 By Dr.

Nelofer Amir
 Student MsPH.
 2009-2010

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 DEFINITION.
 Malaria is caused by a parasite which is called
plasmodium. It is transmitted by from one person to
another by bite of female mosquito called anopheles.
When reached the body it is multiply in the liver and
than infect the red blood cells1.

 It will effect the general population. Among them high

risk groups are pregnant women and children under
five-years of age.

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 Case definition

 There is difference in endemic and non

endemic area case definition. In non-
endemic areas, the diagnosis of clinical
malaria may be made on the basis of fever
and a positive blood film. However, in high
endemic areas, asymptomatic parasitaemia
is very common3

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Symptoms of Malaria

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symptoms of malaria

 Cold stage: fever and shaking chills.

 Hot stage: high grade fever, nausea ,vomiting, headache,
dizziness, pain and delirium.
 Sweating stage: sweating and fall in temperature, prostration.
 Anemia includes pallor, tiredness, fatigue, shortness of breath,
splenomegally,hepatomegally.
 Malarial complications involve:
 Cerebral malaria, death, mother to infant transmission, low birth
weight5.

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Magnitute Of Disease

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 Global situation

 There were an estimated 300 million

cases of malaria and 8,81,000 deaths
from the disease in 2006, mostly among
children in Africa, making it one of the
world's leading killers.8

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Global situation

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 Situation in south east region

Malaria is an enormous health and

developmental problem in the SEA Region as
a approximately 687 million people are at high
risk for malaria, with an estimated 90-160
million infections and more than 120, 000
deaths occurring each year9.
 malaria is a major public heath problem in the
South-East Asia Region. Out of 11 countries
of the Region 10 countries are malaria
endemic.10

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Situation in Pakistan

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 Situation in Pakistan
 Malaria continues to be a major public health problem
in Pakistan.

 Extensive agricultural practices, a vast irrigation

network and monsoon rains have considerably added
to the malariogenic potential in many areas.

 Both P. falciparum and P. vivax are widely distributed.

 The primary vector species are An. culicificies and An.

stephensi.

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 The transmission season is post-monsoon,
occurring from July through November.
 Estimated number of annual malaria episodes in
Pakistan is 1.5 million.
 In 2005, falciparum malaria constituted 33% of
reported confirmed malaria cases, this figure
decreased to 24% in 2008. 40% of cases were
reported from Baluchistan province11 .

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 Situation in Pakistan

P R O V IN C E -W IS E D IS E A S E B U R D E N (A P I) 2 0 0 6

6 5 .9 2
5 .4 4
5

2 1 .2
0 .7 8 0 .7 9
1 0 .0 2 0 .0 7

0
B a lo c h . FA T A S in d h NW FP P u n ja b A JK P a k is t a n

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Key determinants

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 Organization involve in the control of malaria

 WHO,
 GLOBAL FUND,
 National Malarial Control Program,
 UNDP,
 UNICEF and
 World Bank.

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 Organizational and administrative capabilities

 1950- malarial control activity.

 1960- malaria eradication program.
 1973- National malaria control
program. The goal of the national
malaria control program is to improve
the health status of the population by
effectively controlling malaria through
implementation of the Roll Back Malaria
strategies.

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 National malarial control strategies.
 1; early diagnosis and prompt treatment
 2; multiple prevention
 3; early detection and response to epidemics.
 4;developing viable partnership with national
and international partners.
 5;focused operational research
 6;political commitments.

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 1978- Malarial control program integrated
with health system.
 1999- Roll back malarial program. In 1999
Pakistan has signed the RMB initiatives and
includes it in the NATIONAL HEALTH POLICY
of 2001.

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 Success;
 Pakistan sufficiently developed drug manufacturing industry that can help
in fighting malaria.
 Health sector still enjoy interventions like Roll back malaria.

 Failures:
 Low epidemic preparedness at federal and provincial level.
 Low level of monitoring and evaluation of malarial control activity
due to financial and human resources constraints.
 Weakness in human resources capacity and logistics especially
at district and provincial level for qualified and experienced staff.

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 Aim
 Reduction in morbidity and mortality regarding
malaria in general population of Pakistan.
 Objectives;
 1), To give awareness in 100% of the
general population of Pakistan, in two
years.
 2), To promote the use of LLINs in 90%
of general population of Pakistan, in 3
years.

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 Rationale
 This is documented that malaria is still
endemic in many part of our country especially
Baluchistan, sindh and NWFP11. There is high
incidence of any type of malarial infection to
any age group.14 previously very few
interventions have been taken there. So this
project will helpful for the control of malaria at
the national level including endemic and non
endemic areas.

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 Intervention/ prevention strategies of malaria
with priority preference

 Behavioral communication change; behavior can be

changed by strategies at personal level and at
community level.
 Strategies at personal level. Approaches at
personal level needs to modify the behavior of general
population including high risk group like pregnant
women and children under five years of age.
 Regarding their personal protection, use of LLINs,
their own cleanliness, and cleanliness of their house
and surroundings.
 Personal protection measure. Like long sleeves and
trousers out side the house in the evening.

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 Use of repellent creams and sprays and
avoidance of night time activities.
 Use mosquito coils or vaporizing mats
containing pyrethrine.
 Screen windows and doors.
 Draining of stagnant water.
 Treatment of stagnant water with used mob oil
and chemicals where necessary.

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Strategies regarding community participation

 In all the community level activities there will

be collaboration between DCO, Nazim and
Counselors
 Establish relationship with the NGO’s to
mobilize the community members concerned
about malaria protection, to carry out activities
in order to promote regarding educate the
community leader.
 Establish relationship with the other
community based organizations which provide
services regarding literacy, water and
sanitation system.

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 Involve other departments like department of
agriculture and municipal authorities.
 Collaboration with local government organization
such as school, health agencies, and hospitals in
order to promote malarial prevention program.

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 Group discussion regarding prevention
of malaria will be arranged at the house of
most influential person like local choudhry
and sardars etc. A male and female doctor
will visit every month. Information should
be given about personal protected
measures and use of LLINs which will be
available to demonstrate at that point in
time.

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 Mass media campaign regarding prevention
and sign and symptoms of Malaria. Message
will be advertised through local cable channel.
IEC material (written and pictorial ) will be
distributed. Documentaries regarding
prevention of malaria and its disease outcome
will be shown to the people. Displays at most
crowded places such as bazaar, bus stop and
railway station.
 There will be an national malarial campaign
week annually.

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 There will be interpersonal communication
(training of the HCP+ Social mobilizers for
better IPCs)
 Provision of 24 hour hotline number for
information regarding malaria.
 Education regarding malaria will also be given
in the jail, factories and education institutes.
 Identification of the high risk group.
 Providing opportunities on equity basis so
every one can participate regardless socio
economic status and education.

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 Depot services, it is the type of
community based distribution services. A
member of the community store and
supplies. This person is paid fees for this
service. BHUs for general population
and MCHs for pregnant and children
provide the services.
 There will be transfer of resources from
government agencies to the community.

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 The best approach for community
participation for the vector control is to
involve local leaders, imams, teachers
and LHWs for imparting health
education- -messages as well as support
vector control staff in their respective
area of influence.

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 Why it is important;
 They don’t realize danger of malaria.
 Not having to suffer from spending
heavily on treatment.
 To live a healthy life.

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 Use of insecticide treated bed nets (LLINs).
LLINs are extremely effective tools for
personal protection. They provide chemical
barrier as well as physical barrier.
 It is well documented that LLINs leads to large
scale killing of mosquitoes16.it selectively kill
that mosquito population that is ready to bite. It
also inhibits mosquito feeding hence reducing
reproductive potential of highly anthropophilic
vectors16.

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 Ithas advantage for refugees’ population or
internally displaced population or
population living outdoor and under tents17 .
 Delivery of bed nets is through MCP, in
addition to that CHW and LHWs. All these
distribution will be recorded to collect data.

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 Training of the community health
workers and community leaders
regarding proper use of LLINs.
 IEC campaign for the use of bed nets.
 Tax exemption on the importation of
malaria control commodities.

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 Involve social marketing group to operate
at grass root level, provide services at no
cost and distribute ITNs free of cost13 .
 It will be distributed free or at highly
subsidized rate in highly endemic area
residents.
 There will be aesthetic approach regarding
colour of the LLINs.

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 Why it is important;
 Simple measure that protect against the
disease.
 Not costly and prevent against mosquito
bite.

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 Monitoring;

 Monitoring of the session conducted by health

officer and LHWs.
 Repeated cross sectional assessment would
be found to be more suitable for assessing the
impact of ITNs.
 Checking quality of material used.
 Monitoring the establishment of laboratories
making sure that optimum quality standard are
followed.

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 Following strict merit criteria in hiring the
staff.
 Refresher training courses will be
arranged after every three months.
 Regulation of the Pvt. Sector regarding
the prevention & control of the malaria.

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 Establishment of malaria early warning
system(MEWS) for early detection of the cases
among the general population & identification of
the possible factors responsible. There will be
vertical presence of the surveillance system from
national to district level. The purpose of this
surveillance system is to timely address the
possible preventable factors in the occurrence of
the cases and to control the spread of the cases
among the rest of the population. This system will
also help to detect the gaps in the interventions.

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 Evaluation;

 Process indicators ;
 # of LLINs distributed.
 # of case detected.
 # of cases referred.
 # of training session conducted for the HCPs.
 # of HCPs trained.
 # of community awareness sessions conducted.
 # of community members given awareness.
 # of pregnant mothers given awareness.

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 Out come indicator;
 % of death due to malaria.
 % of cases due to malaria.
 % of population of aware of malaria
prevention.

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 REFERENCES;

 1, World health organization.

 2, http://www.who.int/classifications/icd/en/ .Accessed at 17/9/09
 3, parasitol today 1994Nov; 10(11):439-42. Accessed at 17/9/09
 4, Joel G. Breman, Anne Mills, Robert W. Snow, Jo-Ann Mulligan,Christian Lengeler, Kamini Mendis, ET AL.
disease control priorities in developing countries ; 1993.
 5, www.wrongdiagnosis.com/m/malaria/symptoms.htm. Accessed at 18/9/09
 6, http://www.cdc.gov/malaria/history/index.htm. Accessed at 18/9/09
 7, www.searo.who.int/en/Section10/Section21.htm Accessed at 19/9/09
 8, www.searo.who.int/EN/Section10/.../Section340_4018.htm. Accessed at 19/9/09
 9, www.searo.who.int/en/Section10/Section21.htm Accessed at 19/9/09.
 10, www.searo.who.int/EN/Section10/.../Section340_4018.htm. Accessed at 19/9/09
 11, www.emro.who.int/rbm/CountryProfiles-pak.htm Accessed at 19/9/09.
 12, Joel G. Breman, Anne Mills, Robert W. Snow, Jo-Ann Mulligan, Christian Lengeler, Kamini Mendis ET
AL. disease control priorities in developing countries ; 1993.
 13 ,Khamis m s. malarial control strategies in the kolom bero Tanzania . 2000.
 14, Yasinzai, M.I. and J.K. Kakarsulemankhel, 2008. Incidence of human malaria infection in desert area of
Pakistan: District Kharan. J. Agri.
 Soc. Sci., 4: 39–41
 15, John C.B. malaria control in high light of Brundai. A important success story. 2008; available at
http://www.ajtmh.org/cgi/reprint/79/1/1.pdf Accessed at October 3,2009
 16,Hawley, WA et al.Community wide effects of permethrine treated bednets on child mortality and malaria
morbidity in western Kenya. American journal of Topical Medicine and Hygiene, 2003,68(4):1211127
 17, guidelines for planning and implementation of malarial vector control at district
level:Islamabad:tama:2007.
 18, malarial control strategies and target -an overview: Geneva: 2008

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Thank you

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