Biology Reference
In-Depth Information
area during the 1950s-1960s. There was no malaria in Kyrgyzstan until the
early 1980s when regional population movements associated with the war
in Afghanistan reintroduced vivax malaria to the Fergana Valley (
Razakov
Sh, 2000
). By 2002, 2744 cases of malaria (98% vivax) were registered in
Kyrgyzstan and malaria control programs were being re-instituted. During
2002, about 5000 persons were given preventive therapy with primaquine
in a region bordering Tajikistan (
Usenbaev et al., 2006
). In 2007, a localized
peri-urban epidemic led to a decision to give MDA with primaquine in
addition to ordinary case finding and treatment. From a target population of
nearly 9000 persons, it was decided to give primaquine treatment to 6897
persons and 90% actually received the intended medication (
Usenbaev
et al., 2008
). About 2% were unable to tolerate primaquine and stopped the
medication; no haemolytic reactions were reported. In conjunction with
other environmental antimalarial measures such as larvicides, the vivax cases
fell to three by 2009.
4. DIFFICULTY GOING FROM LOW TO NO MALARIA
TRANSMISSION
Disease elimination programs are different in that the unit of treat-
ment is the population and not the individual. Established anti-transmission
methods have repeatedly been shown to reduce malaria transmission
to low levels when used properly and with sufficient vigour. The diffi-
culty is going from low malaria, when it is of little public health conse-
quence, to no malaria, where the parasite is indeed absent. Diminishing
returns are obtained as fewer parasites are killed only by applying increas-
ingly greater efforts. In both Taiwan and the USA, vivax was the primary
parasite and certainly the last one to be eliminated by successful pro-
grams in 1965 and 1952, respectively (
Yip, 2000
;
1991
;
Williams, 1963
;
Lisansky, 1958
).
4.1. Malaria Elimination in Taiwan
The outstanding success of island elimination was Taiwan and it is instruc-
tive to note the scale of the operations required to eliminate both falci-
parum and vivax malaria from Taiwan (
Yip, 1998
,
2000
;
Department of
Health, Executive Yuan, 1991
;
Chen, 1991
). Taiwan conducted a classic
GMEP campaign largely dependent on DDT IRS where MDA was ancil-
lary to the use of insecticides. Advantages that the Taiwan program had
in order to achieve elimination included being an island, absence of drug
