The Garki ProjectEpidemiology & Control of malaria in the Sudan Savanna of West Africa

Publication by

L. Molineaux and G. Gramiccia, 1980

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West African savanna

online google images

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Online google-images

West African savanna

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Chapter 3: Control Operations

What was done

Insecticide residual spray - propoxur Most effective (fumigant) Never used on large scale Total coverage (total spray coverage)

Spray coverage = # huts completely sprayed among total huts (at spray time).

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Contd: Control operations

MDA, sulfalene + pyrimethamine Long lasting Tolerated on empty stomach Effective against blood stage parasites Total coverage (all except naïve infants)

1. High dose – every 2wks wet season or 10wks

2. Low dose – every10wks

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Contd MDA

Residents registered by compound

Active treatment For residents by name Parasitemic new borns Visitors at time of treatment

Effort made to treat absentees (twice) removed if missed >2 or 4x, consecutively

Human coverage = proportion of residents treated at each MDA round

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A1

A2

Bspray

Cuntreated

Garki: treatment areas plus follow up villages

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Residual spraying: results & issues

Coverage - % huts sprayed among total huts Varied by village Varied by spray round

Dose applied Varied between rounds

true coverage lower (new huts/repairs)

74 – 100% or 84 – 100%Intervention follow up

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High MDA

low MDA cool dryhot dry rainy

rainy

* ** ***

* spray round

MDA coverage

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Issues with MDA

1. Definition: human coverage by MDA round (proportion pple treated/MDA round)

1. Mobile2. No census (# to be treated unknown)

1. # visitors count not clear2. # days/visitors “3. Absentee registration varied, unknown

2. Distribution of registered vs treated nonrandom

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no. eligible or registered23 rounds of MDA (6 villages)

CLUSTER 5, 7 (A1)

CLUSTER 6, 8 (A2)Every 10 wks for 9 rounds of MDA

% d

istr

ibut

ion

of

peop

le b

y #

trea

tmen

t re

ceiv

ed -

18

mon

ths

Comparison 1.1 actual distribution vs. binomial distribution

goodparticipants

high MDA score

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Control operations: summary

What was achieved? Malaria knowledge

Self treatment Availability of treatment

What was not? Why? Random MDA

coverage Non randomization

Biased results Ineffective control

Spray coverage & tally inadequate

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