Malaria control strategies must adapt to rapidly changing patterns of infectionPosted: April 18, 2013
According to Sir Richard Feachem, Director of the Global Health Group at the University of California, San Francisco, USA, and senior author of the study, “The malaria control strategies implemented over the last decade have been highly successful in reducing malaria worldwide. However, these strategies must evolve to respond effectively to the changing patterns of infection in low transmission areas. More sophisticated and targeted approaches to identifying those people who are infected, and responding promptly and effectively, must be put in place. The good news is that these new approaches are being pioneered with great success in countries such as China, Sri Lanka, and Swaziland.”
The authors present country examples showing that when malaria is reduced to low levels, it becomes increasingly concentrated in particular places or communities (hotspots) and in particular groups of people (hot-pops). In Sri Lanka, overall malaria incidence decreased by 99·9% between 1999 and 2011, but the proportion of infections in adult men increased from 54% to 93% over the same period.
Migrant workers appear to be at heightened risk, likely due to their participation in outdoor activities such as forestry, plantation work, and farming. Many low-transmission countries now find that the majority of their malaria cases are “imported”, coming from international travellers, migrant workers, and other mobile populations who bring malaria from other high-transmission countries.
One solution to this problem is to rethink the typical malaria control methods used to control infection, tailoring and targeting them to the groups most likely to contract malaria. Traditionally, malaria control has focused on home-based interventions such as bednets and indoor insecticides that protect women and children. However, the authors suggest that different, occupation-based control methods—such as insecticide treated clothing, or hammocks—could be used to protect these populations.