Operational aspects of bednet impregnation for community-based malaria control in Nicaragua, Ecuador, Peru and Colombia.

Community intervention projects with pyrethroid (permethrin and lambdacyhalothrin) impregnated bednets and an accompanying community education programme were carried out in 6 malaria endemic areas on the Pacific coast of Nicaragua, Ecuador, Peru and Colombia as well as in the Peruvian Amazon basin. In this paper the operational aspects are analysed: bednet coverage, results of promotional activities for increased bednet use, the sale of low-cost bednets, techniques and difficulties with impregnation, acceptance of the programme (including washing of impregnated nets), side-effects, residual concentrations of the chemical in the nets, costs of the impregnation programme and insecticide resistance of the malaria vectors. We found that the local manufacture of bednets and their sale through village health workers, even in communities with low cash income, is a viable way of increasing bednet coverage; the impregnation of bednets is well accepted if villagers perceive a direct benefit; pretesting of the soaking capacity of different net materials should be done at central level; the instructions for the impregnation procedures of different net materials (cotton and synthetic) should be simple and unambiguous; very cheap thin net materials should be avoided, particularly in the case of lambdacyhalothrin impregnation; educational methods and/or promotion of dark-colour nets should be further tested in order to decrease the washing frequency of bednets at household level; in areas with early-biting mosquitoes further studies on the protective efficacy of bednets are necessary; careful monitoring of side-effects, particularly those of last-generation pyrethroids, is necessary; and the community-based impregnation programme is a powerful tool for strengthening community involvement in health actions.

Health education for community-based malaria control: an intervention study in Ecuador, Colombia and Nicaragua.

A malaria study was undertaken in 98 rural communities of the Pacific coast of Ecuador (n = 14), Colombia (n = 22) and Nicaragua (n = 62). In-depth interviews on people's knowledge and practice regarding malaria aetiology, symptoms and treatment were conducted and complemented by formal household interviews. On the basis of this information, an educational programme was set up which included the training of village health promoters and community workshops organized by the health workers and used a set of methods of interactive learning. After the baseline survey the communities were paired and randomly allocated to the intervention and control groups. Malaria education took place only in the intervention communities. At the start of the project people's knowledge about malaria-transmitting mosquitoes and malaria symptoms was correct and widespread in those areas where the community exposure to formal health services was pronounced. However, knowledge of the recommended dose of chloroquine was poor everywhere, and self-treatment of malaria episodes deficient. The educational intervention achieved a high level of participant satisfaction which was expressed in a high and continuous attendance rate at the monthly workshops. The knowledge of malaria aetiology and symptoms was 33-61% better in the intervention group than in the control group. Knowledge of the recommended doses of chloroquine increased significantly (34% in Ecuador, 93% in Colombia but not in Nicaragua) and correct use of chloroquine in the treatment of malaria episodes also improved (26% in Ecuador, 85% in Colombia). In Nicaragua the results were less satisfactory due to the short period of promotional activities and the health services' policy of delivering only supervised treatment to the population. It is concluded that health education should play a major role in malaria control.

Insecticide-impregnated bed nets for malaria control: varying experiences from Ecuador, Colombia, and Peru concerning acceptability and effectiveness.

Between 1991 and 1994, an intervention program with permethrin- and lambdacyhalothrin-impregnated bed nets was carried out over a period of nine months in each of five endemic, malarious areas of Ecuador, Peru, and Colombia. This program was evaluated through household surveys, blood sampling, in-depth longitudinal studies, and entomologic analysis. Eighty-four communities (including approximately 35,000 individuals) were paired according to malaria incidence, size, and coverage with bed nets and then randomly allocated to intervention and control groups. The results showed that peoples' acceptance of the measure was related to their perception of an immediate protective effect against insects. The effectiveness of the bed nets, measured as a reduction of malaria incidence in intervention communities as against control communities, showed large variations between and within the study areas. The protective efficacy varied between 0% and 70% when looking only at the postintervention differences between intervention and control groups. The average protection was 40.8% when considering a four-month incidence of clinical malaria attacks and 28.3% when considering a two-week malaria incidence. Important factors for the success of the bed net program were insect susceptibility to pyrethroids, high coverage with impregnated bed nets, high malaria incidence, good community participation, high mosquito densities when people go to bed, and a high proportion of Plasmodium falciparum. In one area, where DDT spraying in the control communities was executed, the effectiveness of bed net impregnation was slightly better than that of spraying.

Malaria y leishmaniasis cutanea en Ecuador: un estudio interdisciplinario: aspectos históricos, epidemiológicos, antropológicos, entomológicos y método de control / Malaria and cutaneous leishmaniasis in Ecuador: an interdisciplinary study: historical, epidemiological, anthropological aspects and entomological monitoring method

Parte A :Contexto y objetivos del estudio: las areas de trabajo. El contexto nacional y provincial del proyecto y los objetivos de estudio; Situacion socio-economica, ecologica y demografica de las areas de estudio. Parte B: La malaria y su control: Metodologia del estudio de la malaria. Historia de malaria en El Ecuador. La malaria en las Americas y Ecuador: los programas de control. Caracteristicas de los vectores. La epidemiologia de la malaria en las areas de estudio. el impacto economico y social de la malaria. Conceptos y actitudes de la poblacion frente a la malaria y los programas de control. Resultados de la intervencion educativa. Eficacia y efectividad de la impregnacion de mosquiteros con permetrin, del uso de repelentes y del BTI. Resumen del estudio de malaria y recomendaciones para los programas de control. Parte C: La leishmaniasis cutanea y su control: Metodologia del estudio de la leishmaniasis cutanea; epidemiologia de la leishmaniasis cutanea y alguns aspectos clinico-parasitologicos; Conceptos y actitudes de la poblacion frente a la leishmaniasis cutanea; Resutlados delensayo clinico con la pomada PR. (AU)