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Malaria Elimination Country Case Study 4: Preventing reintroduction in Mauritius

October 11, 2012 - 20:43 -- The Global Heal...

Many countries are nearing — or have already achieved — malaria elimination, as documented by a new series of case studies by The Global Health Group at the University of California, San Francisco and the World Health Organization (WHO) Global Malaria Programme. Having worked in collaboration with ministries of health in affected countries, the two organizations highlight new evidence about what works — and what does not — for reaching and sustaining zero malaria transmission.

The Mauritius report can be downloaded here: http://globalhealthsciences.ucsf.edu/sites/default/files/content/ghg/mei-eliminating-malaria-mauritius-lowres.pdf

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William Jobin's picture
Submitted by William Jobin on

Thanks to Richard Feachem and Rob Newman, the case study of malaria suppression in Mauritius provided a wealth of historical data, including documentation of recurrences of malaria even after certification of elimination, showing the difficulty of stable suppression of malaria.

Anopheles gambiae in Mauritius had unique habits including breeding on rooftops and outdoor biting, giving larval control a major role, as opposed to indoor spraying.

So success in Mauritius depended on control of breeding sites, not IRS.

During the second malaria elimination campaign from 1982-1988, according to Feacham's case study, and I quote:

“Larviciding with liquid and pellet forms of temephos
was conducted primarily in transmission areas where
IRS operations were not carried out or where coverage
was poor (69). In 1985, larviciding and environmental
management teams visited 37 965 houses, 3 930 (10%) of
which were found to have potential breeding places in or
around them. The teams eliminated 1 603 (4%) breeding
places and treated 15 832 (42%) potential sites with
temephos; 1 202 larviciders and 275 assistants conducted
38 rounds of inspection throughout the island (6)…..
Lebistes spp. (guppies) and Tilapia spp., both larvivorous
fish, were used occasionally during the malaria campaign
(27). …”

“In the opinion of the entomologist during the
campaign, the control and elimination of breeding sites
for An. gambiae s.l. had a greater impact on malaria
transmission in Mauritius than any other vector
control intervention (4).”

“Surveys conducted by the Medical Entomology Division
in Mauritius in the 1980s drew attention to the propensity
of An. gambiae s.l. to breed on the flat rooftops
of concrete houses, the primary housing structure in
Mauritius after 1960 (4). …vector control
was directed towards reducing rooftop breeding with
temephos and larvivorous fish.”

All of this information on mosquito behavior calls into question the current unguided emphasis by WHO and the US PMI on bednets and IRS.

William Jobin Director of Blue Nile Associates