Table 12.3Key Differences between Interventions for Malaria Control and Elimination

IndicatorMalaria controlMalaria elimination
Epidemiological settingHigh and medium transmissionLow transmission, localized, and seasonal
Population at riskEntire population(s) considered to be at riskPopulations living in transmission foci, high-risk groups, migrants, and mobile populations
Vector control
Long-lasting insecticide-treated netsWidespread coverageAt-risk areas and populations; travelers to endemic areas
Indoor residual sprayingWidespread coverageAt-risk areas and populations
Larval control
LarvicidingAppropriate in specific circumstances where breeding sites can be identified and regularly targeted; supplement to insecticide-treated nets and indoor residual spraying; may be better suited to urban areasAppropriate in specific circumstances where breeding sites can be identified and regularly targeted
Environmental managementNot feasible in most high-transmission settings where the specific cases cannot be targetedFeasible in targeted areas
Case management
DiagnosisAll suspected cases should undergo diagnostic testing with rapid diagnostic tests or microscopy; goal is to have a confirmed diagnosis; clinical diagnosis not recommended; diagnosis should distinguish between parasite species; quality assurance protocols should be implementedRapid diagnostic tests, microscopy, or both with confirmatory diagnostics; quality assurance protocols implemented; highly sensitive molecular diagnostic (polymerase chain reaction, loop-attenuated isothermal amplification) may be considered for quality assurance; diagnostic should distinguish between parasite species
TreatmentP. falciparum: ACTP. falciparum: ACT plus single low dose primaquine (0.25mg/kg)
P. vivax:
Blood-stage infections, chloroquine-sensitive areas: Chloroquine or ACT
Blood-stage infections, chloroquine-resistant areas: ACT or quinine during pregnancy
To prevent relapse: primaquine (0.25–0.5 mg/kg) for 14 days
G6PD deficiency: primaquine 0.75 mg/kg once a week for 8 weeks
Prophylaxis for travelers		P. vivax:
Chloroquine-sensitive areas: Chloroquine or ACT for blood-stage infections plus primaquine (0.25–0.5 mg/kg) for 14 days to ensure clearance of liver-stage infection (gametocytes)
Prophylaxis for travelers
Intermittent preventive treatment for pregnant women and infantsn.a.
Mass drug administrationSeasonal malaria chemopreventionHigh-risk groups in geographic or demographic clusters Trials have used DHA/PIP and artemether lumefantrine accompanied by single low dose of primaquine.
Surveillance
PassiveMonthly reporting of aggregate, confirmed cases to a central levelRapid or weekly reporting, ideally electronically, of individual cases classified by origin to a central level
ActiveNot feasible because of high number of casesIncludes case investigation, reactive case detection, proactive case detection (which may include mass screening), and foci investigation
Program management
Program structureIncreased investment in integrated programming in the general health systemVertical programming investment needed; flexibility needed between vertical and integrated systems
Human resourcesLarge teams of dedicated staff for specific interventions; specialized skills trainingDedicated managers; basic skills maintained among cadre of integrated staff
High-level commitmentNational reduction of disease burden (morbidity, mortality)National or subnational goals of elimination; may feed into regional elimination goal; regional collaboration encouraged for controlling imported cases

Source: Gosling and others 2014; RBM Partnership 2008; WHO 2012c.

Note: ACT = artemisinin-based combination therapy; DHA/PIP = dihydroartemisinin-piperaquine; mg/kg = milligrams per kilogram; n.a. = not applicable.

From: Chapter 12, Malaria Elimination and Eradication

Cover of Major Infectious Diseases
Major Infectious Diseases. 3rd edition.
Holmes KK, Bertozzi S, Bloom BR, et al., editors.
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