United Nations

WORLD HEALTH ORGANIZi�TION

RB.Q.ION.AL OFiICl?_ ?OR THE EASTERN. ME]2ITEfulANEAN

REG ION.AL TECmHCAL t1EET ING ON HAL.ARIA ERADICATION

�aghdad, 7-12 DE3cemb_er 1957

DR.AFT FIN.b.L REPORT

of tho

M.A.LARIA CONFE:i:mNCE

Nations Unies

ORGANIZATION NONDIALE DE LA SAl'JTE

BUREAU Rj�GIONAL DE LA MEDITERLLU'J�E __ ..QRIENTALE

EM/Mal.Erad./35 12 December 1957

ORIGINAL: ENGLISH

I

REPORT OF DEBATES

PROGRESS OF MALARIA ERADICATION IN THE COUNTRIES OF THE EASTEiffl-" MTuDITERRANEAN REGION

INTRODUCTION

Apart from Cyprus, where malaria has been eradicated

in 1949, malaria is still the greatest public health proplem

in the countries o-f the Eastern Mediterranean Region. Of

190 million people living in this region, 140 million are

living in the malarious areas only 33 million are receiving

protection under present control and eradication operations.

Plans of eradication have been adopted by Lebanon, Syria,

Iraq and Iran and other countries like Egypt, Jordan and

Israel are in their preparatory phase to embark on malaria

eradication. Great achievements are obtained in terms of

protection of the population, development of national

organizations for implementation of eradication programmes

and an ever increasing intorest of Government members to

support and help these national organizations for the achieve­

ment of their goal by allocation of an enormous amount of

budget exclusively for this programme and provision of laws

or regulations to ease tre administration of the project.

CYPRUS

Malaria was announced eradicated in Cyprus in 1949 after

successful anti-malarial operations which started in 1946.

Before this date, malaria prevailed to a serious extent on

the island and each year between 10 to 18 thousand cases were

reported. More than £15,000 was spent by the Government

sponsoring dispensaries and for the provision of drugs.

Work on vector eradication scheme started in 1946 in one

part of th0 country and extended to cover the whole island

in 1948 with complete freedom from malaria in 1949. Since

1950 maintenance service, integrated with other public health

activities, is in operation actively for search of malaria cases

and malaria vectors •. Adult and larvae.control combined with

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other. insect control measures were applied. Since 1953 no

positive case and no adult anopheline mosquitoes have been found

on the island. These maintenance operations cost the Govern­

ment about £15,000 annually which taking iato consideration the

increase of wage scales and other expenses constitute 1/5 of the

cost of t'he programme, prior to the bc0inning of control

operations.

EGYPT

DDT was introduced in 1946 but was used extensively only

between 1953 and 1955 especially in Fayum province. In this

provinceidue to shortago of insecticides or transport and also

repeated withdrawal of all campaign personnel owing to other

epidemic emergencies the work was interrupted frequently and

oniy a little over 1/3 of the housos could be sprayed yearly

during the years 1948-52. Nevertheless, the results were most

encouraging and the number of notified malaria cases dropped

from 3,069 in 1947 to 11 in 1954. Operations have been

expanded on other areas and satisfactory results are obtained

in terms of reduction of malaria incidence in Egypt.

In 1956, the Malaria Section stopped all applications of

DDT and allied hydrocarbons in ordor to avoid tre development

of resistance in tho mosquitoes. During the current year,

however, instructions wero given to all control sections to

engage in largo scale systematic spraying of walls with

residual insecticides, for a period of throe months, during

summer. This was done with a view to training field workers

in the techniques and procedures of tho spraying operations.

These workers will form the nucleus t'or training the future

personnel •. ::�d workmen who will be engaged in the Malaria

Eradication Progrrunmc.

At present, the Malaria Section comprises 44 stations,

64 sub-stations� nnd serves about 8 million people, at a yearly

expenditure of about L.E. 600,000.

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A plan for malaria eradication in Egypt within a fiv0

year period is prepared in 1956. According to this plan,

the Egyptian territory ia to be divided into three main

:Sectors and operations #ill be expanded by stages. The

loto.l expenses required for such/campaign is roughly estimat-

ed about £3,000, 000. Before pu.tting this programme into

action it is neoessary however, to forestall certain

financial and administrative difficulties and also to meet

the need of a law for malaria eradication by the enactment

of laws or necessary regulations.

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Anti-malaria programme by residual spraying dates back

to 1948 when some control activities were started in

demonstration areas with technical assistance from WHO.

These operations weore expanded with the assistance of

U�S. I. C.A. and U.N.I.C.E. F. during the year 1951 through

1956 covering in the latter year 19,427 villages and

protection of 4,564�100 persons.

Throughout this time much experience was e;ained and

trained personnel became available. ·rhe Institute of

Malariology was established in 1952 as a scientific advisory

institution for training of necessary personnel, execution

of epidemiological and entomological surveys throughout the

country and for continuous evaluction of the results of the

control programme, and provision for study and research of

various technical problems.

In 1956 a programme aiming at the eradication of

malaria by stages was prepared in Iran and to this end

agreements were made with UNICEF and WHO and the programme

received Government financial support from tre development

fund of the Plan Organization and about 13,000,000

dollars arc allocated for operational expenses. The country

is divided into four zones and malaria eradication operation

has started in 1957.

ion of 5,140,384 have been sprayed and surveillance operations

arc to be organized in 12,953 �illages. At the beginning of

this y0ar, spraying operations have been discontinued in about

2_�j12 villages and it is expected to discontinue it at tre end

of 1957 in about 6,00C.-more vi1la2;cs.

Malaria Eradication Organization is managed independently

by a responsible Director General under the direct supervision

of the Minister of Health.

Operations are decentralized on Ostan and Shahris•tan basis

to implement the programme of operations according to the

technical plan established by the Scientific Council of tre

Institute of Malariology.

IRAQ

Iraq_ has su.f.f ored up to 15 years a:�o from severe hyper

endemic malaria in the .foothill· areas pf Zagros mountains

and endemic foci of the palm growing arens of the plains. The

development o.f irrigation schemes on the plains resulted in

great expansion and persistenreof malaria in the country.

Control programmes started by the Nati onal Endemic Diseases

Institute in 1949 was developed in 1954 with the assistance of

WHO.

During 1956� a Plan of Operations for Malaria Eradication

in Iraq was completed and agreed to by WHO,UNICEF and the Iraq

Government. Aided by the support of the Iraq Development Board,

Iraq launchGd this pro0rammo in 1957, venting to operations in

the .following months with residual spray in 14,300 localities,

protection of 4,800,000 persons directly and indir0ctly, in the

entire rural areas of the country j and an expenditure of

Il!J.700,000.

The succe:::.s of the previous operations cruld be described

by the reduction of the number of cases treated as clinical

malaria as compared to the total sick treated for all causes

during tho year at the various dispensaries of the cou ntry from

13. B1S in 1946 to 2. 3�i'i in 1956.

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According to epidemiological investi0ations, t.ransmission

has stopped in many liwas and of 8,177 persons recently examined

in various liwas under op0ration only sevon positive cases

were found in S.ulaymaniya Liwa. Likewise infant parasite rates

wore negative in all liwa!I except in Mosul.

The Endemic Diseases Institute is developed to a

Directorate General and success has been obtained by the

appointmont of a Malaria Board with full authority to

devise simplified administrative procedures n0cossary for

the successful achievement of the programme of Malaria

Eradication.

LEBANON

The extensive control work during the past six years

1951-57 has resulted in a full retreat of malaria in Leb2non.

Several cazas which used to be heavily infected are now free

from mal aria and tho density of tho vector population has been

greatly roc1uc ed and A ,, sacharovi is almost on the verge of

Gradication. The organization has established four brar.chcs of

eradication in different parts of the country conducting

surveillanc e opurations, epidemiological and operational

activities in the region. According to the plan of operation,

spraying operations are aimed at spraying not only the

malarious. villages but also all the villa.gem where anyone of

the two vectors, A. superpictus or A. sacharovi was known to

exist since 1951 until 1956. During the 1957 operation

7,844,640 sq. metres were sprayed with DDT and 939,400 sq.

metres with Dieldrin. In addition, 214,.546 persons al'e protected

Qf, epray1n·g.:and 44,8go by larviciding operations. Epidemiological

surveys are conducted in 1,208 villeges with a population of

about 910,443. During 1645 visits, 29,437 persons are examined

and 49 positive cases are found (lle.re.s.ite Index :::: 0.17% all vi vax).

SAUDI ARABIA

In spite of the gere ral concept th at Saudi Arabia has a

b.Q:l.__arid _climate and of beiruz. in the arid zone it comnrises

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outbreaks. These niches are situated in rural areas and forrred of

a series of oasis around valleys and springs. Prior to 1952 there

was no malaria control service in the country except that was done

in the eastern provincelof DDT residual spraying by Government

ARAMCO Public Health Service. The epidemic of 1950 led to an

agreement with WlIO for a malaria operation project which started

in 1952 and has been running since. This project took necessary

steps for creation of a nucleus for malaria service, establishment

of a training centre with up to date facilities for training and

research work, organjzing control measures by larviciding in

urban area, collection of epidemiological and entomolorrical d2ta.

This organization also tries to &'fe.rcome many difficulties which

might hamper the proper execution of future eradication scheme

such as lack of proper maps, traditional nomadism and pilgrimage

implications. In view of the multi complex of factors present

in Saud i Arabia the government h2s the intention to create

11 malarial stations to work on a de-centralized basis in

different parts of the country pro vic�ing prot0ction to their

respective territory. Also preparation will be made as to training

of necessary p0rsonnel, enactment of proper legislation, planning

a sound technical program and provision for adequate budget

according to the findings and evolution of activities during this

preparatory phase. It is anticipated that such targets will be

accomplished by the end of 1960 and plans for erad ication may be

laid in 1961. It should be indicated that already the malaria

station in the eastern province has passed most of the step:,

mentioned and eradication is contemplated to start at an earlier

date at this province. Methods to be used will bo put under

experiments during the preparatory phase consisting mainly of

spraying of mud walls with DDT suspension at a rate of 2 gram

per square metre and DDT emulsi ons for huts and tents_at the

rate of 3-4 grams per squ:?,re metre. The cost of future operatiom

is estim2ted to be about 27, 500,000 dollars for the next seven

.Jlaars.

implication and also by the movement of population from the

various neighbouring countries who according to existing

regulations hive :free permit :for cntranc e to the kingdom.

By this way reinfest8tion will occur and hamper the achieve­

meht of eradication.

SOMALIA

Somalia with a populati on of 1,364,000 (1953)

(7010 of them nomads) occupies the Eastern horn o:f Africa,

and covers an area close to half a million square kms. ,

without natural barriers at the frontiers. It is a typical

transition area between arid and tropical zones and presents

extremely variable features. Till now eJe ven species

of anopheline mos_quitoes hav e been reported in the country •

.Among these A. funestus has become exceedingly rare and the

malaria problem seems to be strictly connected wit h

A. gamhiae. There are two seasons of transmission separated

by the two rainy seasons.

According to extensive epidemioloc;ical studies carried

out in the recent past, the country may be divided in

four areas:

1. free from malaria (the coast);

2. hyperendemic. malaria (mesopotrnnic ai-'ea,

�1ddle and·. lowcD part a of' j the rivers) ;

3. endemic malaria (mesopotamic area, upper parts of the rivers);

4. epidemic malaria (especially in the northern regions).

Malaria campaigns with residual insecticides have been

carried out in the past, in Somalia, by the S.A.I.S. of

Villabruzzi limited to its concessions since 1945, and by

the Italian Trusteeship Administration of Somalia (A. F. I. S.)

since 1952 irregularly.

Since 1956 a Malaria Control Campaign on a yearly

basis, through residual insecticides spraying, has started

am in two years (1956 - 1957) with assistance from UNICEF

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malaria was known or supposed to exist, protecting the

inhabitants. �Y the end of 1957 the number of persons directly

prote6ted is about 220,000 persons. The problem of increasing

resistance of the bed bues to DDT.exist and, due .to the practical

attitude of the public � front of it, should be seriously taken

into consideration for future planning.

In 1958, Jlnti-malo.ria campaign will be carried out over the

whole of the torri tor"y every six months, with some except ions

envisaged for Northern regions de:i;:e nding on th e climatic events.

It has been agreed that a National Malaria Board be created

to ease and. coordinate the collaboration with other Services on

matters connected with malaria. In addition, a Malaria Technical

Advisory Committee will periodically meet and guide the technical

side of th e progrnmme activities.

From the first year of operation of this new programme, data

will be obtained which will permit to state whether or not it is

possible to eradi cate malaria in Somalia. To achieve this objectiYe

and:.;.in view Qt frequ.en,t,;:·,�ovemcp.t .. of population on the fron:tie.ra.

i,.:t is .necessary that similar action be taken alsoLby the neighbour­

ing countries"

SYRI.A

Syria is one of the first countries in the Middle East which

accepted and started to implement .the malaria eradication program.

This plan approved on December 20th 1956 was approved by the

Parliament and aimed for the eradication of malaria in the

malarious areas of Syria where 1,150,000 inhabitants are exposed.

In 1956, more than 200,000 inhabitant s were protected by DDT

residual spraying operations and with collaboration of WHO wgs

expanded to protect 870,652 inhabitants, almost more than 75� or the

target figures for complete coverage. 2, 387 villages are spreye�

with a total cost of 673,705 L. S. or 188, 432 dollars with a cost

per capita of O, 77 L •. s. or 0, 216 dollars. .An organizing decree

is under preparation for implementation of law of eradication

which will provide more freedom in administration, recruitment or

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YAZMUK-JORDAN

With the exodus of refugees in PaJ.estine in 1948, a serious

epidemic of malaria broke out among them and UNRWA had to

institute malaria cont't-ol mensures by residual spraying of' premises

with DDT. Operations have expanded from 1949 up to 1952 covering

about 1, 845, 170 square metres and protection of 69,930 persons.

After a brief initial period of success it was found that the

two principal vectors, J •• sergenti and A. superpictus have :found

outdoor resting places in natural caves and fissures and evaded

contact with DDT resulting in a high rate of transmission of

mal�ria.

The control strate;'Zy wets therefore changed to larviciding

and in 1953 some 25, 460,000 square metres were sprayed with

62,274 litres of 210 DDT solution. In addition to drainage

activities adulticiding was als o applied -and 48,500 square metres

with direct protection of 4 9 100 persons. These activities brought

the infant parasite rate from 10. 7fa in 1952 to 1. 1% after

larvicidal campaign in 1953. Same device parasite rate among

school children dropped from 29. 2/4 to 16fa.

Since 1954 a 5-year anti-malarinl project has started with

the help of UNRWA to clear the Yarmuk-Jordan valley from Malari�

with a provision of 354,000 dollars for the five years operation

ani an estimated per capita cost of 35 US cents. The program is

composed of applying 2% DDT solution of all breedinK surfaces

within the zone of about 50,000,000 squc:\re metres to be treated

annually with an orsanization of drainage schemes and residual

spraying of premises of some villages in the frontier with

Israel and Syria. Surveys conducted each year at the end of the

campaign in the villases of the project area in 1956/57 have shown

a drop of spleen rate from 21. 3'/o to 10. 110 an:1 of the parasite

rate among school children from l0.57i to o. 73/o and of infant

parasite rate from 3., 7% to O -45/::i. It appears tho. t by t..11.is time

the transmission has been interrupted and positive cases are

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found to be travellers in their infected and unprotected

areas of the country. Presently plans for development of

the malaria eradication program is in progress by organization

of surveillance and treatment of the detected cases far the

entire area conducting in this respect epidemiological surveys

to be used for future development of the country-wide malaria

eradication plan.

II. LEGISLATION, ADMINISTRATION AND FI�ANCE

Introduction.

The success of an Eradication Operation depends largely on a

careful planning, a sound organization and a prompt and efficient administrS1.tion of the pr.igrarnmc.

It is obvious that the Malaria Eradication Organization should be endowed with full authority and funds as to be able to conduct the

operations according to +;he scientific findings of the technica1 staff and at the set up dates.

An eradication programme cannot tolerate any delay or loss of time through slow routine procedures as any delay haphazards the

whole operation and time lost in procuring a required weapon or in its application may mean the loss of the battle •.

In mnny countries where .Antimalarial control programmes are

carried out field operations are usually conducted �s a part of the

provincial PU.blic Health activities and usually there are no vehicles assigned exclusively for antimalaria operations.

Tho appropriation of funds for nslaria control is usually determined in proportion with the whole budget of the Ministry of

Health, which usually is proved to be less than what actually is

needed and sometimes some of it is used for purposes other than m9.,l2.ria.

Due to certain leg�l restrictions and non-availability of sufficient funds, the scale of salaries is quite low, and is not

based on equal pay for equal work. Compensation paid for extra work hours and for time spent outside duty stations is far below

satisfactory. Such conditions do not encourage tho personnel to have sufficient inte?'est in tho programme of their organization to perform.

their duties willingly.

Also due to legal restrictions employees working in malaria control programmes may be employed on daily basis (including the technical staff). It is easy to lo• se such staff whenever they get

better chances. The staff would not feel secure and their moral.e would rapidly degenerate.

In countries where malaria control operations are carried out. there exist anti-malaria enactments, but those are usually adapted to tho older forms of control and are not adequate to meet the needs of a nation-wide prograrnme aiming at �alaria eradication. These enactments do not ensure the co-operation of the medical body, in case reporting,· laboratory·confirmation of clinically diagnosed cases, and

12

Nation-wide malnria eradication progranme c2.nnot be implemented

successfully under the conditions mentioned above and a series of

administrative reforms should be effected. Otherwise the car.ipaign

would definitely fail resulting in loss of good money and hard

labour.

The ref'.)rms will consist of establishing now set ups and

revising the already existing ones. If these reforms could not be

realized. under existing rules or rsgulations, special laws f"l.nd

legislation should be obtained. Those rules >::,J:lcl rGgulations or

legislation should provide for the following adminJstrative rcfc:rms:

II-1.. Establishment of a Central National Malaria Eradication

Service staffed with qualified personnel under a capabla

chief executive. This organization will be in charge of

preparation of necessary progr2.mmes 0f oper,:ttions

organizing the formal structure of the project, staffing it,

directing rmd supervisine the work and also co-ordin-::J;ino

all activities in the field of me,l�ria, in tho whole country.

Technical support and guidance from an es tc�bli_shed scientific

organization is inval1J.able, and every efLJrt should be nade to

build tho programme round any existine; scien-bific institutes

dealing partly with malaria within the schone or to take .fu11.

advantage of their sorviccs. i.n,_ore this is :'..:i1possible,

separate provision is nGcd.ed for all the, nccess2ry

scientific studies.

IL2. The Organize.tL:m sh,Juld be granted vrj_th full authority to

handle every kind of ::i,dministrativo and financial proble:1s

which are handicaps for tho proper implementation of

Eradication Programme in a number cf cou._�tries� These

probler:'ls can be divided into two c2.t2gories interdependent

upon each other. First thoru exist n.n extensive

centralization of tho financial adr:inistration which threatens

the efficiency of the malaria operations. Tho second, there

exists a serious shortage o:f:' skilled human resources e.nd

difficulty in recruiting st'.:l.ff of sufficient educational

standard and experience bec:mse of low salqries and

allowances. Certain freedom from the routine of the

Governrrtont is needec. in orc1-Gr to obtain offici ('!1t skiff,

encourage thom by certain alln,,12crces and guarantee their

tenure after the termination of the _pr,�<_;:.:_"C1.rn_._111e.

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In order to fulfil these points mentioned above the following

,revision should be made:

:r. 2 .1 Creation of a M:alnria Er'1dication Board: This Board will

have an autonomous s.,_tus in approving· tho budgetary plan

of malaria eradication and in facilitating the acquisition

of qualified pc=-sonncl. Tha form of the Board may vary in

different countries according to the existing laws and

cannot be formed on a standardized basis in every country,

The Board should be endowed by law or regulations with the

required authority to lay do�m procedures for h�ndling

financial and personnel problems as required for the proper

implementation of tho progrxlJ:I!le.

(I.2.2 Budget.

An autonomous budget for the period of at least five years

should be provided by tho Governr.iants. In case any of the

existing laws or regulations cause any delay in issuing the

budget alloc2.tions, the :Ministry of Finance or any other

National financing agcmcy should have the authority to

advance to the nalaria eradic:'ltion service the required funds.

The annual portion of tho five years budget for malaria

eradication prograrnne will be made separate and distinct

from funds allocated for othoT co!'.1nunicable diseases.

The Director of the Halari2- Er2.dics.tion S2rvice will have the

control of tho budget and its expenditures and proper

accounting service should be assigned specially for the

Eradication Organization.

II�2.3 Personnel.

The Director of the Halario. Eradication Service should have

the power for appointing and firing the staff� To encourage

personnel working in anti-malaria operations, allowances

should be granted to thera each month beside their basic

salaries and subject to tho concurrence of tho Board. j.lso

provision should be made for the security of the anti-malaria

personnel. 1\.s the time in the Eradic,:-,_,tion Progrmnme is

definite, the future of those working in the prograr.ame should

be secured by appointing them in other Public Health

institutions when the Eradication Programme is over.

rt�2.4 Supplies and Equipment. Necessary supplies and equipment should be ordered in advance in order to be received before the commencement of the operatiQns. Importation of insecticides for the malaria

transport should be exempted 1·rom import ctu'ties .•

�I.2.5 Transport.

The Eradication Programme should be supplied with the necessary transport. The vehicles assigned should be placed under the disposal ni: the Director and should be used exclusively for mal1:!ria work.

Arrangements must be made to effect immediately any needed repairs. These cars must be given priority in Governmental workshops and whenever possible proper garage and workshop should be established within the programme to deal with necessary repairs and servicing of tho vehicles.

II.3 Participation of_othor Government and Non-Government Bodies.

Co-operation of other agencies such as the Army, Development Board, Ministries of Agriculture and Education, and other national or international agencies ie necessary.

Steps should be taken to arrange for doctors and other

personnel working in the eradication service to be exempted from mobilization or their services continue to be confined

to the field of malaria eradication and in accordance and co-operation with the malaria eradication seTvice, as the case is in Turkey and Iran.

In some countries good co-operation· between the malaria eradication service and other Governmental bodies has resulted in provision of additional transport and equipment, co-ordination and participation in the spraying programmes and assistance in operation of surveillance programme and general education of public.

Il.4 Participation of the Medical Profession.

Notification of malaria cases should be made compulsory. The responsibility of notifying the cases is laid down on all persons who have direct or indirect knowledge of malaria.

II.5 Co-operation of the Public.

1. The importance of propaganda and health education is emphasized. Information of the public should go side by side with the operations.

2. House Entrance: Anti-malaria personnel are to be authorized to enter private property to carry out necessary measures. In some coU,lltries it may req_uire a law, in many the

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3. Compulsory examination and treatment should be made obligatory.

U . 6 Movements of the Population _9nd Guaran�ine.

The Conference believed that this problem needs further investigation asto its implications and ways of its restriction and hopes that WHO will take the initiative to lay down necessary directives for this purpose .

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I II - STRATEGY AND TR.L\.INING

III. 1- STR/.TEGY

STRATEGY IN AREAS OF LOW INCIDENC B OF MALARIA

The confere nce rc 8ommGnds that total coverage of malar ious

areas o:f countries be applied in the phase of at tacl{ of an

eradication eampaien, vhenevee.- pos sible. In areas with low

malaria incidence, due either, to naturnl low mal ari a

transmis sion, or to past control ope;_"'ations, or to whatever

otr.cr caus o, ind ividual countries may cons ider the pos sibility

of rcduci nc the number of years of total blank0t spraying,

whe never circumstances give sufficient gucrantee of absenc e

of transmi s si on and of absence of re servoirs of local malaria.

In such circums tances , a reduction in the period of

surveillance, may �lso be considered.

CRITERL\ OF1 DISCONTINU; .. T.[ ON OF SPRJSIHG OPER/1TI ONS

The 3roup r0 cornmcnds that the criteria for discontinuation

laid down by the 6th Exper t Committee on Malnria, be interpreted

for this region by the local m2lar iologist in charge for each

country, and that it will be his rc sponsibili -cy to interprGte

t�1e npplicaticn of such sto.ndo.rd.s to the conditions prevailing

in the various arec.s of his country. Two basic factors will

ho.vo to be obse rved : ( i) no recent t ransmis sion is

demonstrnted by examination of childr en under 4 years o� aec ,

and ( ii) the discovery of any reservoir amongst others , ho..s been

followed by thorough treatment, and active search for, nnd

thorough trentMent of othe r cases in the ,Yicinity. In addition

to these, other factor s will hc.ve to be taken into cons iderat­

ion, such ns : the size and natur e of t he area, the distanc e

botweG n villnge s, the presence of natural barrie r s around the

are2 t o be d.iscontinued , or the pos s ibility of creatir13 an

nrtificio.l one by bnrricr sprn.ying, the moveITB nts of nomadi c

populntion, the 2bsenc e of new se ttlor s, the non-proximity to

arens of' malc.ria trans missLm, the non-proximity t0 malarious

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1nsecticide s , the po s sibi l i ty of operating efficiently the

surveillanc e organiz at i on , e tc .

In order to evaluate the b::r n ic crit eria for dis co nt inuat­

i on , the malar iolog i s t should make use of all pos s ible me thods

l e Qding to the d i sc overy of every mnlcria cnse in the area.

In the pre-dis continu2ti on survey he wi ll chiefly make use of

examinat ion for spl eni c enl si.rgement a.s well as colle cti on of

blood films from all cases of spl enic enl2rgernent -::,r.d of ac tual

o r rec ent fever. Entomolor;ical c olle cti ons shr)uld be focuseec1

chiefly t o ward. the pre senc e , 2.n':L number s , of th e adul t vec t or s

in the hous e s and other shel te r s . For the surve illanc e , the

group rec ommends , that the coll e c t i on o f blood films be m�de

no t only from infant s , but Ql so from children 1�4 who s eem t o

r e pre sent a very sens i t ive c.:.-;e-0roup t o marari a infec t i ons in

th i s re sion. 'I'he surve ill 2nco ar;ont - should also report - nny

abnormal increc: s e of adul t ve c t or s in house s .

The pro s onc e of a fe:JW pocke t s of trans mi s si on , may not

prevent disc ontinuati on in the l arge s t part of the nrea ,

pro vided that they c an b s do2.l t with soparc>..toly without the

r i sk that m::,l aria mny ac;o.in be intPD cluced in the di scont inued

port i on. This dec ision, ag�in , re s t s w i th the oxJX3 ric nc c and the

di scre t ion of t he local mnlar iolo gi s t .

Keeping i n mind the dan3 er repre sent ed by an ove r

prolonced pe r iod o f res iduRl bl anket sprayins o f insec t i c ide s for

the appearo.nc e of r e s is tanc e in the vec t or s , it is fel t thti. t

whenever the cri toria for c1i sc ,:; nt inuo.tion aro not met with , o.ft or

a period of fo ur year s of bl2.nk0t spraying , spe c ial inve sti02.t­

i ons should be me.do and 9

if ncc e s sG:ry , expert advice should be

sought to inve s t i �:c:t e on the reasons , to e ve.lun.te the si tuc,ti on ,

e.nd dec i de on the mea sure s to be applied. In view of some

rec ,c:n t local e vid enc e 9

however , the group recommends that further

invB s t ic;2t ions on the valid ity of spleen rates in the defini t ­

i on o f mal�riousne s s o f 2n are � , end on the relianc e of

e nquiries on fcvor c as e s in the detec tion of all the malaria

case s be undertaken.

OTHER MEI.SUR�S THl-iN RESIDUJ.:;.L SPRAYING IN IVIALI�RIJ\. ER.l\DI C/,TI0N OPERi\ TI om

Tho wo rk accomplished in Egypt for control of mal ar ia

in the western 02s i s hc. slbecn c onsidered o. cree. t 2.chie vement snd

importnfit proere ss in the field of mol 2ri n control and

evaluati on of anti-mo.le..ria meo.sur e s . Larvc.e control st:::trted

in 1 946 parallel to the proerams of Sard ini n and Cyprus . It i s - of

0roo.t intcr,; st to no te the. t after three ye ars the vec tor d i sappear­

ed as in the c ase of tho se two i sland s but respponred later .

In thi s way malnria inc idence whi ch was 14 .. 7'/o in Dakhl a in 1945

dropped to o. 3;o in 1 948 am ro se ar:: <1in after reinfe s tat ion to

2 • . 21° in 1951 . Same way in Khnrc;a parns i te rate was br0 UGht

f'rom 6. 310 in 1 945 to zero in 1950 2nd rose to O . l/o in 1951 .

Spraying ope rations started in 1952 =-1.nd by 1955 ngain paras it e

rates bee aim ze·ro . In 1956 one po s itive c � se w2.s di scovered

nmong 1 , 31 6 bl ood films exrunincd at ·nakhla which proved thut

the or e;eni zEct ion of surveillanc e oper 2-tions parallel to the

spray ins opernti:ms i s of' erc c.t import:=:.nc e to the achie vcment

of malar ia eradic nti on.

Mnss drug di stribut ion was adrni nis t ered s ince 1949 in Siwa

where a prel iminary sur vey re sul ted in a mGl aria incidenc e wi th

a parasi te rc:tc of 13. 870 in 1949 ancl. 2 compl ete survey of 18. 8

in 1950. Para s i te rate became zero in 1955 but 2cain new case s

nre found aft e r tho int errupt ion o f the drug di stribution anrt

by th i s way in 1957 ten new po s i t i vo cas e s n_re recorde d. Thooe

observat i ons n ,{ain supp,1rt the rule far or2;anizc.tion of

surveillance pro cr am as a nec e s sary part of any e radic 3tion pl an.

It i s de termined that the c o s t o f ae:.ul t control i s ab,Jut 1/lOth

of that for l nrvic idinc progr:7-m.

Takin½ al l avnil :::tbl e clnt a into cons ide rati o n , t hc confercnc e

f'eels thR. t the use of o ther mea sure s wi ll larsely be restr ic ted

to two main s e t s .:) f c ircurns t 2..nc e s : ( i ) s itun ti ons which justi fy

an initial dependenc e 8n al t ernat i ve me c.sure s , and ( i i ) where

-19-

resi dual sprayinG alone i s unable to pre vent tr8nsmi ssion or to

provide complete protection to 9. community undor risk. Lnrvici dal

me2,sures , drug d i strib ution , dr:::tinnce and bonifics.ti on ,

explo itation of the zoop:t!ily ,Jf vectors , application of

sanitary measures , all hc�ve the ir well known importance an:l

l imi ta ti::1ns when appl i ed , :-,,lone or in ac1cli tion to spraying a s

t he prevail ins si tunt i ,Jn demands. One may take into considero.t­

ion , in thi s re spect , ( i ) the ph2,se of oradico.ti on ac hie VGd , [Ind

( i i ) the ur0oncy to cope with th e situation , e . s . presenc e of

epidemic mc:.laria , or presenc e of vectors resi stant to 3.. Given

type of insecticide .

The e;roup feels that Pinotti ' s method c,)ul d hs.rdly find

sat isfactory appl icati on in thi s region , ow i ng to the multipl icity

of eas ily avnilable sources· of co mmon salt.

SUMMER HUTS

Summer huts are consid ered as a sui tnble rc sti ng pl c.cc

fo r anopholine ve ctors dur ino: the pcr•iod of the i r erect i'Jn in

certain areas of Iraq and Iran.

Experienc e in hypc r-ondernic malnr ious areas of Irnq ,

has shown th3t spr�ying of summe r huts has b een factual in

reducing the rate of mo.l ari e. trans miss ion. Howev0 r , further

inve stL:::;2,tion i s required as to .the be st fo rmul2-tion , do sac::0 ,

and frequency of nppl icr.ition of insecticide to tompornry summe r

huts , the habit of lo cc.l vector s in resti ng on ws.11 surfaces of

the huts , o.s well as tho extent of extru-mural trans m i ss i on deserve

also furthe r study in thi s reci on.

1. ..f.gi�oduction .

I I I-2 . '.l'RAlN ll\l G

The success of an Eradication Operation depends l · rgely on tho

constant availability of necessary personnel , funds and mat erials in

suitable proport ions and adequate administrative facilit ies for

their use at each phase of a scientifically sound programme . As

very wisely stat ed by Lt . Colonel Jaswant Singh "Even though funds

may be forthcoming , and Expe rts and materials may be provid ed as

aids from international agenc ies like t he WHO , UNICEF , ICA , etc. ,

the main responsibility for the succ essful conduct of such

programme will rest on th,? local personnel".

Therefore it is imperative , that each cat egory of personnel

be well selected , carefully trained , promptly supervis ed , duly

encouraged and promot ed . An adequat e status, salary and

accommodation for all personnel involved in Mal aria Eradicat ion

programme should be provided in order to at tract and retain suitable

personnel, and to prevent the waste of efforts expended in their

training and to avoid to se o the much experienced personnel t o quit

their j ob and to seek for other more lucrative appointm ents , The

absenc e of continuity of service of personnel will therefore

endanger the succ ess of Erad icat ion Operation which will take the

aspect of a s pasmodic attempt , proved to be more harmful to the

l'rogramme .

Although some fac ilities such as Fellowships or Scholarships

are always put at the d isposal of the Governments by International

Org3,nizat ions for trainin0 of certain specialists for the Nat ional

.Programme , the training of various categories of personnel is

�sually done within tho country itself ; it is permitted to say that

no Government should embark on a programme of the magnitud e of

Malaria Eradicat ion without assurance that the available national

teaching and truining fac ilit ies o. ·c ade quat ely d eveloped as to

produce sufficient number of personnel with good t e chnical knowledge

�d ability to carry 0ut their j ob.

2. PlaJ:]-_p_ing a__ rrrain=h_r,i_g_ _;?x_2z.ramme ,

Before plannine of training programmes nnd curriculu.ms , careful

studies should be made first as to dct ---:rmine thl qu.aliti0s and

backgrounds of tho various cc.1.ndidates available within tho country ,

who c ould be trc:lined for and appoint ed to the specific jobs on t he

programme ; and also to dofino the duties and responsibilities , and

the extent of t echnical knowledge of every cehelon of personnel

roquired for each phase of m:::laria eradice,tion operations ; these

aocuincihts will then serve to outline suitable teachinir and tr;:, i nina

Tho professional training progr?cmme should be _plannGd as to give

the candid :1to a full background on v.s,rious aspe ct s of the sub j ect with

suffic Lmt general information about :::11 other relat ed programmes .

Adequat e number of hours should bo d evot ed t o practical work in the

laboratory and in the field ( _proferebly in a field unit well

organized and e quipped for this purpos e ) and 2lso sufficient hours

for re::->,ding and study in th(: library or for roundtable dis cus sion

should be consid ered .

For tho subprofession.':ll training , the progra."Jllle should bo as

simple as pos sible and be conc entrated on tlK p2,rticular objective

that tho c2,ndidatc is trained for , with sufficient oriE,nt::1.tion to the

scheme ?.nd t o oth::Jr workers in it. Experienc e has shown that tho

undergraduate persons will be rapidly c onfused during the study and

e.lso during the work , if many sub j octs <1re thought or askr::d for at

one time .

Careful supervision :md r:::su1ar re oricnt'.ltions of the personnel

�re the next two important st 2ps to bo t aken in order t o ensure that

the organization will gain from the efforts expended in th0ir

training.

It iE: of 5re2,t i::iport ance tlnt tho org�.nization adopts the policy

of progres sive trc.ining 2cnd combirred promotion for each c :1tegory of it s personnel and t o ensure that the msn in charge of oach ph::is c of

the programme ar�:· fulfilling their dutL1s 2,nd res ponsibili tics in a

�J.PPY cnvironi112nt with stable status 9,nd ::1n '.1,t tractive future .

3 . Some As_p<0 cts of _ t l1 3 Tr:c'cini_gg }.cti vi tics in th�Cou�1.trie s of tho Rogian .

Training is l?tid down as one, of the main i t 2ms of the 11 Ins ect

Jon trol Section" of th,2 Minis try of Seal th of Egypt . Aft er the

establishmcmt of the l:c:bor2,t orics at Dokki , the curriculum of the two

e:xistint; s chools since 1947 , one for mal'.':triology and th,::: other for

ins ect control , is amalgc::,,11.1:-1 t od in the; prc? s ent school of "Malnria and Insect C :)ntrol 1 1

•

Th 2 obj (::Ct of tho school is to tr ,-,,in public hc:?'ol th work2rs on

the c ontrol of ins ects of mcdic .21 importanc e in order t o be able t o

supervis e ::nd execute ins ect control progJtAmmes . The main interest i s

t o prepare the worker for the field , and the practico.l 2.nd deductive parts o f the: c ours e nr :..; only me ant to rcmind tho stud ent of his

�edic�l Entomology and t o give him further training on Entomolo�ical

tcchniq_ue .

Two �_§,£_§_ are given in the school: 1. A S Gnior course for university graduates on the methods

of ,jntomological surveys , ins 2ct control , their supervision and execution.

2. A junior cours e for technicians in entomology and malaria,

Before 1944 r:dl anti-malaria control operations in Iran were conducted by persons who received s ome sort of in-service training or short course in Public Health , with spocial lectures :::.nd demonstration on vnrious aspe cts of mal�ria epidemiology and its c ontrol were also given.

Since the creation of tho Institute of Parasitology and Malariology in 1952 in Teher'.ln, spoci9..l tr0.ining courses have been organized for every category of pers onnel necessary for malaria control and since 1956 for the eradicat ion .. programme . These courses

include mainly :

a. Course in Nalariology for graduate physicians , Bchdars and medical students for trainin0 of m2.lariologists . Medical students have been used s ince the beginning of this progr3..rmne in :t1any ways ; they h2.ve contributed during their sWilI!1cr vacations in 11summer survey teams " organized for epidemiological surveys in different parts of th0 country ; they have been used by the Institute as microscopists to examine tho blood smears collected during survey and surveill(?.nce activities ; . they have worked also as Assistant Statisticinn for c ompilation of spr�ying �nd epidemiological survey dnta and their �nalysis . This device has mqde availe.blG a good source of qualified workers during the period of emergencies and great workload. Furthermore, the association of medical students from various medical schools with the Institute and malcria works , their contribution in surveys and contact with rural people, have

introduced a shift in their interest from curative medicine to Public Health.

b. Course in Entomology for Doctors in Veterinary Medicine, Agricultur�l Engineers and Bachelors of Science in Biology.

c. Labor�tory Technic ians ' Course for D�tors of Veterinary Science and Doctors of Pharmacy for tr?,ining of chiefs of malc1ria diagnostic laborat ories in the regions.

d . Malaria Microscopist Course .

e., Blood 2.nd Ins �ct Collectors ' Course .

23

g. Surveillance agcmts 1 Course.

In Iraq tho �ndemic Dis e�ses Institute hns als o org�nized spec ial

courses for training of n ,3cessar;r personnel for epidemiological

investigations and field operations .

In other countries , specially in So.udi Arabia , special

in-service training courses are e stablished for various categories

of personnel .

In all thes e courses s pecial emphasis is given to the practical

side of the training and field works.

The• �lue 6t �riodical reorientation of personnel should be

�lways kept in mind and whenever possible , s eminars be organized

among malaria workers to review all aspects of each activity in

its particular field and in relation to other aspects of the

7:lublic Health Programme .

IV - PL.ANNING AND ORGANIZATION OF THE �.1.ALA.'R.IA ERA:brc:-i.TION FIELD .· OP1.IL1TroNS . ·--- -·---·---

Introducti..£!1:_

Careful planning and a sound administration of the field

operaticms are the two b3.sic req_uisi tes for the: success of

Malaria Eradicat ion Progr3,mmes . Fortun2t ely , the c ountries

launching a malaria eradicat ion progra:-,:,'Yle , or prep::iring to

introduce such an undert3.king , have had , more or les s , a previous

programme of control which has provided them with some of the

knowledge and experience required to implement such a programme .

Moreover , it has demonstrated the striking effects that such a

prograrnme nay produce in the health , ec onomy and social c onditions

of thu nation. Thus , it has prepared the ground for its

continuation and has provided an environment full of expectation

and goodwill which will insure larger financial as sistance and

interest in the prograr:1�e .

Preliminary and special malariometric and entomological surveys

should be conducted in ord er tn s ecure adequate inf on:iation as to

the �reas to b e put under oporation, and methodology and t echnique

of c cmtrol operations planned accorrUng to the: needs and tho degree

of malaria end emicity of the area.

Planning of Field Opera�io�_

In a malaria eradicat ion operation , c ertain information i s

necessary before the organization o f the csmpaign is planned and

before the rcquirenents o f the programr.1c crm be ovaluatod.

It c ould be sunmarized. 8,s follows :

1 . !:,re-OperatiQ_nal Survey.

It should comprise dnta on a village level as well as

informat ion c oncerning general c onditions of the areas of

operation .

At village level , we need to h�ve data relative to the total

population of the village anf_ totn.l square met� to be

sprayed 3.Ild other information c oncerning life habits , summer

huts , agricultural practices , etc .

On tho area l0vel , informat ion is ne eded for defining the

limits of areas of operation , On the basis of this inforr.1ation

and considering clin.ate , s c'.1sonal rainfall , t opography ,

availability and c ondition of roads , c o::i.munications,

2.

It is also of importance to investigate avail�bility of needed operational personnel in each area and preferably in each district . This question is highly important , due to the familiarity of local personnel t o their area. Local personnel could rehder a much more efficient service to the organization, especially if there should be a variety of lan6'1lages used, or if different climatic conditions exist in different :r:arts of the country .

1. 1 Organization of Reconnaissance Survey.

Often , the countries planning for malaria eradication have

had a control programme in previous years , and thus , have available a number of field personnel experienced in field operations . Also, as a result of previous undertakings , some of the information required may already be available . However , the validity of this information and its usefulness largely depends on the type and extent of the operations arid the techniques used in implementation. If the previous operations have been limited to only a part of the country , the existing data cannot be taken for other areas , as the same conditions may not be present . Therefore , a re-evaluation of

the problem through reconnaissance survey se ems t o be both necessary and advisable.

In organizing the survey , the existing personnel and the present set-up could be used for its implementation . The personnel should be spread thrcmghout the entire malo.rious areas on a well designed plan . They should be given questionnaire-forms to fill in for every village, and taught t o make simple mensurements . It is desirable to carry out thi� survey in every village and get the pertinent data accordingly . However , this may not be possible in many countries , and under such circu.mstances such surveys will have to be limited to a significant number of representative villages of the area.

Planning o f Operations.

On the basis o f information gathered during the reconnaissance survey, the planning of the programme can be effected. In this planning , organization of the campaign, and also assessment of requirements and timing of the operations , should be defined. The plan of operation should include provisions for the establishment of an efficient organization with central and provincial branches capable of handling all

26

0f t echnical qnd m�ninistrativG personnol in the vc1.ri�,us

catcgnries as wall as the types, nu.nbcr or quantities of

supplies, equ.ipnent rmd transport requ.irec1. The 0rcanization

of the cn_npaiGn, inclu.cUng the sclecti,,n , recru.i tncmt, tr2-inin5,

assi�1:1cmt of pcrs -:mnel , inclur: ine the c7.istribution :1f

equipr:1ent, supplies anc:. transport, sh•ulcl b e properly timed

and stipulated in the plan. The ti�:.1ing of the field

operations in each province, nrca or district, and the nu.,_�ber

of t ea.':1S to be enr;,?.0ec1 should be clc2,rly inc1icatec1 . The t ot al

cost and the breakdown �f expens es in detail should be well

described in the plan of opcratLm. ii.lso -:in the basis ·'JI

previ')us control activities ')r prelininary surveys, the followin6 data should be detcrnined or estinated :

a. Populat ion to be prot ected ,

b. Surface area to be sprayed per pers on.

c . Spraying period .

d . :Man-Day spraying (Nur1ber n f s quarG met ers spr3.y- 0d

per day by the sprayDan ).

e . Nw.:1.ber and categories of field operation pers onnel

needed .

Two types -�,f p ersonnel ar2 engaged in the fiela_ operati,�ins ;

temporary and permanent. Th0 t2I.'lporary personn0l are engaged

only during the sprayinc; progranne and are riade up 0f the

s praymen, mixers, foremen and miscellane:)us labourers. The

permanent personnel are the supervisory staff, tea'll. leaders ,

dis trict leaders , area leaders , etc. , who will remain with

the pro,3raJJI11e after the s prayin,-; proc;ram1J.c is complet ed. ,

At the end of the sprayinc campaign they will servo tho programme

in the i:riplementation 0f the surveillance programme and other

related activities.

Transportation.

In the malaria eradicati·-in o perat i,:m which involves protection

of a large population in a very lir.J.ited time, transportation is a

very important factor. The type of transport should be su.it�ble to

the needs and requirements -')f the field operatiJns, and the number

should be sufficient and proportional to the number of s praying teams .

27

For the pu.rpc, s e of the spraying oporat i ;n its elf, the pick-up type

with f 1)ur wheel drive is the '7'ehicle of choice , s ince each 0f these

vehicles can accomr.:iodate a sprnyin,:_; tea'TI, with all th::; necessary

equipment and supplies and can cross impassabl e areas and reach isolated villages . ... Supplies and equipment cculd bG trg,nsported by

hired trucks to the c entres ,Jf th�? operation 2.s far as possible.

From there on, d istribution could b e accomplished by the proe7amme

vehicles . The use of the procrai·u�e vehicles should be limited , as

far as possible , to the area in which they are operating. Lons

distance trips should be perf urr:ied by lic;ht progrRr:une vehicles or

by public means of transport .

F0r the surveillance operati0n , the Jeep-Universal type , o r

Land Rover, are the most suitable vehicles since they can

accommodate thre e or four surveillance a;ents 2nd their supervisors .

In s ome countries , and f :ff some areas under ope:ration ,

Mobilettes (bicycle with small molor) have been us ed where the general

cond ition of the area and the existing roads permit their use •

.1.'...nimals are also used to a creat ext ent in difficult

conditions , and finally , in r:mny parts of this region , sprayinG teai11s

and surveillance agents have to walk long distances between the

villaees of the ir d istrict.

Equipment .

The spr::1ying pump is the r,1ain i tcm of equipment neec1ed in

malaria eradication fi eld operations . Other equipment is of less er

importance and can be est imated for and purchased locally.

Number a:q_d Tx_p.§_� .21....§.P..:r::i.Y )¾lr� Compression sprayers are the type ::n0st widely used . Every

sprayman is equipped with a compression sprayer and therefore the

nUt�ber r �quired for the progranme depends upon the number of

spraymen engaged in the spraying operatLm. However, a res erve of

20% to 25% should be provided in order to ensure the continuous

operat i0n of the teams and to allow for operat i8nal defects and

repair of the sprayers . The conference endors es the recommendation

of the 6th Expert CormJittee on Insecticides in the selecti on of

pumps and other equipment.

Accordine to the field observati •)ns it was noted thn,t the

28

T 8002 nozzle t ip , the type widely used in ro.alaria eradication

spraying operations , produces a satisfactory pattern, but erodes

as it operates. Th0refore, it is sucgested that nozzle tips

T 8002 SS be chanced every 15 days to provide uniform distribution and

to gain a saving in. insecticide.

The pressure regulo..tor valves presently used in the sprFwing

pror.,TG.mmes so far have not had satisfactory records. Their

porfection and wide use are desirable as they are able t o produce a

fairly const2nt pressure at the nozzle tip.

Insectic:!,.sl§.§_. The Conference endorses the recommendation of the Expert

Committee on Nalaria and ac;roed that tho kind and amount of

insecticides to be used should be determined accordine_:: to the

scientific findings and the needs of the prograE11:10.

:, • 1 .§.P.rayinp; _Qp_�ra �ion : In planning for ors2.nization of tho field operatj_ons great

emphasis should be placed on the decentralization of the field

operations . The malarious areas of the country should be

divided into areas and districts and each level should be

provided with the nece ss,".ry operational and administrative

facilities. ;i.t the head-qu2..rtc:rs level, an experienced

sanitary engineer or sanitarian should b e; placed in charge of

the execution of th0 plan of operations . He should be provided

with a number of persnnnel to assist him in the over-all

supervision of thG field oper�iti0ns, the co"mpilation of

operational records and statistics, and the drawinc; of maps etc .

A light motor vehicle, preferably a Jeep or Land Rover , shouJ.d

be left pcrnancntly at his dispos.9.l t o facilitate his prompt and

efficient supervisory work.

On the provincial l0vel, a sanitarian ;)r qualified field

technician . should b e responsible for the execution and

supervision of the field operations. It should also be pg.rt of

his responsibility to provide area and district officers with

the nec essary equipment 8.lld supplies, to compile tho operation

records , to prepare tho yearly pian of operati on of . the province ,

and to estimate its requirements .

29

At the area l evel , the area officer will be responsibl e for the

execution of tho field operations in t heir respective areas ,

accordin;_s to the plan of operations , :=md has to supervise the

field oper.?..tions, provide the neccssc-.ry supplies and equipment

to th2 district centres , to Chio-Ck vehicles nnd see that the

necessary maintenance has been carried out regularly, to check

the spraying tearas in operation, coll ect operation reports ruid

forward them to the provincial chief of malaria er?.dication.

They should re:nain and live in the respective area. Each are�

should be provided with a csntre with suitabl e office, storage

space and gar2,ge. Each centre should also have a number of

administrative personnel to take care of payment of field

operation personnel and other administrative and financial

matters.

Districts arc thG sr:iallcst unit s of the m.9,laria eradication

field operation organizat ion. They may include a number of

villages to be sprayed.. or put under survoillance programme.

A field operation technician will be in charge of the operation

in the district . If the district is limited in size , number of

villages and working capacity, the district officor could be

a toam leader . Otherwise, in case several teams 2.re working in

the district, a district of�icer is required. However, if there

are more than three teans wor :ins in the zone additional

assistants to tho district officer will be needed to ensure the

proper supervision of the work.

In tho planning of tho operation for each district, the

requirements o f the operation should be; carefully studied . It

is of great importo.nce to c�etermine the requirements of each

d istrict well in advance. .:.� t cr:iporary centre should be set up

in each district for tho storage of equipment and supplies and

for the compilation of records c:md data. If more than one

sprayin� team is to work in tho district, the working area of

each team should be defined nnd det ermined. This area, with

all the villages loc�ted in it , should be indicated on a Nap

Biven to the team leader. The movement of the spraying teams

should be from village to villace. They should spend tho night

in the last vill age they have sprayed , and next morning , move on

to a new villago. ThG use of available transport by different

30

teams should bG well planned �nd on a proper schedule so that

no time is wasted. in tr2:nsport�t ton of crows .

Surveillan�.£ _Qperation.

During the sprayinG opGration , the surveillance progranrrne

can be accomplished on a limited scale . Tea.� leaders

entering villages when spraying can , at the s��e time, visit

the houses for surveillance purposes. In this way, each

village could be visited once durine the spraying caripaign.

After the spraying is over &'1.d t emporary workers are released,

the surveillance proerarnme could go into full operation and

surveillance aecnts (team leaders ) will pay regular visits to

the villages _ for collection of blood slides from infants ,

children, nnd fever cases as prescribed in the plan of

operation. They will also distribute anti-malaria drugs to the

fever cases, according to tho instructions given to them by the

provincial malariologist. The malariologist will also

determine the frequency of visits to be made to each

village in each area�

In organizing th2 surveillance programme, each surveillance

agent should be given a number of villages , relative to his

working ability T

the size of the villages , thcdr endemicity ,

the frequency of visits to b e mo.de, and the available means

of transport..

During the surveillance programme , the district o::?f•iccr

would g,ct in the same sup·:::rvisory c8.paci ty as in the

spraying prograr:rrne. In addition, ho should collect

regularly blood slides from the surveillance agents and

despatch them to tho area officer or regional laboratories.

Each surveillance agent should be provided with a map of the

district , indicating the villages to be visited by him.

It is also of importance to indic'.lte the dat e each village

is to be visited . This may not be possible to evaluate

clearly at the beginning but it could be easily ad justed

after a few visits to th� village, and when the estimated

time of work in each village has been obtained. As in tho

case of the spraying operation.; the surveillance agents

should also operate from one village to th,:,; next, and not from

the district centre to the villages.

- 31 -

Tho duration of tho surveill�nce prograrnmG from area to

area , and from c ountry to country , depenc.s upon th2 c limatic

conditions as well as the epidemiological features of

malaria transmission.

4. Field Inspection Teams.

In the c ountries whe re ext onsive field operat ions are under

way , Field Inspection Teams should be organized at the head­

quarters level, and at th2 disposal of the chief of the field

operations or tho Director of tho Organization ; Each team should

be made up of at least two qualified inspectors experienced

in the field operations. Tho duties of these t eams are t o

travel about in the c ountry Qnd check the field operations

during and after its accomplishment . They should assess the

field operation and advise the field personnel on the

improvement of their t echniques . The results of their inspection

should be reported to the provincial as well as to the

head-quarters office.

5 . Reporting.

Proper and prompt reporting of the progrg,mme activities

is essential for the evaluation of th ·; rcsul ts and planning of

the ·next year ' s pro�22��0 . The information required should be

tabulated in very simple . form. These forms should be filled

out r0gularly by th;:; field personnel in various echelons and

a copy foruarded to the headquart ers chief o f the operation

for compilation and nocess2ry analysis .

-32-

The tr3.inin::'.: of fie ld ope r:1tion personnel should

be considered hi :hly import ecnt at 3.ll levels. The

type of trainin, : , ·iven to euch cnter;ory of personnel

depends upon the nature of' the worl{ rmd t he dut ies

to be carried out.

Permanent personnel should be riven refresher

traininp ench ye nr in order to acquaint them with

the recent developments in t he fie ld of mal3.ria

eradicat ion. Temporary personnel will rece�ve a

traininc cour>se shortly before 1Je in;-: en: ·2 ; :ed in the

field operations.

7. Timinr : of the Field ...QJ:.2._ero. ti_ons

'Nhen pl ::rnnin:-: the field ope rations 9

th e t iminr::

of nll procro.mrne ncti vi ties shoul d be properly

det ermined. In timing, 2.11 the rnn t ters pertninini : to

the personnel re c1uir ement r3 in the vc:riDUS co. ter'.ories

such o.s their seJ£ c tion , t1· 0. inin,;, rccrui trnent end

assignment to the re ionsl and 2reo. of'f'iccs should

be �Cl e2rly defined. ;: ,.s re -c,rds supplic s ond equipnKmt 9

ste ps sho uld be taken for their t irnely pr1 ocurrnent or:d

distribution. The date of the sprayinr,: and surveill ance oper2 t-

ions, ns well 2s the do.te of their completion in eo.ch

area and zone should be st ipulated in the pl an of

-33-

operation.

8 •. Cos t inp� of the Pro i :r amme

Tbe plan of operntion should be supplemented with a

detailed estirra t e of expenditure and necessary budcet

requir ed. If internati onr:.tl or national : or agencies

otl-E r than the ;:-:overnment are cont r ibu tine to tl:e

p rocramme, their contribution should be shown and its

breakdown clearly defined. Usu2lly , the commitment

of the covernment includes all local expenditure such as

salary and allowances for personnel, wac ss of labourers ,

cost of maintcno.nc e and rep2ir of vehi.cles 9 and

procurement of local equipment , supplies and utilities.

International a ;encies usually contribute nll or part

of t he insecticide, spray pumps, transport malaria

drups and laboratory equipment. The break-down of

expenses should 2lso show a contin_ : ency fund to be used in

case addi ti on s.l funds are needed for procur ement or payment

of different i t erns of the budcet.

V. - SUR�ILLJTC:G

34

V - 1 . De:fi!li t i '.Jn s : ·rho C . . nfcr i,_;nc ...., in Jr(:c 1, t ) c l2..ri.fy "mY

confusi m th::·,t m<J.y n.ri so , r ,..: c•:Jm.11-..:n:.::'..s to refer to ::1. H. o.

Expch' t C nnmi ttcc t '.J define cx2ctly tho w )fi-..s s urvey ,

c -:insolic1:'.ti :Jn , surveill�nc e nnJ vi : :il 'lnc o o.nl� th e ir

The c ;n.fcre nc c fe 0ls thr.t survcill:1nc 0 i s fin etcti vi ty

no t a ph::-.s e of or,._ ::li c ::.t i0n, h'lvinc: the f ;llowi n: : ,b jc c t ive s

a ) hct ivc 0r pass ive detoct i0n of malnri � ccscs

b) Intervc nt i •m in ,)rclor t::i rend e r such C G SG S

non-c-:.. ,,..ni · c 1°ous t • ) the cnmmuni ty

V--:.:t. Or :o.niz inr- o.ncl Pl �:mnini;; ::)f Surve iilr�

Prirl r to c s t nbl i shment of survc ill ::mcc 9 s::::,o c i r:.l s tudie s

s h,::,uld :)c c , ncJ.uct cd ':'.S t•� du t urmino who the 1� trc:.ns mis s i on i s

interrupted c.'cuo to :--:.c t i ve ,,t tnck with r c sic1.uo.l sprn.yin;'. Thi s

could be done by or_ : :=-,niz:;.ti :m o f ct mec hnnis m o1" in:fc:.nt cxi d

childr._.:m ( 0-4 n.c;c ) blo )d p.,:,.rasi t c s ur ve y in ::i sele c tccl ::r,Jup

o.f v illnre s of th0 are a.

The num1::; ...:, r of the vill :--, · ,.::; s Cepcnds on the W'.)rkin

po ssibil i ti e s :Jf the :)r:·�nizc..tion , the ne ed of tho pro - ·r:i.mmo

anc7- the o.vc.ilo.bl e d."..to. Jbt ::-�inoG c1uri n,- · ::)r0vi ; U S reconnnissnnc e

surveys . :Cx:oorienc e s in Ir:-::.q :-nd Irc.n hnvo shown th8.t children

1-4 are be t ter det e c to rs of infe c t i on th2n inf2� s 0-1, who nr e

u su:1lly covcrec7, w it h clo the s in th0ir bod. Howeve r 9

th e vo.lue

of inf2nt po.rc.s i -to survey c oul ,-::"':. n-) t be excluclorl cs it shows

the nc tur:. l mn.lr'_rin tr2ns mi s s ion of tm yo nr. The se survey s

the finc1inc� s of the re ·i onftl mL,l : :r iol ) Ci s t 9

when th e blood

collGct i ons h�ve proved th�,t mnlo.ri 2 trans mi s s ion ha s o ccurr ed.

F'urthe r re senrchc s n.r u ne c c ss �:ry to evnlu::.te th 0 ext ent to which

35

t he se studi e s should be cc.rriecl o ut . :-!hon sufficiGnt 1;roofs

2 :J,JUt t he c e s sc.ti on of tr :::msraissi on ere obt r:i ne d , survci ll 8.nc e

pro ·r8rnmG coulc-:. be or · · :.1.nizec� in the ::tre e;. This C'.)Uld be

started :::. t rm 02-rl icr st ace , but shoul d be or ·�:.nizcd in 100, v

of villn, · e s ;::;.t 1 0 2.st c."'i.ur in,~; the le, st ye G.r of' spr,'"'..yin:; .

It is po ssible to disc ont inue spr2y in: in en arGn even

in the ::;:ire sen,c e o f c ert3.in f:>ci, �s lon.-: a s they 2rc unc1er

intens ive nncl co ncc ntr2t ecl at t n.ck r.m:--:. the nr 0::1 under proper

surve illance .

Dure.tion of' survcill.:-mce ---

n) Surve ill3.nc e shoulc.7. be c mtinuecl c:t le ast fo r three

years 3..ft er cessoti :Jn of spr'.',yin clur inr" whic h no 2utocht enous

case i s di scov0red by n comi--:1l e t c mechnnism ,Jf C [\s e f' inC:.inc.

Nccess r'.ry s t e ps should be t ,,'1rnn duri nr· the l n.st y0cr of'

surve illcmc e t o intec1"';: t o i t into the .:zene:; r2l he :1lth of' the

c Juntry ( vi · · ilnnce ) ::_")ro 7r.:"'.mm::.; s . :t:ffor t s should be made t o nbsorp

the survc illo.nce stc.ff into the se ho nlth proc;rn;1nn0s to insur e

cff'icient rno.intennnc e .

b ) Ye �rly Ope r�tions

Surve illnnce ope:;r-:::ti Jns sh,..1uld be 2..ppl ied thr0u, ·hout

the year wherever 2nd whenever climotolo . ·i c;-:2.l co nch tions _pe rm it

and should nt leas t be s t -. rt er.l one month before P.11:""L be cont inued

for two m'Jnths ator the trc:'.ns mis s i 'Jn season.

c ) F£ec..uency of surve illnnce n.nc1 ext ent

Surve illanc e should covc1"' 1001"' of all villc. ·· e s whe re

spr2.yin,r; hc.s l)e en cl is cont inued.

Blood somple s sh Juld be taken :::.t le nst onc e every month .

Neverthel e s s inve sti · :'. tior..s s11,Juld be undert .::-.ken to de termine

whether on .�ccount of l o c r:.l e::;;idemiolo : � ic8.l condi ti ons mo11 e o r

less freq_uency of vi s i t s P..IB ren_uired.

36

In such studies attention mus• be pnid to

1. Reproduction rate in the are as

2. Pre sence of health centres, medicnl or non­

medical or , ,·anizntions thc.t mny help in cnse

detoctin� and ronor titi of any past or present

epidemics.

3. Time required f'rom ti::kin(; 7Jlood t ill result s

are known o..nd nctions r:-i.r , . taken.

C nse Detectinr:: -------·----- ·

1. Spleen rate s should be obta ined whenever possible

2. Blood exrnin ci.tt912 :

( a) Blood spe cim•:.ms should l::e t�1ken from rrroup

nse 0-4 c.nu. from fe:ver c::lses of nll aces. The

vnlue of blood tnkinr or nre �roup 0-4 without fever in th is phnse of' the nron·re1.nn1e should be studied. Also' ntt�ntion should be pnid

to the observo.tions reported in Iro.q where 84i" of

paretsite c2rriers did not complain from actual

fever or r:,ny symptoms in the pet st.

( b) ; .. dequc,te lc.borntory fncili ties should be

established to obtnin the results o.s cGrly as

possible but it should not exceed thr•ec we eks.

( c) In in o.ccessible pl r::ces, d\t'in :·, rn iny seo.sons,

special a:i.�rr>cn� ements , the i:iype of' wh ich depends

on loccl conditions, o.re tobe mncle in order to obt ain

inform::ttion re l�tin;~ to occurrence of' cnses.

(d) I .. t the time blood ::!.'l tnken, fever cnses should be

t':i vcn o. sin , ·le dose of nnti-mnl c.1rirtl drU,' ', which

mi ·ht be composed of 600 rnr; of a 4 nminoquinoleique

drur; nnd 100 mr; of pyrimethamine.

( e) In order to win the confidence nnd cooperation

of' the public the survey c.1 . :ent should be selected

37

amonr; proper persons with necessc..ry backpround

to be trained 2nd allowed to treat minor ill-

nesses .

Positive cases "____._

When a case is clet;::c;cted the followin.---: steps should

be ta.ken :

1. Epidemiolo: :icnl investi.: · ::- tion to determine whet:tii.er

the cbse is inclic-;enous or imported

2. Necessc..ry entomolo,•icnl inve s ti ;:-'.':". tions

3. Radical treetment of the c2se

4. The c:J.se should "be followed Rt lertst for six months

clurinc re gulnr vis its to ihe .villar;e

Entomolo ·'.icc-tl _side of surveilLmce

The survey o.· '.ent could report Jurin ,,. their re :ulnr visit

to the villa , :es on the density of vector. Speci8l

investi : ".tion teams should be kept at the H. q. to study

nfter reception of these reports the conditions of the

anopheline popul[t tions 2nd study the ir bionomics and

eventual chanrr.e within their normn.l l ife cycle o.nd

development of re sis tc.nce. 82.me studies should be conduct­

ed in vill2, :cs where positive cases of" molnria c,re detected.

1, card show in necesscLi."Y Js.ta9

nnrne 9

address of

cases, tre2.tment .--i ven should be kept in the ville.cc with

a responsible mnn.

Tretininr:

1. Personnel should receive enou. ?h trainin ··: in

blood tn..kin "':, primnry entomolo : 'ico.l methods 2nd blood

ex,<::>.minations.

2. Rer.:ul 2r Refresher courses should be held. for

re-orient2tion of the staff.

38

.Q.Qfil

Cos t of surve illance should b e mP:de known t o o the e

count ri e s . The se informa t ions · re of :;re2t ser1v ic e fo r

ev'1lu8 ti on of t he amount and th e c o :::, t of wo rk done :for

det e c t ion :2nd trer.tment of cas e s .

-39-

VI, TECHNI CJ:.T, _PROBLEMS

The c o nfere nce di s cu s sed in lencth out s t Gndin:: te chni c3.l

problems that h�ve been exper• ie nc e d in t he rer; Lm as , :i ven in

the fo llowinc :

1 . R� s i st ance

Re s i s t r,n ce wn s be l ie ved. to be the mo s t important t e chnic al

problem th2t co nfront s nn erc.ctic st ion p1" o j e c t 1 e spe c ir::lly when

i t appe ers in the locc.l ve ctor as in the case of _ J.,_. stephen_s i

in Saudi i�rabi a and rG c ently in Irno" and Irnn. i, c cordinc to

t e s t s c arried out in the s e two c ountr ies , l, . _ s t ephensi show s

, considerable legree of re s i s t :::nce t o DDT even in arens wi th

one sinr;le sprayinr:: with DD'!' · However , i t shows a hich de('ree

ct: . suscept ibili ty t o Dieldrin and B. H. C . whieh prove s that the

nRture of this re s is tanc e i s spe c if ic t o DDT and acc ord in[�ly the

c onferenc e endorsed th e us e of Di eldr in for i t s control in

tho se areas . The sudde n flare up of re s i s t snc e ove r a l ari�e

t e rr i t ory wa s explaine d wi th re serve exc e pt ional in t he l i zht

of me t e orolopical and cl imat olor icQl c ond i ti on s pr evail ins

in the Gre a an:i the po s s ibil i ty of intro duc t ion of r e s i s t3n t

s pe c i e s :from c.re3s , Yvhere previously re s i s tr:nc e hss been

developed. In this respe c t. i t is rec onnnended , thc,t re ,-:ul o.r

a s s e s sment te s t s be c arried out at different time s of the

y e o..r b efore any spr2.y in oper2.ti on s t t1rt s . Thi s should not

ne c e s snri ly be t aken 3 S o.n exac t me a sure for computinr:

re s i st ance level , but to provide a c n se line for c omp ari son

of sus c ept ibility within n po,r t i cul o.r Gre a . Thiti will ·. als o

s e rve in de t e rminin� the insec t i c ide o..nd the do s are t o b e

used. Furth ermo re in the s e s tudi e s at tention should b e p;,i d al so t he

t o the de t e rminnt ion of Lc5 0

and/Lc100

of the spe c i e s .

( a) Pil r0r imr'-r:;e --�--�

The effort done for c ontrol o:f mnl o.r ia nt Lie c c o. and

-46-

Jedda was cons idered·• th �;reat sati sfact ion and the conference

welcomed the idea that similar contr ol measur es be extended to

Medina and o t her stations s it u2 t ed on the pilr;11 ims ' route s ,

e spec ially thnt this moveme nt will soon fall within the

transmi s sion per iod there . i,l thourh the nva ilo.ble inforrn'.:l. tion

concernins the way and the locnli t i e s where 9il�r ims mi rh t

c2.tch malaria , are no t compl ete 7 i t i s adv is;o._ble thn. t

combined act ion be twe en the c ountr ies se ni in,r:: pilr·r ims and

the receiv inc c ountry be unde rtaken to e nsure the proper

admini strc .. t ion of ant imalar ial dru ;s on departure from

e i ther pl ace . The d11u � and c1osar-e to b e used shoul d al s o be

det e rmined after further study.

The conferenc e belie ve s that "'VHO sl:'\oulc1 co nt inue with the aeroplanes , ships and

s tudy of problems of dis inse c t i zat ion of/vehi cl es and to

de t e rmine the proper me thods for this purpose .

(b) Nomadi sm

In many countri � s of this re , · ion , million s of persons

live a nomadi c life and prnctice short or lon::: d i s t2nce

transhumance to seek pasture for t he ir animal s or to harves t

crops in the ir summer or w int e r quarter s . Tribes no t only

cro s s many are&s \Ji t hin the ir mo ther countr• ies but in certain

part of' the rer·: ion t hey ero s s t he front i e r s an& in tl1i s way

produce a potent ial dan?e r of intr oduction ot: mnl o.r io. in

another area . /, c co rdin,; to s t ud ie s c onduc ted in I ran ani

Syria , . the namadi c t r ibe s when l ivinr' ar:d cro s sinc the non­

infec t ed ar eas are u sunlly exempted from mal 2u1 ia

1,1 thouc::h c e r t ain ins tare es of intertribctl malaria

transmi s s ion are reported , the OI'i . •i nal foci on s e t tled vi lla · es

around whic h nomad : ;r oups :remain for a shor t or lone period

are the point s of mo st import rmce ; 8.nl it is the re whe re

-41-

dist ribut ion of drurs am re s idual sprayine; ou. "ht to be done •

. Accordinc·; t o Iranian s tudies 9

spray in;· of tents wi th kerosene

DDT , will last effe c t ive for about 40 day s , which i s suffi c ie nt

for the protec tion of tribe s when cross inr: infe c t ed areas .

Same act i on should be taken for prevent ion of malaria outbreak s

amonc labour r:roups o r mo vine lnbourers .

Tre t em:por2.ry transfer o f pe o:9le dur ine; the ho t seo. son from

the i r permanent house s ..to summe r hut s and t ent s are de al t vii th

in parasraph 3. 1 on Pace 19.

3. Larvae Control by Larvic ide §

In spi t e of the fac t that adul t ic i din� i s the usual me thod

of c hoice 9

t he us e of l arvi cide s i s al s o recommended in

part icular are a s , such as in the case of' ;.,. . ser:�: ent i in Jordan ,

whe re scattered bre ed in:: place s exi st in remote ani in­

acce ssibl e areas 8nd where eff e c t ive adul t i c idinc� cannot be

don e due to varia ti ons in t opo :�·r aphy and ve c t or behaviour .

1 1Re s i dual a larvic idiD[' with dieldr in at a dosa[�e of

0. 25 s/m2 appl ied in the form of 250 e; of 5010 w . d . p. dieldr in

per 10 l i t r e s of wat e r , was t r ie d in certain se le c t ed areas

in Jordan. Effect ive control of anophel ine bre edin � was

obtained for peri ods vo.ryin:' :fr 01:1 3 to 7 months , wi th this

method. Te s t s wer e also conduc ted w i th lower do sare . However ,

while be inr: e qually toxic t o :fi sh e t c . , i t showed inf erior

residual e:ffe c t and as such is not recommended.

Thi s meth od is al so recommended in t he case of urban

bre ed.ing plac e s .

4. Sorpt_ion

Al thoush acc orct.inr; to s tudi e s conduc tea wi th s o i l s from

the southe rn part of Iran , th ere exi s t s a rapid s orption of

inse c t ic ide s on wall surfac e s . This problem i s not yet

fully s tudied in other arGa s .

-42-

·rhe desi:�nation of a special refe re nce laboratory to

coni uct these tests on soils from various countries is

desirable and bioessays should be conducted whenever an:l

wherever possible to de tect any deficiencies either due to

sorption or the development of resistance in the vector

s:i;:ecies.

- 43

VII . INTERNAT IONAL COOJ:g?IN.ATION

l. Tho cooperation and coordi,..,ation between neighbouring

countries is more them needed in eradication programme ;

The successful eradication of malaria from any one countcy

which made possible the interruption of spraying operation

could be jeopardiz ed by lack o f comparable effort in

neighbouring countries and consequent risk o� reinfect ion.

In view of the necessity of coordinating eradication

proerammes in the are� , bilateral agr�ements should b e

encouraged and furthermore it is sugci_:estod· that all

International J\gencies keep the WHO informed of their

malaria eradic8-tion ac-tivit ies in any particul8.r country.

The participat ion of such agencies as FAO and ICA who

undertake water use pro j ects such as irrig�tion shouid

also coordinate their activit ies with 1�tlO .

Malaria Eradic�tion plans should oe coordinated with

adj oining courl.tries by direct contact and correspondence

or intor country agreement and through the WHO

representative who �ttends countries in formulating their

annual plan.

The activities along the frontiers of both countries should

be coordinated by exchange of :

a . regular reports of operations in that aroa ;

b . interchange of t eams to deal with inaccessible areas ,

such operations to be coordinated through a

boundary commission ;

c. to persuade adj oining countries which are not

undertaking eradication schemes to intensify control

work at international bound3.ries and

d . by loan of insecticides in case o f t emporary shortage

whenever possible , to adj oining countries for use in

malaria pro j ects along th , ; frontiers .

- 44

In s.pite of tho present · dif'ficulties of male..ria quarantine measures on individuals it is suggested that the WHO Expert Committee on Quarantine continue to study this problem. In the . case of mass mit,rations, pilgrims or nomadic tribes, it is re�ornmended that such measures a� s�pprcssive doses o f such drugs as pyremethamine befo re departure might prove helpful�

In addition investigations are needed on the risk of

malaria importation by human carriers as well as further study on methods of disinsectization of aircraft and on persistence of pyremethamine . single dosages in stopping transmission (25 mg for adults , 12 . 5 m� for children 6-12 , and 6 . 25 mg fo r children up to 6 ) exclusively when taken by pilgrims and nomads crossing the frontiers.

Migration of people within or 9.,cross the borders o f n�ighbouring nations serve as bridges b y whieh m�l�ria may 'be. reintroduced into areas alr0ady considered as "cloan" and whieh aro under surveillance . Control o f mal�ria in this migratory population poses many difficulties , and c ountris� sharing mutual problems may help to more clearly map-out the known routes than could be done by each country on its own. They may devise satisf�ctory control techniques either by drug administra.tion or n.iaintaining control in tho wholo to:.�idor of migration ::.1.nd it would enable the other country or countries to benefit by tho prompt submittal and discussion of this 1nf�xmation.

2 . The adv�ntago and usefUl._noss of se��11:"�

The Eighth World He3.l th A.sscmbly laid upon tho WHO the duty of taking the initiative, providing technical advice , and encouraging research and coordination of resources in the implementation of a prograiTIJ.ne air.iing at world wide eradication of malQria.

Tho C onference expresses its gratitude t o the World Health Organization for tho initiative to organize inter or intra-regional · conferences in different parts o f tho world , thus providing an excellent opportunity for malaria workers

45

and Public Health Administrators to review tho development

of the malaria progrB.1:1me , to exchange scientific information .,

and to discuss problems o f mutual int0rcst.

It is sug5ested that every year the antiraalnria Directors should me0t and it is b,::;tter to hold t his annual �on!eren�e in a different country in ord0r to observe the

activities in other countries ,

It would bu advisable for those responsible for fiscal matters to attend the conference and familiarize themselves ,-ri th the V3.rious technical and organizational problems.

This c onference should, of course, be hold under t he eponsorship cf the World Heal th Organization •.

A tentative agenda for these seminars should be prepared to enable the respective Directors to discuss the progress of

the Eradieation operations in their country, tho moans, . and methods of application, policy and rules for implementation a.a4 specially techniques which have developed to deal with " epee!al problems such as rosist :: nco, organization and eupervision of field activities, tribal movements, training and recruitment of personnel, administrative an� financial difficulties . otc .

The Conference believes that WHO should take the leadership in supporting the international coordination of Malaria Erndication and initiate any activities necessary to this end by organization of seminars, conferences , and distribution of information to all interested and concerned countries.

-46-CONCLUSIONS

1. The conf'erence noted with satisfact :i,on the pro1�ress made

in all the participating countries in the implementation of

malaria eradication programmes and hopes that these as well as

neighbouring countries will accelero.te their activities so

as to complete eradication before the problem of resistance

takes a serious turn.

2. 'rhe conference noted the admini strat ive and f' inane ial

dif'ficulties encountered by the Malaria Eradication Orranizations

and wishes to reiterate the need for:

a) Giving full uthority to the Directors of the

Eradi cation Pror;rarnmes in admini sterinc the allocat­

ed f'unds by simplifying procedures of expenditure

sanct ions.

b) Increasins t heir remuneration of the personnel by

the sanction of a special ; 'malaria eradication

allowance. i i

c) Improv e t he status and tenure of appointm ents of

the · key personnel in the pror:rammeo

3. The conference stresses the urcent need of making

leGislat ion provisions in respect of the following :

a) to srant full authority to the Director of t he Malaria

Eradication Or:: :anizutions to handle fully the

administrativ e and financial problems for the

implementation of the proe·ram.

b) To ensure the lec:islation of house entry anc:1 other

activities connected wit h eradication pro>3ram11e.

c) To sanction the power to enforce com pulsory notificat­

ion of malaria cases and their treatment.

d) To exempt insecticides 9

and anti-malarial dru;zs from

custom duties.

- 47 ....

STRATEGY

4. The conference was satisfied with the studies initiated

in the rec ion concernini:; s tra ter;y but will appreciate the

advice of the \iVHO Expert Cormni ttees concerning the followin0 :

a) The exact definition of the criteria of discontinuation

of spraying activities.

b) The policy resardinc sprayine; of summer hut s and t ribal

tents.

e ) The exact definition of the various f'orms of surveys and

surveillance and their characteristics in the eradication

prograrmne.

d) The role of schezontocidal end sporonticidal drur!s during

the various .phases of the eradication pronramme.

e } The policy and timing of the use of alternative insecticide s

in areas of resistant malaria vectors prevalence.

f) The development of a satisfactory device for reculating

and ensurinc uniform discharce of insecticides from the

nozzles.

TRAINING

5. The conference noted with satisfaction the prot;ress made

in developins :Co.cilities for training of anti-malaria

personnel and stresses the need for international help in t he

training of senior staff 9

throu(;h the establishn1ent and

development of rr:: ['.ional traininL; centres.

S URVE ILLf1NCE

6. The conference stresses the importance of heal th educati on

of the public in the successful execution of the eradicati on

programme. The conference also records the need for the

preliminary integration of the malaria eradication personnel

with the public health department in the last phase of

consolidation so as to ensure a smooth chance over to the

preliminary integration of the malar ia eradi cati on per so nnel

wi th t he public heal th departrre nt in the las t phase of

consol i dat ion so as to ensure a smooth chanpe ov er t o the

maintenanc e phase .

PLANNING -----•-·-

7. The conference not e s w i th sati sfac t ion the de tai l s o f

the or ' ;anizat ion pat ter ns and the plannin:,: for field

ope rations and wishe s to s tr e s s the importance of de central iz­

at ion of tl1 e eradic ation ope rat ions and o f the nece s s i t y of

t iming the operati onal a c t ivi t i e s in relat ion to the malari a

transmi s s ion se ason •

.YiTiRNATIONAL CQ_ORDH�P.TION

8. The c onferenc e no t e s the sat isfac tory nature of c o-oper at­

ion between the vari ous inte:...·nR.tional ar:e nc i e s ar:d als o

t he ne ighbourin[s c ountr ie s i n the mal ari a e r adic ation

programme .

The confe rence s tre s s e s the need for seminars and

reJional c onference s in f'urtherinr, suc h coope :r•a t ion and

apprec ia t e s the leader s hi p of the WHO in this respect .

ACKNO•.VLE_DG EMEN�

T�e conference pas sed a vo t e of thanks to th e Gov e rnment

of Iraq for the gene 1·ous hos pi talit y ext ended to i t , to Hi s

Exc ellency the Mini's ter o:r Health Dr . Al-Alawy and to D11 • Ali

Hannnrun � Direc t er Gene 1·al of the Endemi c Di se ases Inst itute

and i t s Cha irman , and to the WHO Sec re tar iat for the effic i ent

organi z ation o:f t he conference and the c ordial rece pt ion

and as s i s tanc e extended to all the part ic ipant s .