Integrated Vector Management: Concept and Practice

摘要

While malaria control in Africa remains a challenge there is emerging evidence, based on conceptual considerations and direct observations that targeted and integrated vector management may be highly effective in the highland and urban ecosystems. Furthermore it seems likely that this approach is sustainable due to its relatively low cost. Previously, the vector control practice has been to undertake blanket cover of the whole ecosystem without due consideration of the spatial-temporal distribution of the vectors and indeed disease. Given that drug resistance remains a threat to integrated malaria control, it is prudent to strengthen integrated vector management with the aim of reducing transmission and thus the threat of drug resistance. Integrated vector management (IVM) has been advocated as a replacement of the often single tool strategy for malaria control. However, there are very few examples of where this concept has been applied for malaria control in Africa. Vector control has relied heavily on indoor residual spraying but issues ranging from human and environmental toxicity, insecticides resistance, logistical constraints, to cost have caused concern. Recently the application of safe synthetic pyrethroids for treatment of bed nets has shown great promise in reducing mortality and morbidity. For example in a large scale trial in Western Kenya in areas of intense perennial malaria transmission, ITNs prevented approximately one in four infant deaths, but their efficacy was compromised if re-treatment was delayed beyond six months (Philips-Howard et al., 2003).