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Integrated vector management and malaria control WHO EMRO Regional meeting, Muscat, 27032002

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The utilisation of all appropriate technological and management techniques to ... Epidemic prevision and response. Emergencies (war, natural disasters. ... – PowerPoint PPT presentation

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Title: Integrated vector management and malaria control WHO EMRO Regional meeting, Muscat, 27032002


1
Integrated vector managementand malaria
controlWHO EMRO Regional meeting, Muscat,
27/03/2002
  • Dr. Pierre F. Guillet
  • Parasitic Diseases Vector Control
  • WHO Geneva

2
Few definitions...
  • Integrated Vector Control (IVC)
  • The utilisation of all appropriate technological
    and management techniques to bring about an
    effective degree of vector suppression in a cost
    effective manner.
  • WHO, 1983

3
Definitions
  • Selective Vector Control
  • The targeted use of different vector
    control methods alone or in combination
    to prevent or reduce human-vector contact
    cost-effectively, while addressing sustainability
    issues
  • WHO Expert Committee on malaria, 1994

4
Declaration of the 50th session of the WHA,
resolution 50.13
  • To take steps to reduce reliance on insecticides
    for control of vector borne diseases through
    promotion of integrated pest management
    approaches in accordance with WHO Guidelines, and
    through support for the development and
    adaptation of viable alternative methods of
    disease vector control

5
Definitions
  • Integrated Vector Management
  • A process of evidence-based decision making
    procedures aimed to plan, deliver, monitor and
    evaluate targeted, cost-effective and sustainable
    combinations of regulatory and operational vector
    control measures, with a measurable impact on
    transmission risks, adhering to the principles of
    subsidiarity, intersectorality and partnership.
  • WHO, draft working definition, 2001

6
Elements of IVM
  • Its about process, not contents
  • spells out the need for an evidence base
  • retains economics and sustainability as key
    criteria
  • mentions both regulatory and operational measures
  • further defines output indicators

7
Elements of IVM
  • Ecosystems analysis as a starting point
  • Leads to a logical build-up of integrated
    measures, from environmental management to
    biological and chemical control approaches
  • Leaving chemicals as a measure of last resort,
    recognises their value as a resource that need to
    be sustained as long as possible

8
IVM, a basis for implementation of vector control
interventions
  • Vector control, an essential element of vector
    borne disease control
  • Not an individual programme but a component of
    disease control, in line with national policies
    and health sector reform
  • Based on sound knowledge of ecological and
    epidemiological situations, cost effectiveness
    analysis and judicious integration of available
    options

9
  • Should be effective, safe, environmentally sound,
    economically feasible, socially acceptable and
    sustainable.
  • IVM Objectives
  • To reduce vector breeding where and when possible
  • To reduce abundance and longevity of vectors
  • To reduce human vector contact (personal
    protection)

10
Strategies
  • Vector management principles and decision making
    criteria to be integrated into existing
    frameworks of national health policies
  • Establishment or strengthening of vector control
    services in conjunction with
  • the creation of enabling policy framework for
    intersectoral collaboration
  • the strengthening of legislative and relevant
    regulatory frameworks and their enforcement

11
  • Social mobilisation involvement of communities
  • Capacity building addressing human, material
    financial resources
  • Promotion of research
  • Initiation and strengthening of regional
    collaboration networks

12
Steps towards implementation
  • To prepare and disseminate technical guidelines
    for
  • situation analysis and need assessment for IVM
  • planning, implementing, monitoring and evaluating
    vector control interventions based on IVM
  • To provide technical assistance to the Member
    States for above steps

13
IVM and malaria control
  • Fundamental parameters to consider
  • Anopheline female life expectancy
    (daily survival rate)
  • duration of sprorogonic cycle
  • feeding and resting habits
  • stability of transmission
  • development of human immunity

14
Larval control a limited role
  • Reduce adult densities but not life expectancy
    (Mac Donald and Garrett Jones formulas)
  • proper planning and experienced staff needed
  • expensive and labour intensive
  • potential environmental impact
  • more suitable for urban and peri-urban
    environments and few special settings (low
    vectorial capacity)

15
Indoor residual spraying
  • Gold standard method in malaria
    control but..
  • absence of vector control structures
    in a number of countries
  • limited choice of insecticides
  • cost and logistical constraints (increase in
    human populations)
  • high impact of insecticide resistance
  • increasing problem of acceptability

16
Insecticide treated materials
personal protection
  • A highly targeted and selective
    use of insecticides
  • When compared to IRS, reduce by
    150 to 300 times consumption of
    insecticides. Difference even higher with long
    lasting insecticidal nets
  • How does it work personal protection versus
    community protection

17
ITNs or ITMs?
  • Immediate and long term efficacy of ITNs already
    established
  • Efficacy of impregnated curtains to be confirmed
    (expected differences according to local
    conditions and type of curtains)
  • Long lasting impregnated plastic sheetings and
    impregnated blankets for refugee settings and
    complex emergencies

18
ITNs, strengths and limitations
  • No need for vector control services
  • Distribution by various channels health
    services, private sector, NGOs...
  • Opportunities for partnerships
  • Social acceptance
  • Low retreatment rates, especially in Africa
  • Heavy reliance on pyrethroids (resistance)

19
  • ITNs, a tool for multi-disease
    prevention
  • Better integration of human communities in health
    programmes
  • A first level approach to catalyse and build up
    interest on vector control at central and
    peripheral levels
  • Opportunities for innovative approaches (e.g.
    LLINs)
  • Optimal combinations of drugs and insecticides
  • ITNs, not a universal silver bullet but a
    component of IVM strategies and approaches

20
Other interventions
  • Space spraying, very limited in malaria
    prevention
  • Environmental management
  • house improvement (e.g. La Réunion)
  • sanitation in urban areas and modifications of
    environment
  • Biological control (bacterial larvicides (Bti),
    larvivorous fishes)

21
EMRO, an heterogeneous region
  • A range of cost-effective strategies may be
    developed, depending upon local ecological and
    epidemiological contexts as well as resources
    available (human, financial, logistical..)
  • From highly malaria endemic countries (e.g.
    Sudan) to eradication almost completed (Morocco,
    Oman)

22
IVM, development of new toolsstill an heavy
reliance on insecticides
  • Need for strengthening pesticide management
    practices and resistance monitoring networks
  • We are loosing our weapons
  • Need for detailed comparative risk benefit
    analysis
  • Public information and legislative campaigns to
    preserve the availability and use of pesticides
    for disease vector control

23
On going challenges in malaria control
  • Epidemic prevision and response
  • Emergencies (war, natural disasters..), follow up
    of population movements
  • Risk assessment for vector borne diseases in
    planning agricultural development schemes
  • POPs negotiations and DDT phasing out
  • Capacity building, training in vector control
  • Co-ordination to further improve country support
  • Et la lutte continue !!
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