Provides an authoritative guide to the many changes needed, at national and local levels, in order to implement the new global strategy for malaria control, a plan of action adopted at a ministerial conference in 1992. Responding to the deteriorating malaria situation, the strategy calls for a fundamental redefinition of the way the malaria problem is addressed, emphasizing the urgent need to reduce mortality and morbidity through the selective application of feasible, flexible, cost-effective measures. With this need in mind, the report aims to help planners understand the practical and technical implications of the strategy as a framework for a renewed attack on malaria that is at once more realistic and more sustainable. Throughout the report, recommended lines of action take their authority from decades of practical experience, which has yielded a number of clear lessons concerning the most effective measures for control in a range of different epidemiological and social situations. Drawing on this vast experience, the report helps planners redefine priorities, think through the various options for control, know when resources are either wisely invested or wasted, and adjust programmes accordingly. The report also alerts readers to several persistent practices that are neither cost-effective nor inducive to good patient care, and thus contribute to poor programme management. The report has five main sections. Background information is provided in the first, which describes the many complex factors that have contributed to the deteriorating malaria situation, and explains why and how the new control strategy was developed. Problems cited include rapidly evolving resistance to antimalarial drugs, a troubling array of adverse reactions to these drugs, the increasing number of foci of intense transmission, the inadequacy of health services, the absence of managerial and epidemiological capability, and the lack of financial and technical resources. Disease management is covered in the second section, which offers advice on the development of a national policy for disease management and describes practical measures that can help programmes meet the priority need for rapid diagnosis and effective treatment. Particular attention is given to the special problem of antimalarials available outside the health services and the question of when laboratory diagnosis can be expected to yield useful information. The third section, on disease prevention, concentrates on the most effective measures for personal protection and vector control, presenting compelling arguments for a reorientation of control programmes towards selective vector control, rather than total coverage based on outmoded eradication concepts. The fourth section provides guidance on the essential features of information systems reoriented towards disease management and focused on disease trends and patterns as the principal concern of the programme. The report concludes with a discussion of the main priorities of programme management, offering step-by-step advice on how to translate the global strategy into effective national plans and programmes for the control of this difficult, yet preventable and curable disease.

eng fre rus spa.

WHODOC

WHO monograph

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