Drug-Resistant Malaria - libdoc.who.int - World Health Organization

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136 / APPENDICES 2. Selection of area Monitoring of drug sens~tlvity is essentially a country··wide activity. Within the areas selected for study a stratification may be applied according to the following: Epidemiological strata Administrative divisions Geographical and ecological strata Domestic and international borders Migration areas Domestic Seasonal Pilgrim International Construction and projects 3. Case selection Political Labour Illegal Roads Hydro-electric works Canals and irrigation systems Agricultural development Others Baseline data are a sine qua non for a meaningful, longitudinal (sequent ial) comparison which is the essence of monitoring. The baseline needs to be established in a way that is representative of the area as a whole and of its various strata (see 2 above). In areas with a high prevalence and incidence this will be possible by following the usual sampling procedures for obtaining representative samples; in areas with low prevalence/incidence of P.falciparum baseline assessment needs to be exhaustive, i.e. covering the maximum available number of cases. The subsequent analysis of results should aim at clarifying the origin of infection and at defining the sensitivity status on a geographical basis. In this connexion, the following classification may be useful: Locally contracted Imported Within the village Within the study area Within the province/zone/state Within the country Across international border adjacent to the study area, short range movements Arising from neighbouring countries, long range movements Arising from distant countries
APPENDICES / 137 4. Screening points The screening considerations and following: Villages Schools Malaria clinics Health centres Hospitals Others 5. Screening approaches points are selected according to epidemiolgical the objectives of the study and may include the Disciplinary camps/centres Private practitioners Border check-posts Sea and airports Labour aggregations Army, police Screening to locate and select suitable cases to be included in the study would essentially consist of: Mass blood surveys Mass fever case surveys Out/in patients (passive case detection) Active case detection as appropriate under the specific circumstances. 6. Test methods The testing methods will greatly depend on practicability of the various techniques available, but it is to be noted that in vitro tests are required for the monitoring of sensitivity levels especially in areas where there is still a satisfactory in vivo drug response. (a) (b) in vivo in vitro 7-day tes t 28-day test Macro test Micro test Technic The above-mentioned tests have been described in WHO al Report Series 529 (1973) an document WHO/MAP/80.2. It is realized that certain operational, technical and administrative constraints may render the large-scale performance of these tests, especially of in vivo tests, quite difficult. In these circumstances a simplified procedure for preliminary orientation would be required especially for areas adjacent to those with resistant P.falciparum, other areas which are exposed to the occurrence of drug resistance and areas where the prevalence/ incidence of P.falciparum remains high in spite of intensive malaria control measures. Such a preliminary orientation could be carried out as follows:
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Drug-Resistant Malaria The Report o
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Foreword A meeting on drug-resistan
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CONTENTS Page Drug Pressure and Res
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2 / INTRODUCTION Differences in dru
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II. Opening Address and Messages Ol
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OPENING ADDRESS / 7 phical boundari
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OPENING ADDRESS / 9 to preserve for
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OPENING ADDRESS / 11 is also here a
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Ill. Review of Drug Resistance in P
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REVIEW I 15 Table 1. Sensitivity Te
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REVIEW / 17 Other Studies Validatio
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Distribution of Chloroquine-Resista
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REVIEW I 21 are signs to suggest th
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REVIEW / 23 (h) specialized investi
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REVIEW / 25 TABLE 3~ Comparison of
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REVIEW / 27 Of 22 mefloquine in vit
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REVIEW / 29 operational conditions
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REVIEW / 31 the possible influence
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IV. Monitoring of Drug Response of
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MONITORING / 35 during recent years
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MONITORING / 37 India, Sri Lanka an
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Table 4. Results of Micro In Vitro
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MONITORING / 41 The superiority of
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MONITORING / 43 input of the result
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MONITORING / 45 table time 1ag and
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Table 6. Probability of Detecting t
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MONITORING / 49 prevalence = 10% an
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MONITORING / 51 TDR. At the end of
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54 / RESEARCH RESULTS characteristi
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56 / RESEARCH RESULTS EXO-ERYTHROCY
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VI. Control of Drug-Resistant P. fa
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CONTROL / 61 DRUG USE AIMING AT PRE
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Table 7. Specific Actions for the C
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CONTROL / 65 Table 8. Drugs or Comb
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Table 9. Suggested Use of Antimalar
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Table 9. Suggested Use of Antimalar
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CONTROL / 71 Radical therapy of mic
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CONTROL / 73 Tanzania several years
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VII. Field and Laboratory Research
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RESEARCH FOR CONTROL / 77 In vivo a
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RESEARCH FOR CONTROL / 79 migrants
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RESEARCH FOR CONTROL / 81 and Phase
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RESEARCH FOR CONTROL / 83 (b) Metho
Page 94 and 95: 86 / RECOMMENDATIONS and sulfonamid
Page 96 and 97: 88 / RECOMMENDATIONS (xiii) Simple
Page 99 and 100: IX. Summary The Meeting on Drug-Res
Page 101 and 102: APPENDIX 1 List of Participants, Ob
Page 103 and 104: APPENDICES / 95 Sri Lanka Dr M.K. B
Page 105 and 106: APPENDICES / 97 Papua New Guinea Dr
Page 107 and 108: APPENDICES / 99 TEMPORARY ADVISERS
Page 109 and 110: APPENDICES / 101 Dr L.E. Molineaux
Page 111 and 112: APPENDIX 2 List of Documents A. WOR
Page 113 and 114: APPENDICES / 105 Comparative study
Page 115 and 116: APPENDIX 3.1 I 107 RESPONSE OF Plas
Page 117: APPENDIX 3.2 / 109 RESPONSE OF P. F
Page 120 and 121: 112 / APPENDICES 0.25 0.50 0.75 1.0
Page 122 and 123: 114 / APPENDICES Chloroquine is eff
Page 124 and 125: 116 / APPENDICES 1.4 Sulfonamide pl
Page 126 and 127: 118 / Various tetracycline analogs
Page 128 and 129: 120 / APPENDICES A loading dose on
Page 130 and 131: 122 / APPENDICES The drug should be
Page 132 and 133: 124 / APPEND ICE S 2. INDICATIONS f
Page 134 and 135: 126 / APPENDICES they are already r
Page 136 and 137: 128 / APPENDICES 5.2 In suppressive
Page 138 and 139: 130 / APPENDICES Outline research p
Page 140 and 141: 132 / APPENDICES Long-term To preve
Page 143: APPENDIX 8 Considerations Related t
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