Malaria News |
Malaria Elimination: When the Tools Are Great but Implementation Falters 
In the current issue of the American Journal of Tropical Medicine and Hygiene, Silas Majambere and colleagues report the outcome of a trial to control malaria in rural parts of The Gambia through larval source management (LSM). In response to the increased uptake of treated bed nets and indoor residual spraying across Africa, various integrated programs that include LSM have been, or are being implemented, in line with the World Health Organization's (WHO) advocacy of integrated vector management (IVM). Area-wide larviciding thus seemed an attractive integral component for IVM along the Gambia River where annual flooding produces numerous breeding sites in the first kilometer of landward edges of the river. Parallel to this study, several authors were also engaged in a similar trial in West Kenya, the results of which were published recently, which showed unequivocally that larval control significantly enhanced the impact of bed net use only. Regretfully, in The Gambia the trial failed, with no reduction in clinical malaria, parasite prevalence, or anemia. This trial failed despite a massive 88% reduction in apparent larval densities. What went wrong?
|