testing LNs for personal protection and malaria vector control. It is intended to harmonize testing procedures in order to generate data for registration and labelling of such products by national authorities and provide a framework for industry in developing novel LN products. This document replaces the previous guidelines, published by WHOPES in 2005. (Excerpts)
Environment International. 2012 Oct 15; 47:17-22.There is an assumption that pyrethroid pesticides are converted to non-toxic metabolites by hydrolysis in mammals. However, some recent works have shown their bioaccumulation in human breast milk collected in areas where pyrethroids have been widely used for agriculture or malaria control. In this work, thirteen pyrethroids have been studied in human breast milk samples coming from areas without pyrethroid use for malaria control, such as Brazil, Colombia and Spain. The concentrations of pyrethroids ranged from 1.45 to 24.2 ng g- 1 lw. Cypermethrin, -cyhalothrin, permethrin and esfenvalerate/fenvalerate were present in all the studied samples. The composition of pyrethroid mixture depended on the country of origin of the samples, bifenthrin being the most abundant in Brazilian samples, -cyhalothrin in Colombian and permethrin in Spanish ones. When the pyrethroid concentrations were confronted against the number of gestations, an exponential decay was observed. Moreover, a time trend study was carried out in Brazil, where additional archived pool samples were analyzed, corresponding to years when pyrethroids were applied for dengue epidemic control. In these cases, total pyrethroid levels reached up to 128 ng g- 1 lw, and concentrations decreased when massive use was not allowed. Finally, daily intake estimation of nursing infants was calculated in each country and compared to acceptable WHO levels. The estimated daily intakes for nursing infants were always below the acceptable daily intake levels, nevertheless in certain samples the detected concentrations were very close to the maximum acceptable levels.
MJAFI. Medical Journal Armed Froces India. 2008; 64(1):57-60.World Health Organization (WHO) estimates 1.7-2.5 million deaths and 300-500 million cases of malaria each year globally. As an initiative WHO has announced Roll Back Malaria (RBM) programme aimed at 50% reduction in deaths due to malaria by 2010. The RBM strategy recommends combination approach with prevention, care, creating sustainable demand for insecticide treated nets (ITNs) and efficacious antimalarials in order to achieve sustainable malaria control. Malaria control in India has travelled a long way from National Malaria Control Programme launched in 1953 to National Vector Borne Diseases Control Programme in 2003. In India, the malaria eradication concept was based on indoor residual spraying to interrupt transmission and mop up cases by vigilance. This programme was successful in reducing the malaria cases from 75 million in 1953 to 2 million but subsequently resulted in vector and parasite resistance as well as increase in P falciparum from 30-48%. In view of rapidly growing resistance of Plasmodium falciparum to conventional monotherapies and its spread in newer areas, the programme was modified with inclusion of RBM interventions and revision of treatment guidelines for malaria. Early case detection and prompt treatment, selective vector control, promotion of personal protective measures including ITNs and information, education, communication to achieve wider community participation will be the key interventions in the revised programme. (author's)
Indoor residual spraying. Use of indoor residual spraying for scaling up global malaria control and elimination. WHO position statement.
Geneva, Switzerland, WHO, Global Malaria Programme, 2006.  p. (WHO/HTM/MAL/2006.1112)WHO's Global Malaria Programme recommends the following three primary interventions that must be scaled up in countries to effectively respond to malaria, towards achieving the Millennium Development Goals for malaria by 2015 and other health targets: diagnosis of malaria cases and treatment with effective medicines; distribution of insecticide-treated nets (ITNs) to achieve full coverage of populations at risk of malaria; and indoor residual spraying (IRS) as a major means of malaria vector control to reduce and eliminate malaria transmission including, where indicated, the use of DDT. Scaling up access and achieving high coverage of these effective interventions, particularly to populations who are at the highest risk of malaria, and sustaining their implementation, remain major challenges for achieving current global malaria control goals. (excerpt)
Lancet. 2007 Jan; 369(9558):248.In September, 2006, WHO recommended wider use of indoor spraying with dichlorodiphenyltrichloro ethane (DDT)--once banned because of its toxic effects on the environment--and other insecticides to control malaria. Since then, a number of African countries have made their old foe DDT their new friend. Malawi is the latest, announcing last week that it would be introducing indoor residual spraying with DDT in its fight against malaria. WHO cited many reasons for making DDT a main intervention in malaria control, alongside insecticide-treated bednets. DDT has the potential to substantially reduce malaria transmission. The chemical is better than other insecticides, as it lasts longer, thereby reducing the number of times that houses need to be sprayed, is cheaper, and can repel mosquitoes from indoor environments, as well as kill those that land on sprayed surfaces. But DDT is far from problem-free. WHO, and countries that decide to adopt indoor residual spraying with the insecticide, need to monitor any negative effects of the chemical on health. They also need to ensure that DDT does not contaminate crops. (excerpt)
Lancet. 2006 Dec 16; 368(9553):2111-2113.A recent press statement from WHO about dichlorodiphenyltrichloroethane (DDT) and indoor residual spraying for malaria control caused a considerable stir, despite the fact that, in terms of policy, it merely reiterated WHO's endorsement of DDT as a useful insecticide for malaria control, albeit in a highly promotional way. In this recurring debate, arguments for and against DDT, as before, have been heated and mainly based on considerations far removed from the realities of malaria control. One group that criticised the WHO statement has inferred that my resignation from WHO's Global Malaria Programme in September, 2006, was related to my opposition to its promotion of DDT. This assumption is erroneous. For many years, WHO's malaria-control professionals have fought hard against pressure from various sides to ensure access in malaria-endemic countries to DDT. Hopefully, the statement now issued by the Global Malaria Programme will put an end to this debate, so that all countries that need DDT for malaria control will have unfettered access to use it in accordance with WHO guidelines and with the Stockholm Convention on Persistent Organic Pollutants, if they are signatories to the latter. (excerpt)
Africa Renewal. 2005 Jan; 18(4): p..The Millennium Development Goals (MDGs), which include halving world poverty and slashing child mortality by two-thirds, are as challenging as they are ambitious, Mr. Sachs said at UN headquarters in New York in late September, in briefings on the work of the Millennium Project, which he directs. But meeting those goals, said Mr. Sachs, can be as simple as distributing a $1.50 mosquito net or providing a family farmer with a sack of fertilizer. "These are not metaphysical problems. These are not grand cultural problems.... These are practical problems, and they don't cost very much money." Mr. Sachs asserted that while substantial progress has been made in some regions of the world, "Africa on the whole has not achieved progress and has experienced significant regress in many areas." The continent is the epicentre of global poverty, he continued. World leaders are slated to review progress towards the goals in September 2005. The reasons for Africa's halting progress are numerous, he said, including poor soils, the effects of climate change and shortages of basic transportation and communications. But these problems have been worsened by the donor community's insistence on market mechanisms, inadequate and poorly targeted aid and a tendency to blame Africa. The continent's problems "cannot be folded under the rubric that poor Africa just doesn't govern itself properly," Mr. Sachs observed. "Blaming the poor will not solve the problem. Nor is it an accurate, analytical picture" of the obstacles to Africa's development. (excerpt)
Use of intermittent presumptive treatment and insecticide treated bed nets by pregnant women in four Kenyan districts.
Tropical Medicine and International Health. 2004 Feb; 9(2):255-261.The roll back malaria (RBM) movement promotes the use of insecticide-treated bednets (ITNs) and intermittent presumptive treatment (IPT) of malaria infection as preventive measures against the adverse effects of malaria among pregnant women in Africa. To determine the use of these preventive measures we undertook a community-based survey of recently pregnant women randomly selected from communities in four districts of Kenya in December 2001. Of the 1814 women surveyed, only 5% had slept under an ITN. More than half of the 13% of women using a bednet (treated or untreated) had bought their nets from shops or markets. Women from rural areas used bednets less than urban women (11% vs. 27%; P < 0.001), and 41% of the bednets used by rural women had been obtained free of charge from a research project in Bondo or a nationwide UNICEF donation through antenatal clinics (ANCs). Despite 96% of ANC providers being aware of IPT with sulphadoxine–pyrimethamine (SP), only 5% of women interviewed had received two or more doses of SP as a presumptive treatment. The coverage of pregnant women with at least one dose of IPT with SP was 14%, though a similar percentage also had received at least a single dose as a curative treatment. The coverage of nationally recommended strategies to prevent malaria during pregnancy during 2001 was low across the diverse malaria ecology of Kenya. Rapid expansion of access to these services is required to meet international and national targets by the year 2005. The scaling up of malaria prevention programmes through ANC services should be possible with 74% of women visiting ANCs at least twice in all four districts. Issues of commodity supply and service costs to clients will be the greatest impediments to reaching RBM targets. (author's)
Monday Developments. 2003 Sep 22; 21(17):8-9.At the end of June, the Zambian Red Cross in coordination with the Ministry of Health helped vaccinate five million children between the ages of six months to 15 years against measles. The integrated campaign delivered an unprecedented number of health interventions at the same time. To combat malaria, 75,000 insecticide treated bed nets were distributed to vulnerable families with children under five. Vitamin supplements and a de-worming medication called Mebendazole were also administered by some 1,800 Red Cross volunteers. (excerpt)
[Geneva, Switzerland], WHO, 2003. 69,  p. (WHO/CDS/MAL/2003.1093)This report is an initial effort to collect, analyse, and present information on the malaria situation. The report focuses on Africa and specifically on those African countries with the highest burden of the disease. These countries bear more than 90% of the global malaria burden. Emphasis is also given to the technical strategies for malaria control established by the Roll Back Malaria Partnership and the targets set at the Abuja Summit. In addition, with due regard to the importance of understanding the resource requirements of malaria control, a chapter on resource mobilization and financing is included. The data contained in this report have been drawn from a variety of sources in order to provide the most complete picture of the malaria situation in Africa. The UNICEF Multiple Indicator Cluster Surveys and the and Health Surveys, in particular, are national surveys that represent a major advance in collection of baseline data to provide benchmarks against which progress can be measured. It is fully expected that the recent consensus on core data needs, well coordinated efforts to collect data, and progress in solving methodological and other data collection problems will together fulfil the new demands for malaria information. (excerpt)
Insect wars in eastern province. Nangarhar people hope malaria mosquitoes will be an early casualty of peace.
London, England, Institute for War and Peace Reporting [IWPR], 2003 Jun 9. 3 p. (Afghan Recovery Report No. 63)The new campaign, funded by the World Health Organization, the UN Development Programme, and Nangarhar’s own health department, is intended to teach people how to protect themselves from bites by using sprays and mosquito nets. It will also attack the insects themselves, clearing stagnant waters, spraying pools where they lay their eggs, and introducing “mosquito-fish”, a species which eats the larvae. (excerpt)
Comparative performances, under laboratory conditions, of seven pyrethroid insecticides used for impregnation of mosquito nets. [Performances comparées, dans des conditions de laboratoire, de sept insecticides à base de pyréthroïde utilisés pour l'imprégnation des moustiquaires]
Bulletin of the World Health Organization. 2003 May; 81(5):324-333.Objective: To compare the efficacy of seven pyrethroid insecticides for impregnation of mosquito nets, six currently recommended by WHO and one candidate (bifenthrin), under laboratory conditions. Methods: Tests were conducted using pyrethroid-susceptible and pyrethroid-resistant strains of Anopheles gambiae and Culex quinquefasciatus. Knock-down effect, irritancy and mortality were measured using standard WHO cone tests. Mortality and bloodfeeding inhibition were also measured using a baited tunnel device. Findings: For susceptible A. gambiae, alpha-cypermethrin had the fastest knock-down effect. For resistant A. gambiae, the knockdown effect was slightly slower with alpha-cypermethrin and much reduced following exposure to the other insecticides, particularly bifenthrin and permethrin. For susceptible C. quinquefasciatus, the knock-down effect was significantly slower than in A. gambiae, particularly with bifenthrin, and no knock-down effect was observed with any of the pyrethroids against the resistant strain. Bifenthrin was significantly less irritant than the other pyrethroids to susceptible and resistant A. gambiaebut there was no clear ranking of pyrethroid irritancy against C. quinquefasciatus. In tunnels, all insecticides were less toxic against C. quinquefasciatusthan against A. gambiaefor susceptible strains. For resistant strains, mortality was significant with all the pyrethroids with A. gambiaebut not with C. quinquefasciatus. Inhibition of blood-feeding was also high for susceptible strains of both species and for resistant A. gambiaebut lower for resistant C. quinquefasciatus; bifenthrin had the greatest impact. Conclusions: Efficacy for impregnation of mosquito nets against A. gambiae was greatest with alpha-cypermethrin. Bifenthrin is likely to have a significant comparative advantage over other pyrethroids in areas with pyrethroid resistance because of its much stronger impact on the nuisance mosquito, C. quinquefasciatus, despite its slower knock-down effect and irritancy. Selection of pyrethroids for mosquito vector control and personal protection should take into account the different effects of these insecticides, the status of pyrethroid resistance in the target area, and the importance of nuisance mosquitoes, such as C. quinquefasciatus. (author's)
Lancet. 2003 May 10; 361(9369):1657-1658.After the banning of WHO class I pesticides, the class II organochlorine insecticide, endosulfan, became the most commonly used pesticide in suicide attempts in some rural communities and an important cause of status epilepticus.5 Endosulfan was banned in 1998 and deaths from this pesticide in Anuradhapura hospital fell progressively from 27 in 1998 to three in 2001 (D Roberts, unpublished observation). The total number of deaths caused by pesticides fell by the same number—there was no apparent switching to other pesticides. There are other examples of active pesticide regulation in Sri Lanka. Jayasinghe and de Silva are wrong when they suggest that “any toxic pesticide” is available in Sri Lanka. (excerpt)
Africa Recovery. 2001 Jun; 15(1-2):42.On May 9, 2001, the UN Food and Agricultural Organization released a study which found that stocks of deadly, obsolete pesticides are five times larger than previous estimates and constitute a toxic "ticking time bomb" in Africa and other developing regions. The figures set the amount of prohibited and outdated pesticides at 100,000 tons in Africa and the Middle East, 200,000 tons in Asia, and 200,000 tons in eastern Europe and the former Soviet Union. These pesticides, including some of the most poisonous compounds ever made, are often stored in deteriorating and leaky containers without adequate safeguards for people and the environment. The WHO estimates that more than 1 million people are affected by exposure to pesticides worldwide, causing 20,000 deaths annually. The problem is particularly severe in sub-Saharan Africa, where farmers and government regulators often lack the financial resources and technical capacity to handle pesticides safely and screen out substandard, banned, and contaminated compounds. Although clean-up efforts are being started, the cost and difficulty of disposing of Africa's obsolete pesticide stocks have hampered such efforts. However, several international agencies are assisting African governments identify and respond to the toxic threat.
HEALTH FOR THE MILLIONS. 2001 Jan-Feb; 27(1):36.Around 30% of pesticides marketed in developing countries with an estimated market value of US $900 million annually do not meet internationally accepted quality standards. They are posing a serious threat to human health and the environment, the UN Food and Agriculture Organization (FAO) and the World Health Organization (WHO) have warned. "These poor-quality pesticides frequently contain hazardous substances and impurities that have already been banned or severely restricted elsewhere," said Gero Vaagt, FAO Pesticide Management Group. Such pesticides, he added, often contribute to the accumulation of obsolete pesticide stocks in developing countries. The global market value for pesticides is estimated at US $32 billion in 2000, with the share of developing countries around US $3 billion. In developing countries, pesticides are mainly used for agriculture, but also for public health, such as insecticides for controlling insects spreading malaria. Possible causes of low quality of pesticides can include both poor production and formulation and the inadequate selection of chemicals. "In many pesticide products, for example, the active ingredient concentrations are outside internationally accepted tolerance limits," said Dr. David Heymann, executive director of WHO Communicable Diseases activities. "In addition, poor-quality pesticides may be contaminated with toxic substances or impurities." (full text)
WORLD HEALTH FORUM.. 1998; 19(4):417-27.Ministers of Health sometimes cover up malaria epidemics. Then, when the epidemic is exposed, the entire government Cabinet falls. The case of Egypt and how malaria control remains political are noted. The World Health Organization (WHO) should not have disbanded its malaria control program. If malaria control programs are reinstituted, the control activities should not be integrated into primary health care work. To control malaria, the responsible vector must be stopped. While primary health care workers can treat malaria, they cannot handle the vector. Vector control is the military part of public health, with certain mandatory steps taken with military precision. The author responds to interview questions on the funding of a malaria control campaign based upon vector control, how people are born to lead rather than trained to lead, the role of the health care system in handling malaria, steps to take in Africa, and WHO's strengths and weaknesses.
Tropical Medicine and International Health. 1999 May; 4(5):319-21.The World Health Organization-led "Roll-Back Malaria" (RBM) initiative opens the possibility for malaria control programs to explore new and broader strategies against malaria. Through the RBM, there is closer collaboration with UNICEF, the World Bank, the UN Development Program, and other public organizations working in health, economic, and community development. The commercial sector can also be used by national malaria programs to broaden the scope and sustainability of preventative and curative services. This paper outlines a model for engaging the commercial sector in launching a nationwide insecticide-treated materials (ITM) initiative in Ghana, and how the model can be used with the pharmaceutical sector to promote a national malaria drug policy. The model described has been successfully used to promote contraceptives in Morocco, reproductive health products and services in Indonesia, hand washing with soap in 5 Latin American countries, and oral rehydration solution in Bolivia.
AFRICA HEALTH. 1998 Jul; 20(5):34.The African Initiative for Malaria Control in the 21st Century (AIM) will be launched in 1999 to cover all 46 countries of the Africa region of the World Health Organization (WHO), and will spearhead WHO's global program against malaria. Britain's Prime Minister, Tony Blair, has pledged to provide US$90 million from the Department for International Development (DFID) for the initiative. Malaria is sub-Saharan Africa's biggest health problem, attacking 270-480 million people and killing 1.5-2.7 million every year. Areas in which malaria was largely previously unknown are now experiencing epidemics of the disease, while the malaria parasite has developed resistance to some anti-malarial drugs and insecticides. Among the Bushmen of the Kalahari, malaria is the second most important cause of death after tuberculosis. Health Unlimited is helping to organize the distribution of bednets impregnated with pesticide in a bid to reach 80% of the population in Bushman land over the next 3-5 years.
TDR NEWS. 1996 Jun; (50):3.Malaria causes considerable morbidity and mortality in Africa, killing 1.5-2.7 million people on the continent annually. A meeting on insecticide-impregnated materials was held at the World Health Organization (WHO) Regional Office for Africa (AFRO) during March 18-20, 1996, to promote the use of insecticide-impregnated materials by communities in Africa, review and discuss the results of recently conducted studies in the Africa Region on the use of insecticide-treated nets (ITNs) in malaria control, examine the best ways of implementing the wide-scale use of insecticide-impregnated materials under differing epidemiological and socioeconomic conditions, discuss major operational research priorities, and make recommendations for the promotion and wide use of insecticide-impregnated materials by malaria control programs and communities. The meeting was jointly organized by the WHO Division of Control of Tropical Diseases (CTD), the UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR), and AFRO, and attended by experts, malaria control program managers, private sector representatives, nongovernmental organizations, and technical and scientific institutions. Conclusions and recommendations include the need to assess whether pregnant women could benefit from the use of ITNs. Elements of the successful implementation of sustained malaria control activities involving the use of ITNs are listed. Problems encountered in the large-scale implementation of ITNs in Africa should be addressed collaboratively at the regional and global levels, and coordinated by WHO.
UN CHRONICLE. 1998; (1):12-3.Infection by onchocerca volvulus, a parasitic worm, causes onchocerciasis (river blindness), a debilitating and often blinding disease endemic to tropical areas of Africa and Central and South America. The adult onchocerca volvulus invades the human host where it lives and reproduces for up to 14 years, creating millions of infant worms which cause itching, loss of skin color, rapid aging, and disfiguring skin disease in the host. Onchocerciasis often causes blindness in the human host by approximately age 35 years, and is the third leading cause of blindness in Africa. Onchocerca volvulus is transmitted among humans through the bite of blackflies which breed in fast-flowing rivers. The Onchocerciasis Control Program (OCP) was formally launched in 1974 by the UN's Food and Agriculture Organization (FAO), the UN Development Program (UNDP), the World Bank, and the World Health Organization (WHO) in Benin, Burkina Faso, Ghana, Cote d'Ivoire, Mali, Niger, and Togo. Vector control is the central strategy of the OCP, consisting of weekly helicopter spraying of larvacide to prevent the blackfly from reproducing and transmitting the disease. In addition, Merck & Co. is providing drug therapy against the infant worms in the human host free of charge to 16 million people in endemic areas. Onchocerciasis has now almost been eradicated in the 7 original target countries. Also through the OCP, by 1996, more than 34 million people were protected against the disease, about 2 million who were seriously infected have fully recovered, and an estimated 600,000 people have been prevented from going blind. 12 million infants born since the launch of the OCP face no risk of contracting the disease, and approximately 25 million hectares of arable fertile riverine land has been opened for resettlement. Labor productivity has also increased.