ADAPTIVE DESIGN OF URBAN MALARIA CONTROL PROGRAMS

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ADAPTIVE DESIGN OF URBAN MALARIA CONTROL PROGRAMS
Marcia Caldas de Castro 1 Deo Mtasiwa 2 Burton
Singer 1 Marcel Tanner 3 Juerg Utzinger 1 Yoichi
Yamagata 4
1 Office of Population Research Princeton
University
2 Dar es Salaam, Tanzania City Council
3 Swiss Tropical Institute
4 Japan International Cooperation Agency
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CHARACTERISTICS OF SUCCESSFUL MALARIA CONTROL
PROGRAMS

• Environmental management is the central focus,
  with several interventions/surveillance methods
  acting simultaneously.
• Tuning the package of interventions to minimize
  the number of malaria cases per year is an
  adaptive process involving ongoing performance
  evaluation of each of the tools and the outcome
  measure (interventions are adjusted over time in
  response to these evaluations).

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• 3-5 years were required before a given package of
  interventions exhibited high level performance.
• Diagnosis of malaria cases, anti-malarial drugs,
  bed-nets, and the use of chemical insecticides
  (following the discovery of DDT) were necessary
  but not sufficient (for success) components of
  the program.
• Program staff contained people knowledgeable
  about entomology, hydrology, epidemiology/ecology,
  and clinical aspects of malaria.
• The implementation strategy, including the mix of
  tools employed, was highly idiosyncratic to the
  particular locality.

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a) Roan Mine
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A.Gambie and A.Funestus larval habitats

• A.Gambie
• Open and un-shaded natural or man-made pools of
  standing water, near rivers and tributaries
• Open water tanks and nature wells loosely
  overgrown with grass
• A. Funestus
• Shaded banks of rivers and tributaries
• Swamps and flooded areas with partial shade

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Biting pattern
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Reduction of Average Monthly Malaria Rate and
Total Malaria Cases after the Implementation of
Malaria Control Program - (1930-1933)
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Average Monthly Malaria Incidence Rate and Annual
Malaria Cases at the Roan Antelope Mine between
1944 and 1949
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b) Nkana Kitwe Mine
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Reduction of Malaria Incidence at Nkana-Kitwe
Mine between 1935-1943
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Reduction of Malaria Incidence at Nkana Mine
between 1944-1950
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Malaria, Rainfall, and Anopheles Statistics at
the Roan Antelope Mine between 1944-1949
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Urban Malaria Dar es Salaam, Tanzania
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Dar es Salaam
Area Study
Africa
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Urbanizationin Dar esSalaam
Source http//mshand.geog.gla.ac.uk/DAR/Tanzania.
htm
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- Land Use -Vegetable Production
Source http//www.cityfarmer.org/daressalaam.htm
l
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History of Malaria Control in Dar es Salaam1902
- 1961

• 1902-1912 German Colonial GovernmentDrainage,
  soil modification, bednets
• 1912-1918 German ordinances for controlling
  breeding sites proscribed urban agriculture
  (potatoes and other ridge-and-furrow type
  cultivation
• 1918-1961 British ProtectorateContinued
  drainage works, stronger legal measures
• 1920 Sanitation Branch established
  East Africa Malaria Unit established
• 1951 Tanganyika Malaria Service

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History of Malaria Control in Dar es SalaamPost
colonial period

• 1961 Urban mosquito control integrated into
  general health services
• 1971 Integrated malaria control experimentDar
  es Salaam City Council WHO East Africa Aedes
  Research Unit
• 1980 Reduction in size of central malaria
  control unit Consequential to adverse economic
  conditions (1970s high inflation)
• 1988-1996 JICA Malaria control
  initiativeJapan-Tanzania bilateral project

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- Breeding Sites - Aerial Observation
Misimbazi Creek
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Breeding Sites - Aerial Observation
Temeke
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- Breeding Sites - Aerial Observation
Regent State Kijito-Nyama
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Breeding SitesMalaria Risk Mapping
Dar es Salaam, 1993
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Breeding SitesMalaria Risk Mapping
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Breeding SitesMalaria Risk Mapping
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Breeding SitesMalaria Risk Mapping
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Breeding SitesMalaria Risk Mapping
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Interventions StrategyIndoor Residual House
Spraying (IRHS) and Larvicide
Kisarawe
Selected schools
Pagu Kajungeni
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Effect of Interventions - IRHS
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Effect of Interventions - Larvicide
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Effect of InterventionsBoth IRHS and larvicide X
no intervention
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Total Length of Drain Cleaned(cumulative -
meters)
Dar es Salaam
Tanga
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- Program Implementation -Based on successful
programs in the past

• Environmental management is the central focus,
  with several interventions/surveillance methods
  acting simultaneously.
• Tuning the package of interventions to minimize
  the number of malaria cases per year is an
  adaptive process involving ongoing performance
  evaluation of each of the tools and the outcome
  measure (interventions are adjusted over time in
  response to these evaluations).

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• 3-5 years were required before a given package of
  interventions exhibited high level performance.
• Diagnosis of malaria cases, anti-malarial drugs,
  bed-nets, and the use of chemical insecticides
  (following the discovery of DDT) were necessary
  but not sufficient (for success) components of
  the program.
• Program staff contained people knowledgeable
  about entomology, hydrology, epidemiology/ecology,
  and clinical aspects of malaria.
• The implementation strategy, including the mix of
  tools employed, was highly idiosyncratic to the
  particular locality.