The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #56349

Cameron Macauley, MPH, International Health, Boston University School of Public Health, 715 Albany St., Boston, MA 02118, 617 232 9387, cmac@bu.edu

Since 1996 the Brazilian Ministry of Health has adopted a malaria control strategy known as aggressive active case detection (AACD), in which most or all members of every community are tested and treated for malaria on a monthly basis. The strategy attempts to identify and treat cases of asymptomatic malaria, which, if untreated, continue to transmit the infection. Malaria remains uncontrolled because almost all health care systems in the world rely on passive case detection: treating only symptomatic cases of malaria. Research has shown conclusively that asymptomatic cases exist in any population where malaria transmission is stable and incidence is high; therefore passive case detection simply will not succeed in breaking the cycle of transmission. Numerous case studies show that malaria has been successfully controlled on a regional or national level by mass blood surveys. AACD is an effective malaria control strategy if used in conjunction with other methods, especially when 1) an effective treatment exists, 2) influx of potential carriers of the infection can be monitored, and 3) people are inclined to cooperate with monthly blood testing. AACD requires access to rapid diagnostic tests (RDTs), microscopy supplies, extensive human resources, and affordable, effective treatment. Clinical diagnosis, microscopy and RDTs are compared in terms of accuracy and feasibility. AACD is compared to PCD in terms of clinical efficacy and cost effectiveness in a case study of malaria in the Brazilian Yanomami Indians.

Learning Objectives:

• 1. Participants will be able to describe the epidemiological importance of asymptomatic malaria, and explain why it has frustrated malaria control programs that are based on passive case detection.
• 2. Participants will be able to explain why the Brazilian strategy has succeeded in reducing the incidence and mortality due to malaria.
• 3. Participants will be able to explain how AACD could effectively control malaria in the developing world without incurring major expenses.

Keywords: Infectious Diseases, International Public Health

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: OptiMal Rapid Test for malaria (Flow, Inc.)
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.