Reshaping the vector control strategy for malaria elimination in Ethiopia in the context of current evidence and new tools: opportunities and challenges

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chloroquine 1 infectiousdiseasesdrugs
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malaria 118 infectiousdiseases
malathion 2 infectiousdiseasesdrugs
onchocerciasis 1 infectiousdiseases
permethrin 7 infectiousdiseasesdrugs
filariasis 1 infectiousdiseases
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chloroquine 6553 Service’ in 1959 [[20]], and employed blanket IRS of houses with DDT and treatment of cases with chloroquine [[20]]. However, the country failed to attain its malaria eradication goals, and the approach was changed
ivermectin 1277 of vector control tools, such as intensifying the use of LLINs and IRS, and supplemented by use of ivermectin administration, zooprophylaxis, odour-baited mosquito trapping, improving housing and larva control
ivermectin 17195 exophilic vectors [[48]]. It has been shown that with fewer MDA (mass drug administration) rounds, ivermectin can increase the impact of MDA with an ACT on malaria transmission, and thus adding IVM could sustain
malathion 13197 insecticide for IRS against malaria vector are grouped under: Organochlorine (DDT), Organophosphates ( malathion , fenitrothion, pirimiphos-methyl WP, pirimiphos-methyl CS), Carbamates (bendiocarb, propoxur) and Pyrethroids
malathion 13520 WP, etofenprox and lambda-cyhalothrin) [[35]].In Ethiopia, An. arabiensis is highly resistant to DDT, malathion and deltamethrin, but susceptible to pirimiphos methyl, bendiocarb and propoxur [[22]]. Moreover, the
permethrin 10943 LLINs in the households were used the night before the survey [[16]].Recent trials using LLINs with permethrin (a pyrethroid) and pyriproxyfen had increased efficacy compared with LLINs treated with permethrin alone
permethrin 11042 permethrin (a pyrethroid) and pyriproxyfen had increased efficacy compared with LLINs treated with permethrin alone [[29]]. Therefore, there is a need to use the new LLINs coated with a long-lasting chemical, such
permethrin 13326 pirimiphos-methyl WP, pirimiphos-methyl CS), Carbamates (bendiocarb, propoxur) and Pyrethroids (alpha-cy permethrin WP, alpha-cypermethrin WG, bifenthrin, cyfluthrin, deltamethrin SC, deltamethrin WP, etofenprox and
permethrin 13349 pirimiphos-methyl CS), Carbamates (bendiocarb, propoxur) and Pyrethroids (alpha-cypermethrin WP, alpha-cy permethrin WG, bifenthrin, cyfluthrin, deltamethrin SC, deltamethrin WP, etofenprox and lambda-cyhalothrin) [[35]].In
permethrin 19768 impregnated with insecticide is usually used as a shelter when erected in refugee camps [[57]]. Moreover, permethrin -treated blankets, top sheets and clothing are also used as a personal protection in military camps [[58]].
permethrin 19973 camps [[58]]. Insecticide-treated plastic sheeting is effective in the areas of vector resistance to permethrin , as a result of the repellent effect of permethrin. A randomized controlled trial in a refugee setting
permethrin 20024 is effective in the areas of vector resistance to permethrin, as a result of the repellent effect of permethrin . A randomized controlled trial in a refugee setting in Sierra Leone showed that ITPS is safe, effective
primaquine 26638 of patients with P. vivax treated at health centres and hospitals in non-malarous endemic areas is primaquine [[62]]. However, there is a fear that primaquine can increase the risk of haemolysis in patient with
primaquine 26687 centres and hospitals in non-malarous endemic areas is primaquine [[62]]. However, there is a fear that primaquine can increase the risk of haemolysis in patient with glucose-6-phosphate dehydrogenase (G6PD). A recent
primaquine 27089 little or no clinical significance [[72], [73]]. These findings supported the adoption in Ethiopia, primaquine for interrupting P. falciparum transmission and for radical cure of P. vivax. However, as the presence
Select Disease Character Offset Disease Term Instance
filariasis 16377 is an effective medicine against a variety of parasites and vectors, and is used to treat lymphatic filariasis and onchocerciasis [[6]]. Studies have shown that IVM can kill Anopheles mosquitoes feeding on human
infectious disease 1501 tailored to the local situation of malaria transmission, may be needed.BackgroundMalaria is a parasitic infectious disease , and transmitted by female Anopheles mosquitoes [[1], [2]]. The disease is a global public health problem,
malaria 64 Title: Malaria JournalReshaping the vector control strategy for malaria elimination in Ethiopia in the context of current evidence and new tools: opportunities and challengesTaye
malaria 442 measures, long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), reduce the risk of malaria infection by targeting indoor biting mosquitoes. These two interventions are found to be effective in
malaria 552 infection by targeting indoor biting mosquitoes. These two interventions are found to be effective in malaria control, but not sufficient to eliminate malaria. The main challenges with LLINs and IRS are insecticide
malaria 601 These two interventions are found to be effective in malaria control, but not sufficient to eliminate malaria . The main challenges with LLINs and IRS are insecticide resistance, misuse of the interventions, host
malaria 953 feeding on bovine blood, outdoor biting and outdoor resting. Therefore, for complete interruption of malaria transmission in a defined area there is a need to consider a variety of interventions that can help
malaria 1096 there is a need to consider a variety of interventions that can help prevent out-door as well as indoor malaria transmission. In Ethiopia, to achieve the malaria elimination goal, a mix of vector control tools, such
malaria 1146 that can help prevent out-door as well as indoor malaria transmission. In Ethiopia, to achieve the malaria elimination goal, a mix of vector control tools, such as intensifying the use of LLINs and IRS, and
malaria 1432 mosquito trapping, improving housing and larva control measures tailored to the local situation of malaria transmission, may be needed.BackgroundMalaria is a parasitic infectious disease, and transmitted by
malaria 1757 Africa [[3]]. Cognizant of the serious health, economic and social challenges posed by the disease in malaria endemic countries, the Roll Back Malaria (RBM) Partnership was launched in 1998 with the goal of halving
malaria 1880 countries, the Roll Back Malaria (RBM) Partnership was launched in 1998 with the goal of halving world’s malaria burden by 2010 [[4]]. The evaluation of RBM shows that the global malaria incidence has decreased by
malaria 1954 goal of halving world’s malaria burden by 2010 [[4]]. The evaluation of RBM shows that the global malaria incidence has decreased by 37% between 2000 and 2015 [[5]]. However, the decline has stalled between
malaria 2082 decreased by 37% between 2000 and 2015 [[5]]. However, the decline has stalled between 2015 and 2016, and malaria remains a global public health problem in 2016 [[3]]. The reduction in malaria has mainly been attributed
malaria 2161 between 2015 and 2016, and malaria remains a global public health problem in 2016 [[3]]. The reduction in malaria has mainly been attributed to improved case management, and scale-up of long-lasting insecticidal nets
malaria 2364 insecticidal nets (LLINs) and indoor residual spraying (IRS) [[6]]. In 2015, a re-organized global effort for malaria control and elimination has adopted a Global Technical Strategy for Malaria 2016–2030 (GTS) with targets
malaria 2489 elimination has adopted a Global Technical Strategy for Malaria 2016–2030 (GTS) with targets to reduce malaria incidence and mortality by at least 90%, eliminate malaria from at least 35 countries and prevent malaria
malaria 2548 2016–2030 (GTS) with targets to reduce malaria incidence and mortality by at least 90%, eliminate malaria from at least 35 countries and prevent malaria re-establishment from malaria free countries by 2030
malaria 2595 malaria incidence and mortality by at least 90%, eliminate malaria from at least 35 countries and prevent malaria re-establishment from malaria free countries by 2030 [[7]]. In the GTS, vector control measures remains
malaria 2625 at least 90%, eliminate malaria from at least 35 countries and prevent malaria re-establishment from malaria free countries by 2030 [[7]]. In the GTS, vector control measures remains a core intervention strategy
malaria 2751 2030 [[7]]. In the GTS, vector control measures remains a core intervention strategy for the global malaria elimination programme [[8]].Vector control refers to measures of any kind against malaria transmitting
malaria 2841 the global malaria elimination programme [[8]].Vector control refers to measures of any kind against malaria transmitting mosquitoes, intended to limit the ability or vectorial capacity to transmit the disease
malaria 3187 at a given place and time, assuming that the human population is, and remains, fully susceptible to malaria [[9]]. The modified formula for vectorial capacity is:\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym}
malaria 4027 mosquitoes, such as IRS and LLINs, can play major roles in limiting the ability of mosquitoes to transmit malaria . This theoretical basis had been used to inform policy makers to select the most appropriate malaria
malaria 4128 malaria. This theoretical basis had been used to inform policy makers to select the most appropriate malaria vector control measures. For example, the use of IRS with dichloro-diphenyl-trichloroethane (DDT) in
malaria 4257 measures. For example, the use of IRS with dichloro-diphenyl-trichloroethane (DDT) in the 1950s and 1960s malaria eradication interventions was found to be effective [[10]].The two main vector control interventions,
malaria 4466 LLINs and IRS, are used to target mosquitoes biting and resting indoor, but cannot prevent outdoor malaria transmission in the presence of efficient vectors that prefers to feed on human blood outdoors, or bite
malaria 4725 challenges with the use of LLINs and IRS are insecticide resistance and residual transmission (remaining low malaria transmission in the presence of high coverage of LLINs and IRS to which the local vector is fully susceptible)
malaria 4875 coverage of LLINs and IRS to which the local vector is fully susceptible) [[9], [12]]. The remaining low malaria transmission is attributed to mosquito resting and biting behaviour (biting outdoors, biting indoors
malaria 5230 outdoors at night [[13]]. Hence, the scale-up of LLINs and IRS can result in substantial decline in malaria burden during the control phase, but fail to completely interrupt malaria transmission [[13], [14]].
malaria 5304 in substantial decline in malaria burden during the control phase, but fail to completely interrupt malaria transmission [[13], [14]]. In such circumstance, there is a need to use a combination of vector control
malaria 5434 [14]]. In such circumstance, there is a need to use a combination of vector control tools that target malaria vector at different life cycle stages in addition to the LLINs and IRS [[14]].Malaria control in EthiopiaIn
malaria 5641 EthiopiaIn Ethiopia, approximately 68% of the land mass of the country have favourable conditions for malaria transmission, and 60% of the population are at risk of malaria [[15], [16]]. The transmission of malaria
malaria 5704 country have favourable conditions for malaria transmission, and 60% of the population are at risk of malaria [[15], [16]]. The transmission of malaria is unstable and seasonal, usually characterized by frequent
malaria 5746 malaria transmission, and 60% of the population are at risk of malaria [[15], [16]]. The transmission of malaria is unstable and seasonal, usually characterized by frequent focal, and sometimes large scale epidemics
malaria 5951 epidemics [[15], [17]]. Plasmodium falciparum (70%) and Plasmodium vivax (30%) are the common causes of malaria [[18]]. The primary malaria vector in the country is Anopheles arabiensis and the secondary vector is
malaria 5979 Plasmodium falciparum (70%) and Plasmodium vivax (30%) are the common causes of malaria [[18]]. The primary malaria vector in the country is Anopheles arabiensis and the secondary vector is Anopheles pharoensis [[17]].
malaria 6384 behavioural preferences for anthropophilia and zoophilia (human and bovine blood) [[11], [19]].The national malaria control programme was initiated as the ‘Malaria Eradication Service’ in 1959 [[20]], and employed
malaria 6615 with DDT and treatment of cases with chloroquine [[20]]. However, the country failed to attain its malaria eradication goals, and the approach was changed from malaria eradication to a malaria control programme
malaria 6676 However, the country failed to attain its malaria eradication goals, and the approach was changed from malaria eradication to a malaria control programme in early 1980s [[15]]. This control programme was implemented
malaria 6701 to attain its malaria eradication goals, and the approach was changed from malaria eradication to a malaria control programme in early 1980s [[15]]. This control programme was implemented as vertical programme,
malaria 6894 vertical programme, and case management and selective indoor residual spraying with DDT were the main malaria control measures [[20]]. In 1993, the vertical programme was reorganized through integration of malaria
malaria 6998 malaria control measures [[20]]. In 1993, the vertical programme was reorganized through integration of malaria control in the health services in a decentralized approach during which scanty targeted IRS and case
malaria 7149 decentralized approach during which scanty targeted IRS and case management were used as a tool to control malaria [[15]]. Since 2005, in line with RBM initiative, Ethiopia has scaled-up malaria control interventions
malaria 7229 as a tool to control malaria [[15]]. Since 2005, in line with RBM initiative, Ethiopia has scaled-up malaria control interventions which now include prompt diagnosis and treatment of cases with artemisinin-based
malaria 7587 particularly the use of LLINs and IRS [[21]]. This coordinated effort has substantially reduced the malaria burden in the country between 2005 and 2015 [[5]]. Despite the low level of national confirmed malaria
malaria 7690 malaria burden in the country between 2005 and 2015 [[5]]. Despite the low level of national confirmed malaria prevalence (0.5%), large variation exists among the regions of the country as shown in Fig. 1 [[16]].Fig. 1Map
malaria 7814 (0.5%), large variation exists among the regions of the country as shown in Fig. 1 [[16]].Fig. 1Map of malaria strata by districts in Ethiopia (©2017), adopted from National Malaria Elimination Road Map [[18]]Cognizant
malaria 7949 Ethiopia (©2017), adopted from National Malaria Elimination Road Map [[18]]Cognizant of the decline in malaria prevalence, the country has launched malaria elimination road map to eliminate malaria by 2030 [[18]].
malaria 7994 Elimination Road Map [[18]]Cognizant of the decline in malaria prevalence, the country has launched malaria elimination road map to eliminate malaria by 2030 [[18]]. In the meantime, the variation in malaria
malaria 8036 the decline in malaria prevalence, the country has launched malaria elimination road map to eliminate malaria by 2030 [[18]]. In the meantime, the variation in malaria transmission risk between districts was taken
malaria 8094 malaria elimination road map to eliminate malaria by 2030 [[18]]. In the meantime, the variation in malaria transmission risk between districts was taken into consideration, and the intended approach is to attempt
malaria 8262 consideration, and the intended approach is to attempt sub-national elimination before embarking to national malaria elimination [[18]]. The proposed vector control interventions in the elimination road map (unpublished
malaria 8794 Therefore, the question is if the currently used vector control interventions are sufficient to eliminate malaria in Ethiopia? Or does Ethiopia need to re-shape these interventions?The aim of malaria elimination is
malaria 8880 to eliminate malaria in Ethiopia? Or does Ethiopia need to re-shape these interventions?The aim of malaria elimination is reducing transmission to a levels less than self-sustaining called basic reproduction
malaria 9179 one [[24]]. A review by Ferguson suggests that to reduce Ro < 1 requires an over 99% reduction in malaria transmission intensity to achieve malaria elimination [[24]]. It is also well documented that LLINs
malaria 9221 that to reduce Ro < 1 requires an over 99% reduction in malaria transmission intensity to achieve malaria elimination [[24]]. It is also well documented that LLINs and IRS (main proposed vector control for
malaria 9329 elimination [[24]]. It is also well documented that LLINs and IRS (main proposed vector control for malaria elimination in Ethiopia) are effective in malaria control, but not enough to eliminate malaria [[25]].This
malaria 9379 that LLINs and IRS (main proposed vector control for malaria elimination in Ethiopia) are effective in malaria control, but not enough to eliminate malaria [[25]].This paper evaluates the possible supplementary
malaria 9424 for malaria elimination in Ethiopia) are effective in malaria control, but not enough to eliminate malaria [[25]].This paper evaluates the possible supplementary vector control options to re-shape the proposed
malaria 9556 evaluates the possible supplementary vector control options to re-shape the proposed interventions in the malaria elimination road map of Ethiopia, while LLINs and IRS should remain as main malaria elimination tools.
malaria 9640 interventions in the malaria elimination road map of Ethiopia, while LLINs and IRS should remain as main malaria elimination tools. A literature search was performed in PubMed databases, the grey literature, the World
malaria 9886 Ethiopian Ministry of Health archives in June 2018 using the key words “vector control” and “ malaria elimination”. To describe the successes and challenges of vector control strategies for malaria control
malaria 9984 “malaria elimination”. To describe the successes and challenges of vector control strategies for malaria control and elimination in the past, the literature search was done without time limit.Methods of vector
malaria 10231 insecticidal nets (LLINs)Studies have shown that the use of LLIN is an effective tool in preventing malaria transmission, and has been implemented as one of the main vector control intervention in malaria endemic
malaria 10328 preventing malaria transmission, and has been implemented as one of the main vector control intervention in malaria endemic countries [[26], [27]]. High coverage and utilization of LLINs is recommended to achieve malaria
malaria 10433 malaria endemic countries [[26], [27]]. High coverage and utilization of LLINs is recommended to achieve malaria elimination goals [[22]]. In Ethiopia, vector resistance to the insecticide chemicals on the LLINs,
malaria 11924 new LLINs in areas where the vector is An. arabiensis. Moreover, as LLINs remains the mainstay in the malaria elimination goal, due emphases should be given not only to universal coverage but also to correct use
malaria 12693 mosquito resting on these surfaces [[32]]. Studies have shown that IRS is effective in reducing new malaria infections and mortality from malaria [[32]–[34]], and has been implemented as one of the major vector
malaria 12731 [[32]]. Studies have shown that IRS is effective in reducing new malaria infections and mortality from malaria [[32]–[34]], and has been implemented as one of the major vector control measures. The use of indoor
malaria 12941 residual spraying with DDT had played a central role in the success of the 1950s and 1960s WHO-led malaria eradication campaign, and remains the mainstay in the global coordinated effort to control and eliminate
malaria 13054 eradication campaign, and remains the mainstay in the global coordinated effort to control and eliminate malaria [[7], [20]]. The WHO recommended insecticide for IRS against malaria vector are grouped under: Organochlorine
malaria 13123 effort to control and eliminate malaria [[7], [20]]. The WHO recommended insecticide for IRS against malaria vector are grouped under: Organochlorine (DDT), Organophosphates (malathion, fenitrothion, pirimiphos-methyl
malaria 13700 propoxur [[22]]. Moreover, the rapid emergence of insecticide resistance is a threat to the future malaria elimination plan [[36]]. Therefore, there is a need to implement insecticide management and have new
malaria 13886 management and have new chemical insecticide on track, as IRS remains a key intervention tool in the malaria elimination plan of Ethiopia.Improving housingPoor housing conditions, such as the presence of open
malaria 14057 conditions, such as the presence of open eaves or holes allowing mosquito entrance are risk factors for malaria infection [[37], [38]]. Meanwhile, mosquito-proofed housing can limit the entrance of mosquito into
malaria 14205 mosquito-proofed housing can limit the entrance of mosquito into the house and reduce the risk of indoor malaria transmission that occurs before sleeping time [[38]]. Among others, screening and a general housing
malaria 14373 others, screening and a general housing improvement had been used as supplementary component in the malaria elimination strategy in the developed world [[25]]. A randomized controlled trial in south Ethiopia
malaria 14578 Ethiopia has shown that almost 50% reduction in indoor vector density, entomological inoculation rate and malaria incidence among houses in which windows and doors screened with wire-mesh [[39]]. This strategy of house
malaria 15568 co-intervention of LLINs and/or IRS [[40], [41]]. For example, a study from south Ethiopia showed the primary malaria vector, An. arabiensis, feeds both on human and bovine blood [[19]]. Hence, targeting mosquitoes feeding
malaria 15824 insecticide-treated livestock can be a supplementary vector control tools in an effort to eliminate malaria . A mathematical model combining data from Pakistan and Ethiopia has shown the intervention can decrease
malaria 15936 mathematical model combining data from Pakistan and Ethiopia has shown the intervention can decrease malaria transmission in areas where zoophilic vectors, such as An. arabiensis, are the main malaria vectors
malaria 16028 decrease malaria transmission in areas where zoophilic vectors, such as An. arabiensis, are the main malaria vectors [[40]]. Moreover, a recent systematic review also showed that this intervention can be used
malaria 16192 also showed that this intervention can be used in East Africa [[42]], and could be an option to reduce malaria transmission in Ethiopia.Ivermectin administration to humansIvermectin (IVM) is an effective medicine
malaria 16815 in Greater Mekong sub-region has shown that IVM mass drug administration has a potential to prevent malaria transmission [[46]]. Moreover, a study conducted in West African countries showed a single dose of IVM
malaria 16963 conducted in West African countries showed a single dose of IVM administration substantially reduced malaria transmission [[47]]. IVM drug is safe at high doses as 300 μg/kg/day for 3 days, and is an option
malaria 17252 fewer MDA (mass drug administration) rounds, ivermectin can increase the impact of MDA with an ACT on malaria transmission, and thus adding IVM could sustain impact on malaria prevalence even if the MDA coverage
malaria 17318 the impact of MDA with an ACT on malaria transmission, and thus adding IVM could sustain impact on malaria prevalence even if the MDA coverage is reduced [[43]]. Therefore, the WHO is considering the use of
malaria 17654 been tried in Ethiopia, and there is a need for research to inform policy makers on the use of IVM in malaria elimination plan.Odour-baited mosquito trapping systemsA synthetic odour blend consisting of mosquito
malaria 17968 mosquitoes [[49]]. This system can attack both male and female mosquitoes, and result in reduction of malaria vector density [[25]]. Studies have shown that an odour-baited station can be used as a trap and the
malaria 18208 escaping the trap shortly afterwards [[50]]. Odour-baited traps can supplement LLINs and can reduce malaria transmission. It is an affordable tool to help malaria elimination plan in Africa [[51]]. Moreover,
malaria 18263 Odour-baited traps can supplement LLINs and can reduce malaria transmission. It is an affordable tool to help malaria elimination plan in Africa [[51]]. Moreover, a cluster randomized trial in Kenya showed low malaria
malaria 18363 malaria elimination plan in Africa [[51]]. Moreover, a cluster randomized trial in Kenya showed low malaria prevalence in clusters using solar-powered odour-baited mosquito trapping system compared to control
malaria 19234 effective [[54]]. The WHO recommends space spraying in buses, trains and airplanes at their departure from malaria endemic countries as a strategy to prevent re-introduction of malaria into countries where malaria is
malaria 19304 airplanes at their departure from malaria endemic countries as a strategy to prevent re-introduction of malaria into countries where malaria is eliminated [[55]], and to control epidemic in urban area or refugee
malaria 19333 malaria endemic countries as a strategy to prevent re-introduction of malaria into countries where malaria is eliminated [[55]], and to control epidemic in urban area or refugee camps [[56]]. Further investigation
malaria 19557 to generate evidence to recommend space-spraying as a supplementary tool in an effort to eliminate malaria from Ethiopia.Insecticide-treated plastic sheeting (ITPS)Plastic sheeting (polythene tarpaulins) impregnated
malaria 20570 randomized trial from Ethiopia showed that mosquito repellents are potentially effective to reduce malaria infection [[59]]. However, a cluster randomized controlled trial in the Greater Mekong Sub-region has
malaria 20758 Mekong Sub-region has shown that mass distribution of repellents did not contribute to reduction of malaria [[60]]. A recent Cochrane systematic review has shown that there is insufficient evidence concerning
malaria 20924 there is insufficient evidence concerning the effectiveness of mass distribution of repellents for malaria prevention [[61]]. Thus, better evidence from further studies with rigorous methods is needed in Ethiopia.Larval
malaria 21332 stage of mosquitoes [[56]]. This could be an important tool to reduce risk of vector biting in low malaria transmission settings, especially those planning to eliminate malaria [[55]]. The WHO recommends larval
malaria 21402 risk of vector biting in low malaria transmission settings, especially those planning to eliminate malaria [[55]]. The WHO recommends larval control measures as complementary to LLINs or IRS in areas where mosquito
malaria 21851 [[62]]. It is effective and safe for use in water [[63]], and a potential complementary tool to control malaria in areas where breeding sites are findable places, such as urban areas, dams, irrigation canals and
malaria 22446 (larva-eating) fish feed on mosquito larvae, and have been used around the world in attempts to control malaria [[64]]. The advantages of using larvivorous fish are that it is a cheaper and more environmentally friendly
malaria 22615 is a cheaper and more environmentally friendly alternative to insecticide-based measures to control malaria [[64]]. The use of larvivorous fish in combination with IRS and case treatment in India was found to
malaria 22740 of larvivorous fish in combination with IRS and case treatment in India was found to be effective in malaria control [[65]]. A systematic review has shown that the use of larva-eating fish in concrete tanks was
malaria 22863 A systematic review has shown that the use of larva-eating fish in concrete tanks was effective in malaria control [[54]]. However, countries should not invest in fish stocking as a standalone or supplementary
malaria 23004 countries should not invest in fish stocking as a standalone or supplementary larval control measure in any malaria transmission areas outside the context of the research included in this review. The limitations are
malaria 24004 more expensive than control programmes, as it requires advanced tools to diagnose all persons with malaria infection, including asymptomatic carriers, a strong surveillance system (entomological and epidemiological),
malaria 24831 at grass root level in the Ethiopia health system is one of the opportunities to implement a mix of malaria prevention and control tools. In the Ethiopian health system, there is one community health post per
malaria 25105 approximately 5000 population). The health post is staffed by two HEWs, and they are an important agent for malaria case management, can identify transmission foci, coordinate IRS and LLINs operation, perform surveillance
malaria 25285 LLINs operation, perform surveillance and carry out information, education and communication to prevent malaria transmission. Moreover, HEWs can play a major role in mobilizing the community for larval control (environmental
malaria 25681 partnership, good global and international resource mobilization.ChallengesThe main challenges for malaria elimination are the observed high prevalence of asymptomatic malaria infection [[70]], drug and insecticide
malaria 25750 mobilization.ChallengesThe main challenges for malaria elimination are the observed high prevalence of asymptomatic malaria infection [[70]], drug and insecticide resistance, climate change, political instability, a poor health
malaria 26435 time, and result in clinical infection that cannot be prevented by use of LLINs or IRS [[71]]. In the malaria guidelines of the Ethiopian Ministry of Health, the recommended drug of choice for radical cure of patients
malaria 27494 monitoring.ConclusionsCurrently available vector control tools such as LLINs and IRS can substantially reduce malaria transmission. Achieving and sustaining zero malaria transmission is unlikely without additional innovation,
malaria 27546 such as LLINs and IRS can substantially reduce malaria transmission. Achieving and sustaining zero malaria transmission is unlikely without additional innovation, particularly in the presence of residual malaria
malaria 27651 malaria transmission is unlikely without additional innovation, particularly in the presence of residual malaria transmission, insecticide resistance and asymptomatic malaria. Ivermectin administration, zooprophylaxis,
malaria 27713 particularly in the presence of residual malaria transmission, insecticide resistance and asymptomatic malaria . Ivermectin administration, zooprophylaxis, odour-baited mosquito trapping systems, improving housing
malaria 27889 trapping systems, improving housing and larval control measures can be potential options for reducing malaria transmission
onchocerciasis 16392 medicine against a variety of parasites and vectors, and is used to treat lymphatic filariasis and onchocerciasis [[6]]. Studies have shown that IVM can kill Anopheles mosquitoes feeding on human blood, and simultaneously

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