Efficacy and cost‐effectiveness of environmental management for malaria control

Abstract

SummaryRoll back malaria (RBM) aims at halving the current burden of the disease by the year 2010. The focus is on sub-Saharan Africa, and it is proposed to implement ef®cacious and cost-effective control strategies. But the evidence base of such information is scarce, and a notable missing element is the discussion of the potential of environmental management. We reviewed the literature and identi®ed multiple malaria control programmes that incorporated environmental management as the central feature. Prominent among them are programmes launched in 1929 and implemented for two decades at copper mining communities in Zambia. The full package of control measures consisted of vegetation clearance, modi®cation of river boundaries, draining swamps, oil application to open water bodies and house screening. Part of the population also was given quinine and was sleeping under mosquito nets. Monthly malaria incidence rates and vector densities were used for surveillance and adaptive tuning of the environmental management strategies to achieve a high level of performance. Within 3±5 years, malariarelated mortality, morbidity and incidence rates were reduced by 70±95%. Over the entire 20 years of implementation, the programme had averted an estimated 4173 deaths and 161 205 malaria attacks. The estimated costs per death and malaria attack averted were US$ 858 and US$ 22.20, respectively. Over the initial 3±5 years start-up period, analogous to the short-duration of cost-effectiveness analyses of current studies, we estimated that the costs per disability adjusted life year (DALY) averted were US$ 524±591. However, the strategy has a track record of becoming cost-effective in the longer term, as maintenance costs were much lower: US$ 22±92 per DALY averted. In view of fewer adverse ecological effects, increased sustainability and better uses of local resources and knowledge, environmental management ± integrated with pharmacological, insecticidal and bednet interventions ± could substantially increase the chances of rolling back malaria.

Integrated malaria vector control with microbial larvicides and insecticide-treated nets in western Kenya: a controlled trial

“…Truly integrated and well-managed malaria control efforts have led to major successes in the past, including the eradication of A. gambiae from Brazil 45 and Egypt, 46 the eradication of malaria in the United States, Europe and the Middle East 47,48 and the control of malaria in Zambia. 20 Yet these successes have largely been forgotten or dismissed. Our study is among the first to reassess the impact of larval source management on malaria transmission and infection incidence in contemporary Africa.…”

“…[9][10][11] While ITNs are currently the priority strategy, there is growing interest in attacking the aquatic stages of malaria vectors with microbial larvicides, in conjunction with environmental management. 5,6,[12][13][14][15][16][17][18][19][20][21] Presently, microbial larvicides are being used in an operational context only in Dar es Salaam, in the United Republic of Tanzania. 22,23 However, in the future larvicide application will be expanded to many of the 15 countries included in the President's Malaria Initiative and this interest is likely to spread to other African countries.…”

Malaria: current status of control, diagnosis, treatment, and a proposed agenda for research and development

“…Deployment of impregnated bednets in China and Africa has been successful in reducing malaria morbidity, mortality, or both, [19][20][21] although the resulting decrease in naturally occurring immunity may limit this effect in the medium term. 22 Resistance of the vectors to insecticides is generally increasing.…”

Environmental factors affecting malaria parasite prevalence in rural Bolifamba, South- West Cameroon

“…Reduction in man-vector contact may be achieved by the use of protective clothing, insect repellents, bed nets, insecticides or environmental management. In Zambia, multiple control interventions, including environmental management against Anopheles larval stages and improvement in hygiene and sanitation reduced the overall malaria incidence and mortality rates by approximately 50% [4]. In Europe and North America, malaria was eliminated through use of insecticides and manipulation of the environment [5].…”