WORLD HEALTH ORGANISATION MONDIALE ORGANIZATION DE LA SAN〕*

1 EXECUTIVE BOARD EB2V21 2 December 1958 ffwenty-third Session cmiGINALs ENGLISH Provisional agenda item ^

PRESENT STATUS OF THE WORLD-WIDE MALARIA ERADICATION EFFORT

CONTENTS t I^ge

I. INTRODUCTION 2

II» STATUS OP ANTIMALARIA ACTIVITIES BY REGIONS 5

1 African Region 5

2 American Region ...... 29

35 Eastern Mediterranean Regi»n ., 70

斗 European Region ,.，....， 85

5 South-East Asia Region ..... 105

6 Western Pacific Region .... 136

.7 Summary of present statue of malaria eradication • 165/166

III. PILOT PROJECTS 169

IV. SPECIAL RESEARCH PROJECTS 181

V. PRESENT STATUS OF INSECTICIDE RESISTANCE IN MALARIA VECTORS 187

VI. GLOBAL MALARIA ERADICATICMï APPRAISAL OF TOTAL COST 190

VII. EPITOME OF WHO EFFORT 209 SB23/21 page 2 •

INTRODUCTION Almost equal in importance to Ross's epoch-making discovery at the @nd of the last -century, of the role of anopheline mosquitos in transmitting human malaria . . - was the revelation during the Second World War of the use of DDT as a residual insecticide against the melalgia vector., The introduction of DDT caused a revolutionary diange in the strategy against malaria. Until then the reduction of the size of anophellne population s had b een the only vtay to reduce the intensity of malarial transmission. This was done by the permanent elimination through sanitaiy aigineering works, or the temporary destruction throu^i larvicides, of anophellne larvae in their breeding places. But breeding conditions vary so considerably, and the relation' of breeding places to man is also so variable, that long preparatory studies were aecessary for the control of anopheline breeding in any particular situation. Such laborious and costly operations could be undertaken only in coimunitles of a marked demographic, economic and strategic value, and as a consequence the areas of control were mere dots in the malarious map of a count ly. The introduction of residual insecticides moved the theatre of operations from the anopheline breeding places to the habitations of man, and based the control of malaria on the reduction of the life span of the vector species, instead. o£ on an indiscriminate reduction, oí the whole anopheline population. The economic implications of the use of residual insecticides were even more' significant. In the first place, the diminution of the cost of operations was such that it became possible to exte,nd antimalarial work to the rural areas which had been always the most sever&Ly affected by malaria. Secondly it was possible л to estimate the cost of operations on the basis of the size of the human population and the size of human dwa?lings. Here was a concrete, definite framework on which could be based the calculation of costs. For the first time campaigns could be planned on a national scale, simply working out the human population to be protected and the average surfaoe to be sprayed per capita.

At first the objective remained, as in the past, the control Q£ malaria. But the extensive use of residual insecticides was followed by two tecshnical observations of great importance. One was the fortuitous eradication of malaria, even in areas where this had been specifically pre-planned, and the other was the growing resistance of insects of public health importance to the action of residual insecticides, followed by the development of cross resistance to allied insecticides^ The first showed that the eradication of malaria is possible, by the reduction^ and finally ty the extinction, of the parasite reservoir when transmission has been interrupted. The second observation signalized the urgent need to embark upon malaria eradication before the development of resistance of the vector species could render ineffective this most feasible method of malaria control.

These were the reasons which in 1954 moved the Fourteenth Рал American Sanitary Conference, the Malaria Conference for the Western Pacific and South* East Asia Regions, and in 1955 the Eighth World Health Assembly to recoraraend the "implementation of a programme having as its ultimate objective the world-wide eradication of malaria".

It was affirmed at that time (and it remains true) that malaria infection dies out within three years if no reinfection occurs; therefore the interruption of transmission for a period of three years would mean the eradication of the disease.

The simplicity of this concept led to an enthusiastic idea that three to four years of extensive spraying would mean malaria eradication, and that thus all our troubles would be over. T.xis notion is quite correct from the purely tactical point of view: four years of total coverage (equal to three years of total interruption of transmission) will normally lead to eradication i but veiy 11 soon it was realized that an operation of "total coverage requires a preparatory- period of about one year for a pre-eradication survey and the organization of a true eradication service, and that later not less than three years must be set aside to cover the period of surveillance operation of the consolidation phase. Thus eight years are needed to complete an ideal eradication plan, assuming that all activities ars performed on schedule and with "Uie necessary efficiency. But these programmes are essentially national enterprisesj and countries are so diverse in their historical political, administrative and epidemiological 3 features, that each technical plan, in spite of its inherent simplicity, needs to be conditioned to the pattern of every individual country. Moreover, if the large number of well-trained personnel needed for eveiy project is not forthcoming immediately, the simultaneous development of eradication programmes in all countries according to. the standard scheme will be hamp^red and even rendered impossible. Various other contingencies arising on the human side, such as political instability, nomadism, economic depression, etc. or on the vector side, such as extradomiciliary transmission, behaviouristiс changes, or the dreaded development of insecticide resistance may impede the normal process of eradication operations.

Consequently, and in spite of the sound and stable technical principles upon which the theory of malaria eradicatioa is based, the timing and the progress of a global attack on malaria cannot be adjusted to tiie minimum theoretical peilod necessary for a single ideal eradication scheme.

This report contains a rough assessment of the global attack• It is possible, by studying the map inserted under Part II, point 1»7 to appreoiate the shift of the world towards malaria eradication. In the history of public health, no similar "administrative" progress has ever before been achieved in any other activity, in spite of the difficulties referred to in the previous paragraphs. It is still too early for any accurate assessment of the epidemiological results: this may come in due time. In order to facilitate the evaluation of the progress made in different parts of the world, narratives and tables have been presented by the various Ш0 Regions in Part II.

Particular attention is drawn to Part VI, which contains for the first time a tentative appraisal of the total cost of the world-wide programme as from 1 January 1959.

One big handicap to global planning and co-ordination is the inadequacy of the present reporting syston. This report was prepared with the best available data and estimates. It is expected that future documents of the same kind will provide corrections and improvements in the factual information, until finally it becomes possible to attain the thoroughness and perfection which are now so deeply needed in all programmes of malaria eradication. II. STATUS OF ANTIMALARIA ACTIVITIES ВУ REGIONS

1Л AFRICAN REGION

General Picture

In 1955, when the Eighth World Health Assembly adopted the principle of global malaria eradication, Рашрапа and Russell Í1955) pointed out that in tropical Africa "the situation is not quite so promising, owing to the current relatively high cost of malaria control in that region and to the absence thus far of any convincing success on a country-wide scale. There is no reason to doubt that the difficulties will be overcome but one cannot yet foresee the elimination of malaria in the near future".

The sixth report of the Expert Committee on Malaria (1956) appreciated the fact that in tropical Africa special conditions have modified the application of methods of malaria eradication è>y insecticide spraying and that in certain projects the degree of control has been inccMiiplete so that transmission has not been interrupted.

In consequence the 1956 WHO Expert Committee on Malaria recommended the setting up of pilot projects aivî the furtherance of other studies•

The general prospects of malaria eradication in Africa are now somewhat brighter than two years ago. The results of pilot projects in south-east Africa have shown that malaria interruption can fee achieve终 by residual insecticides alone at the periphery of the distribution of the notorious African vector, A, gamblae. Consequently the time has ооше for the planning, in that part of Africa, of a large WH6-^9poneored inter-terrltorial malaria eradication project covering an area inhabited by 4.3 million persons.

In two other areas (Mauritiua and Yammdé pilot area 4n the a^th Ûemeroons) the era- dicatioA pp^spects aie so bright that an insHtutim of surveillance aaxï be conterplated in 1959.

On the other hand, in tropical Africa proper, where residual insecticides alone have not succeeded yet in bringing about the interruption of transmission, a series of research and pilot projects will be set up to appraise the possibility of malaria eradication by the combined action of insectioidal methods and chemotherapy. Extent of the Problem

The African region covers an area of 7 848 542 square miles or 20 319 875 sq. km and has an estimated population of 153 975 000.

Malaria is prevalent over the whole region with the exception of three countries:

(a) Basutoland Protectorate, the altitude of which varies from 5000 feet to 11 000 feet (population 800 000);

(b) the island of St Helena, situated 2100 miles from the west coast of

Africa (population 5000)j

(c) Seychelles and its Dependencies., which consist of 92 islands with a population of 40 000.

Naturally， several countries of the African region have areas where malaria is absent- mainly because of topographical and climatological conditions (deserts and highlands). It is estimated that the total population of the Region exposed to malaria amounts to no less than V\0 millions* {See Tables 1-3¿)

Organization of National Malaria Services

In most of the countries in Africa there is no national malaria service in charge of all surveys, anti-mosquito operations and evaluation. Antimalaria activities are carried out in urban areas by general b^Zbh services. Only in countries where pilot projects or eradication activities are afoot is there either a national malaria service^ or a relevant, section of the Medical Department.

In British East Africa the Malaria Institute of Amani acts in an advisory capacity to the three governmerits, and plans the activities carried out by the General Health Services.. The same is done in Nigeria, where the Federal Malaria Service advises the Medical Department. In French Africa special sections of the Endemic Diseases Service have the same responsibility.

This is shoxn in Table 4,

Legislation

Out of 40 countries in Africa only 12 have any form of special legislation which has some bearing on malaria eradication. Compulsory case reporting is in force in five countries only (Union of South Africa^ Reunion, Bechuanaland, Mauritius and Tanganyika). Personnel (National and International)

The data available on the number and distribution of national personnel in the African Region are too scanty for a comprehensive evaluation. Generally speaking there is a great shortage of trained national personnel especially of supervisory grades.

With regard to international personnel, Table 8 gives the preset distribution of staff. The total numbers are at the present time I seven malariologists, five entomologists, five sanitarians and six laboratory technicians, which are considered « insufficient,

Field Operations In some areas of Africa antimalaria schemes using residual insecticides in rural areas had already commenced during the period 19^8-1950• Such was the case tn Mauritius, Madagascar, Union of South Africa, Southern Rhodesia and Southern Nigeria (Ilaro). During the past few years a greatly increased number of antimalaria programmes were carried out in the African Region either by the national governments or assisted by the United Nations agencies.

The results of these programmes could fee classified into two groups. In countries of southern Africa such as the Union of South Africa (Transvaal, Natal), Bechuanaland, Swaziland Southern Rhodesia, Mauritius, Réunion and the highlands of Madagascar # the results of residual insectioi^al campaigns were very good and there is evidence that malaria eradication is within sight.

This was particularly true with regard to Mauritius, Swaziland and Réunion, where the cessation of spraying an^ the institution of surveillance are being organized.

The second group of programmes was carried out in tropical Africa sensu stricto, the main body of the continent stretching from the 15° N parallel to approximately the tropic of Capricorn.

Most of these schemes were the responsibility of the national governments often with the help of the United Nations Children's Fund or the United States bilateral programme • Several were assisted by WHO either in the form of international personnel or additional funds• These schemes in West Central Africa were situated in Liberia, French West Africa (Senegal, Dahomey, Haute Volta), French Cameroons and French Togoland and Western Sokoto in Northern Nigeria.

In East Africa two schemes were carried out! Mandi area in Kenya, and T&veta Pare in Tanganyika-Uganda.

1-n this second group of programmes the results obtained in the pilot area of Southern Cameroons were most encouraging. The malariometric indices showed that after four years of residual spraying with dieldrin the interruption of transmission was so close that erganization of a surveillance system is now planned together with a cessation of spraying. It should be pointed out, however, that the epidemiological conditions of the Southern Cameroons are rather unusual, since the vectors are A. moucheti and A. gambiae.

In remaining programmes the spraying with residual insecticides decreased, often, quite spectacularly, the amount of malaria but the transmission was not interrupted after three to four years of spraying and new infections were still occurring. •

The geographical and ethnological features of rural African areas are such that a 100 per cent, coverage of all dwellings and outhouses can be accomplished when the legistics of the programmes are flawless. Any hitch, in the form of delayed supplies, shortage of petrol for transport, breakdown of vehicles, unusually early and heavy rains, etc., puts the whole programme out of gear. Needless to say, these happenings have been responsible for a good deal of difficulties, although things have greatly improved during the past two years. Incomplete coverage may also be due to intrinsic ethnological causes and many examples of this could be quoted..’

The extreme privacy of the houses of Moslem populations ¡èf Central Africa must be respected and the greatest tact is needed when dealing with areas when women are in purdah. In Liberia the "crop-huts" or "rice-kitchens" where people live during the cultivation of their crops are far away from the villages, often Impossible to locate and to spray. Elsewhere the inside walls are replastered after spraying or many houses built between two spraying cycles.

Nomadic populations like the Fulani of Northern Nigeria or the Sudan and Somaliland carry with them their huts or tents, which are not suitable for residual spraying. Generally speaking, even the mobility of the permanent populations in tropical Africa has been under-estimated. It is understandable that the results of a pilot project limited in size can be prejudiced by the possibility of reinfection, fought from outside the protected area of the project,

Most of the rural dwellings in Africa are built of mud with a thatched roof. These mud walls are characterized "Dy a potent sorptive action which together with the high environmental temperature causes:a rapid fall in the activity of all insecticides. Thus the spraying cycle must be repeated at least every two months and the insecticide dosage muet te correspondingly high.

Chemotherapy in ？¿alaria Eradication in Africa

The difficulties and disappointments connected with the use of residual insecticides produced an understandable swing cf the pendulum towards chemotherapy. It is now the general concensus of opinion that antimalarial drugs V7ill have to play an important part in our strategy. Well conducted and well assessed field trials of antimalarials are still too "but even at this stage cne can assess the possibilities of this method.

We have a number of drugs which alone or in conibination are exellent for treatment of malaria or for long-term protection of well supervised groups of populations like labour camps, schools, etc. Unfortunately all the drugs available today are relatively rapidly excreted from the body агЛ must be administered at regvJLar intervals of not lees than once a month. This creates immediately a problem of long-term mass administrationIt is obvious that it cannot be solved by itinerant health units periodically visiting the area and giving the drug to every individual. The only practical solution is to organize a peripheral system of drug distribution by village headmen^ after an intensive public health briefing of the people concerned.

An alternative to this is the administration of medicated salt according to the method introduced five years ago by Pinotti in Brazil. A field trial of this method is now in the preparatory stage in N. Ghana. During the period 1958-1960 a series of drug trials will be carried out in Africa in conjunction with residual spraying or without any anti-mosquito measures. Spraying Squads

Table 5 shows available information on the organization of spraying squads in African programmes. The difficulty and expense of recruiting suitable supervisors is reflected in the large squad sizes used in several countries. Stirrup-pump type sprayers and knapsack sprayers are preferred in many programmes for their durability and ease of maintenance, but compression sprayers are used in the WHO/ÜNlCÉP-assisted programmes of West Africa. Although programmes on the whole are well equipped with motor vehicles, these are often unusable in rural areas where spraymen must walk long distances to reach remote villages and seasonably occupied shelters.

Transport

Data available on vehicles in use in antiroalaria programmes are given in Table 6.

Entomological Operations

In all African programmes entomological operations play an important part although the extent and quality of the entomological follow-up is not the same in each project.

The main problem is caused by the particular ecology of A. garobiae, one of the world s most ' Powerful malaria vectors. Special research projects are in operation with the object of finding ways to control transmission by this vector.

The most serious and recent technical difficulty of malaria eradication in Africa is undoubtedly the phenomenon of resistance to insecticides. In October 1955, the first authentic case of resistance of A. gambiae to dieldrin was reported (see Table 7).

HoffeveE in many other areas where dieldrin or BHC have been used for three to four years no resistance has been reported. These areas include Togo, Dahomey, S. Cameroons, Kenya (Nandi), Tanganyika (Taveta-Pare), Transvaal, S. Rhodesia and Swaziland.

Fortunately there is no resistance in tropical Africa to DDT, and in areas of dieldrin resistance DDT still remains an effective weapon.

Appraisal of WHO Effort

International personnel are shown in Table 8 according to countries. Technical advice is given by the Regional Office. A number of fellowships have been awarded, and training courses are held from time to time. Meetings and seminars have been organized in various parts of the region. Prospecta

Results of pilot projects in the Union of South Africa, in Swaziland and in Southern Rhodesia have shown that malaria eradication in these areas is practicable. The recent WHO meeting on malaria eradication in Lourenço Marques recommended the organization of a large interoountry eradication programme in the south-eastern part of Africa. This programme will include the southern portion of Mozambique, Northern Transvaal and Bechuanaland Protectorate, Natal, Swaziland and Southern Rhodesia. It has a great chanoe of success if carried out with the necessary thoroughness and with the full support of national governments.

The full estimate of the population involved in this project is not yet definite, but the following approximate figures can be given:

Northern Transvaal 1.8 million Mozambique 1.5 million Southern Rhodesia 0Л million Swaziland 0.25 million Bechuanaland 0.2 million Northern Natal 0.15 million

4.3 million

The plans for the organization of this campaign fall into three stages:

(1) pre-eradicatlon survey by a number of assessment teams;

(2) adequate co-ordination of the programme between various territories by a standing committee;

(3) training courses to improve the field techniques.

Two other areas, Mauritius and Yaounde in South Cameroons, have proceeded so far with their eradioation activities, so that the supppeesVon of spraying and Institution of sur^eiîtanoé wit>î be carried out in 1^59.

As far as the difficult part of tropical Africa is concerned it has been recognized that the best way of solving the technical problems, which are still facing us, is to carry out a series of reliable pilot projects, the aim of which is to find out the best method of interrupting transmission in tropical Africa. An increased attention to entomological assessment and to the technique of spraying operations is expected. Possibilities of chemotherapy as an additional method of malaria eradication will be assessed.

Suoh trials are now planned in the following countries and te^ritCries: Senegal, Haute Volttû (Bobo-Piçulasse), То@&, Dahomey, Frenfch t^iaeFoonSi-L.iber-tehena, Nigeria Zanzibar, Sotnsllüand^ Uganda, Sputhernn|üiodesiá, Tanganyika and Madagascar.

It has been estimated that the cost of malaria eradication in Africa amounts to 41 cents per capita per annum. Even if one half of this sum is provided by the United Nations agencies, the resulting 20 cents per capita per annum represents a considerable proportion of the total per capita budget on medical and health work of most of the governments in Tropical Africa. Thus the relative cost of malaria eradication activities in Africa will remain relatively too high until the economic standards rise considerably above the present levels.

On the other hand, the economic status cannot rise rapidly without a preliminary rise of standards of health and education.

Naturally, low educational standards have an important bearing on the availability of indigenous professional and well trained auxiliary personnel so necessary for country-wide health programmes.

Moreover, the public health education in matters of active co-operation with malaria eradication activities cannot be adequate in under-developed areas of Tropical Africa.

ÎHirthêrmere the change frbm a passive acoeptance of upablio health'飞 activities to a collective enthusiastic effort (aa-seen in South, A®«f tc») ie； most difficult at a time when many parts Africa are in an acute transitional stage, highly influenced by changing political trends and passions. TABLE 1. COUNTRIES IN WHICH MALAEIA IS NOT ЫЮШ TO HAVE OCCDEEED OR HAS DISAPPEARED WITHOUT SPECIFIC ERADICATION MEASURES

1 Country or Territory Estimated population" '

Basutoland 624 ООО**

Seychelles 红О ООО*

+ Spanish West Africa Bk ООО*

St Helena 5 ООО

Total 766 ООО

"Tfni, Rio de Ого, Sagula el Hamra. 1 1957 estimates, unless otherwise noted as follows :

mid-year 1956 estimates (1957 United Nations Demographic Yearbook)

1956 census . TABLE 2 • EXTENT OF MALARIA PROBLEM BY POPULATION

Area under Area with malaria not Population surveillance yet eradicated of the Country or Total Less than 5 years 1 original Regularly Antilarvei without indigenous Territory population sprayed operations malarious case area Population Spr. Population Population cont.

3hana (1+956) b 765 000 紅 7бЗ ООО 0 5 ÍJ-OO 165 ООО

Liberia (1957) 1 250 000* 1 250 ООО 0 469 000

Guinea 2 520 000* 2 520 ООО 0

Union of South х Africa (1956) 1红 1б7 ООО 4 ООО 000 0 2 500 000 (Transvaal) (k 810 000a) (1 800 ООО) 0 ；1 500 ООО) (Natal) (2 ^16 000a) (150 ООО) 0

х South West Africa 红96 ООО* 230 000 0

Belgian Congo 12 811 ООО* 12 811 ООО 0 i 250 ООО (1953)

Euanda-Urundi k 517 ООО k ООО ООО 0 红 100 ООО 200 ООО (1957)

French Cameroons 5 188 ООО* 3 188 ООО 0 1 紅07 ООО (1957) French Equat. Africa (1956) 4 82k ООО* k 82k ООО 0 370 ООО (370 ООО)

French West Africa (1957) 16 370 ООО* 16 570 ООО 0 1 671 ООО (Senegal & Dakar) (2 250 ООО») (2 250 ООО) 0 (907 ООО) (Upper Volta) (3 3^0 ООО») 0 (50 ООО) (Dahomey) (1 680 000х) (1 680 ООО) 0 (71^ ООО) French Sudan Ivory Coast Mauritania Niger

Footnotes : see page 16 TABLE 2. EXTENT OF MALARIA PROBLEM BY POPULATION (continued)

Area under Area with malaria not surveillance vet eradicated Population Total of the Less than 3 years Country or 1 Regularly Antilarval Territory population original without indigenous sprayed operatlooa malarious case

‘ � + • » -. area Populat ion Spr. Population Population с ont.

French Togoland 1 088 000* 1 088 000 0 31+0 000 (1957)

Madagascar (1956) k 905 000* k- 505 000 0 k 000 000

000 La Reunion (1957) 310 000 233 000 0 39 000 150

Comoro Islands 171 000* 171 000 0 8 000 (1955)

Angola (1955〉 317 000* k 317 000 0 1 300 000

Cape Verde Islands (195З) 178 000* 111 000 0 86 000

Mozambique (1955) 6 105 000* 6 105 000 0 622 000

Portuguese Guinea 553 000 553 000х 0

Sao Tomé and Principe (195^) 58 000* 58 ooo 0 50 000

Spanish North Africa 000* 20 ООО 0

Spanish Guinea 209 000* 209 ООО 0

• II • 1 i hi asm

Bechuanaland 527 000* 200 ООО 0 35 000 (1953)

British Somali- land (1957) 61+0 000* 0 25 000

Footnotes : see page Хб TABLE 2 • EXTENT OP MALARIA PROBLEM BY POPULATION (continued)

Area under Area with malaria not surveillance Population yet eradicated Country of Total of the Less than 3 years Eegularly Territory population^-' original without indigenous Antilarval sprayed malarious case opordtiora area Population Spr. Population Population с ont.

х British Cameroons 1 55紅 ООО* 1 500 000 0

jambia 285 ООО* 285 ООО 0

Kenya (1957) 6 252 ООО 6 ООО ООО 0 112 600 500 ООО

Mauritius (1956, 588 ООО 588 ООО 388 000 No 〜200 ООО 1957 & 1958)

Nigeria (1957〉 52 k33 ООО 52 433 ООО 0 55紅 ООО 1 520 ООО

Fed . of Bhodes ia anâ Nyasaland 7 338 ООО* б 200 ООО 0 (Northern В hod.) (2 180 ООО*) (1 772 ООО) 0 (Nyasaland ( 1956)) (2 678 ООО) (2 678 ООО) 0 350 ООО (Southern Ehod. (2 480 ООО*) (1 750 ООО) 0 1 032 ООО (1956)) +1 200 ООО (ndirectlyi )

S ierra Leone 2 100 ООО 2 100 ООО 0 121 ООО (1956)

Swaziland (1958) 237 ООО** 250 ООО 150 000 No

Tanganyika (1956) 8 778 ООО 8 ООО ООО 0 50 ООО 200 ООО

Uganda (1956) 5 593 ООО* 5 ООО ООО 0 500 ООО

Zanzibar & Pamba 280 ООО* 280 ООО 0 (targe t) 260 ООО 紅5 ООО (1956 & 1958)

Total ]Л9 329 ООО 15紅 562 ООО

瞧•丨園_|, 1957 estimates^ unless otherwise noted as followsi * ** mid-year 1956 estimates (1957 United Nations Demographic Yearbook) 1956 census a 6 IQ )! estimate TABLE З. PRESENT STATUS OP THE ERADICATION OF MALARIA BY POPULATION IN THE AFRICAN REGION {November 1958)

Status Population Per cent. f и .1 1 1 • • . - • — .‘ ». —— — —“ — — - —• • 150 095 000 100

Malaria never indigenous or has disappeared without 15 533 000 10.35 specific eradication measures

Total original malarious area 134 562 000 89.65

Malaria eradicated 0 0

Under surveillance or being 538 000 ) prepared for it ) ) 17.15 Regularly sprayed 25 214 000 )

Transmission known to occur but no organized programme 108 810 000 72.50 of total coverage under way

134 562 000 89.65

-„U^m • m “ • -"»• • 1 • - .-••'«•-•• ‘ • 1 г • ™ ,„ - ,- -——.-r-— —~ —

(e) Swaziland (150 ООО) and Mauritius ()88 ООО)

* his includes antilarval operations in urban centres T TABLE 4. THE ORGANIZATION OF NATIONAL MALARIA SERVICES

Country or Territory Official Name of Service Position Other Activities of of Service Service

Ghana (Health Service, Accra)

Liberia (Ministry of Health)

Guinea • • • • �

Union of South Africa (Union Health Department)

South West Africa • •參參

Belgian Congo (Service Général de Santé Endemio diseases Publique, Léopoldville)

Ruanda-Urundi (Service Médical Provincial)

French Cameroon， Section Paludisme du Service d'Hygiène Mobile et Prophylaxie

French Equatorial Africa Section Antipalustre du Endemic diseases Service Commun de lutte in rural areas contre les grandes Endémies

French West Africa ) (Senegal & Dakar)) Section Antipalustre du Endemic diseases (Upper Volta) ) Service Commun de lutte (Dahomey) ) contre les grandes Endémies

French Togoland (Santé Publique)

Madagascar Service Central Antipaludique None

Comoro Islands • • • •

Angola (Department of Medical Services, Loanda)

Cape Verde Islands » ««參

....No information available TABLE 4. THE CTIGANIZATH r,F NATIONAL MALARIA SERVICES (continued)

Country or Territory Official Name of Service Position Other Activities‘ of of Service Service

Mozambique Estaçao Antirnalarlca.de •.. . • Lourenço Marques

Portuguese Guinea Instituto de Medicina < General public Tropical, Bissau health

•Sao Tomé and Principe

Spanish North Africa « • • •

Spanish Guinea » » «拳*

Bechuanalaná (Health Department), • л I- - - ^ ,,

British Soma3.iland • •參畚

British Canoroons (Medical Department, Victoria)

Gambia (Medical Department, Bathurst)

Kenya (Medical Department)

Ka.uri.tius Insect-borns Diseases Division, Medical Department

1 Nigeria Federal Malaria Service; Malaria research, Northern Regional Malaria training and Unit pilot projects

Fed. of Rliodesia and Nyasaland (Northern Rhodesia) ) (Nyas aland) ) (Ministry of Health) (Southern Rhodesia) )

Sierra Leone (Health Department, Freeto^)

No information available TABLE 4. THE ORGANIZATION OP NATIONAL MALARIA SERVICES (continued)

Country or Teïritory Official Name of Service Position Other Activities of of Service Service

Swaziland Malaria Section, Medical Department, Bremersdorp

La Réunion (Direction départmentale de la Santé, Service de Prophylaxie)

Tanganyika East African Malaria Institute, Insect-borne Amaxii diseases

Uganda East African Malaria Institute, Insect-borne Amani diseases

Zanzibar and Pemba (Health Department) TABLE 5. SPRAYING SQUADS

7 No, of Type of Spraymen* Type of Country Year % work time squads sprajrer per squad transport in travel

Ghana (Accra) 1956 4 Compression 3 or 6 «會》 6 knapsack Guinea

Liberia (WHO) 1957 12 Compression 6 Foot and • • pickup Union of South Africa South West Africa French Cameroons 56/57 20 Compression 10 Pickups 20

French Equatorial 1956 ‘ about Compression 6 Pickups «參* Africa 50 Tifa and Swingfog French West Africa: Senegal^ 1956 3 Compression 21 Pickups 20 Upper Volta 1957 . 6 Compression 6 Truck or 50 pickup Dahomey 1957 7 Compression 8 or 14 Pickups 7 French Sudan

Ivory Coast 1957 參• • Compression 6 - 7 Truck • • • Mauritania Niger

Togoland 1956 7 Compression 8 Piokups • • • ’í Madagascar 1955 • • • Compression 7 Pickups 參 La Réunion 1957 10 Compression 2 Pickup 14 or Jeep Comoro Islands

Belgian Congo 1957 . 參 • • Compression 5-15 Trucks 2 Ruanda^Urundi 1957 28 Knapsack 5 or 10 Pickup 25 Angola Cape Verde Islands Mozambique

Pbôtàô^esî gee foilowlMg page EB2^/21 page 22

TABLE 5. SPRAYING SQUADS (èontîijued).

No. of Type of Spraymen Type of % work time Country Year * 4 squads sprayer per squad transport in travel

Portuguese Guinea 1957 參奢« Compression 5 Trucks • • • Sao Tomé & Principe Spanish North Africa Spanish Guinea Bechuanaland 56/57 о data . British Somaliland British Cameroons Gambia

Kenya Ш6 10 Stirrup 3 Pickups 5 Mauritius 1958 18 Stirrup and 2 • ‘ • ... knapsack Nigeria 1957 20 Compression 3 Pickups 20-30 Federation of Rhodesia & Nyasaland:

Nyasaland 56/57 3 Stirrup 8 Foot 25 Southern Rhodesia 56/57 . 6 Stirrup 20 Pickups 10 Sierra Leone 1 Compression 18 56/57 Pickups • • • knapsack Tanganyika 1956 N о residual ssprayin g Uganda 1956 o reeidual £ >praying Zanzibar 1956 о data ‘ 4 五 1 1 Tîïilès region

Eight beloñg to health services, 20 by contract TABLE 6. TRANSPORT FOR ANTIMALARIA ACTIVITIES

Total Trucks í Jeeps ！ ； motor 0 toil 丨 Pickup or Motor j ： . Country Year vehicles or over);trucks equiv• cycles 丨Bicycles 丨Other “ . ! • Ghana No data Guinea Liberia Union of S. Africa S. West Africa

Pr, Cameroons 56/57 . 35 2 20 . 13 - - - Pr¿ Equat. Africa 1956 124 41 50 19 - 98 - Pr. VT Africa: о

Senegal 1956 23 1 19 3 • •

Upper Volta 1957 16 5 4 6 - _

Dahomey 1957 16 1 10 5 - - - Pr. Sudan Ivory Coast Mauritania Niger

Togoland 1956 » • • 參• 《 7 « « • • « • • в • • • • Madagascar

La Réunion 1957 19 1 6 11 1 2 - Comoro Is. Belgian Congo 4 Ruanda-Urundi 1957 II 1 7 3 - - - Angola ,Cape Verde Is•

Mozambique * Port. Guinea S. Tomé & Principe

Footnotes : see following page TABLE 6. TRANSPORT POR ANTIMALARIA ACTIVITIES (cdritîmed)

f 11 ！ ！ Total (Trucks Jeeps Г j motor- |(3 ton Pickup or Motor Country S Year ivehioles ！or over) trucks equiv. cycles Bicycles Other Sp. North Africa Sp. Guinea Bechuanaland 56/57 None Br. Somaliland Br. Cameroons Gambia Kenya 1956 12 mm 6 3 • • Mauritius Nigeria 1957 27 8 16 - 12 65 Federation of Rhodesia & Nyasaland:

Nyasaland 56/57 1 - 1 - » 一 S. Rhodesia 56/57 15 1 13 1 - • • , Sierra Leone 56/57 1 - 1 - - • • Tanganyika 1956 ^o da'fea Uganda 1956 ^o data Zanzibar 1956

i

3 sedans, 11 boats 2 、 Thiès region )Sedan 4 . 4 belong to health services, 2 by contract 3 trailers, 3 caravans TABLE 7. PRESENT POSITION OF INSECTICIEE RESISTANCE Ш MALARIA VECTORS (OCTOBER I958)

Assessment of Susceptible Resistant Insecticide to Population living in Country or other Area of susceptibility vector vector which they are area of resistance political unit resistance made? species species resistant (estimated)

AERO

Angela NO Bechuanaland NO Belgian Congo YES A• gambiae British Cameroons NO British Somaliland NO Cape Verde Islands NO Comoro Islands NO French Cameroons YES A• gambiae A, moucheti French Equatorial Africa NO French Togoland NO French West Africa YES A. gambiae Dieldrin* Haute Volta 5 800 000 j Côte cT Ivoire Gambia NO Ghana NO Kenya YES A. gambiae * Liberia YES A. gambiae Dieldrin Central Liberia 500 000 Madagascar NO Mauritius YES A. gambiae Mozambique NO Nigeria YES A. funestus A• gambiae Dieldrin* Sok#t© 2 ООО 000 Northern Rhodesia NO I Nyasaland NO j i Portuguese Guinea NO 1 Réunion NO í Ruanda-Urundi NO Southern Rhodesia YES A. gambiae Sao Tomé and Principe NO^ ** Sierra Leone * YES A• gambiae Dieldrin Freetown 100 000 South West Africa NO Spanish Guinea NO Spanish North Africa NO Swaziland NO Tanganyika YES A. gambiae Uganda YES A. gambiae Union of South Africa NO Zanzibar and РешЪа YES Л. funestus

• A. gambiae '

* п Dieldrin resistance characteristically extends to EKC and to Aldrln, chlordane and other eye"odiene derivatives".

** In larvae only. TABLE s. ттттютъ STAFF FOR шажв. ERADICATION ш THS AFRICA! RSGIOM Bî 1958

c ： 。untiy or Medical ^ntomo-| ^ Adm. |others“ E ineerë s ； ！

Territory 丨 Officers :logists! 丨 Cons•丨 ； i i ！ í ！ i Ghana 1 Í i 1 laboratory ! ‘ Î • ： technician ; • i » ¡ ； Guinea ； • i , ！ ！ 1 X ！ 2 1 2 lab. teohs. j Liberia .‘ ； ！

Union of ! ‘ S. Africa ;. :‘i j S. West Africa i • \ Belgian Congo ！ i ： Î : Ruanda-Urundi У ‘ ) i Fr. Equat. Africa ‘ • î •• Fr. West Afriea； X (Senegal & Dakar) • (Upper Volta) X lab. tech. (Dahomey) X #

«

Cameroons (Fr.) 1 . Madagascar i La Réunion Togo j Comoro Islands

j Angola .• • • • Cape Verde Islands Mozambique Portuguese Guinea Sao Tomé & Principe ！ Sp. North Africa i Sp. Guinea i

For footnotes: see following page TABLE 8. BITERÏTATIONAL STAFF FOR MALARIA ERADICATION Ш THE AFRICAN REGION Ш 1958 (continued)

Countiy or Medical Entomo- Adm Engineers Sanitarians # Others Territory Officers logists Cons.

Bechuanaland British Somaliland 1 X British Cameroons Gambia Kenya Mauritius

Nigeria 2 2 Fed. of Rhodesia & Nyasaland 1 1 (N. Rhodesia) (S, Rhodesia) (Nyasaland) Sierra Leone Swaziland Tanganyika

Uganda X X X Zanzibar & Pemba 1 1 1 3 lab, teohns«

x Unfilled, posts

Pre-Eradication Survey Programme in 1959 1.2 AMSRICAN BEQION

General Picture With the exception of three small areas of little epidemiological importance ( cuba, British ОиАала, abd Dominica), the entire Hemisphere is now covered by in eradication programmes. Only one country, Brazil, has yet to begin total-coverage operations; but active preparatory work is under way and the operations are to be initiated in January 1959. Nicaragua, which had begun total coverage, found it necessary to revise its plan of operations, and will resume total coverage probably before the end of the year. Table 1 shows an impressive "YES" line in the eradica- tion programme column, while only one affirmative reply appears in the colunin for control programmes, to which should be added the reply of another country that did not forward information. The same table shows the initiation and termination dates total coverage. The last column at the right thus gives the outlook for the of malaria situation in the Hemisphere in 1962.

The programme of malaria eradication in the Western Hemisphere has given great Impetus to the development of the concept of "eradication" in public health. Some aspects of the programme merit special comments the collection of basic documentation and its detailed study; the development of procedures for geographic reconnaissance "inch by inch" for the purpose of locating and numbering all houses; the rigid planning of each operation, adapted to a strict chronologyj the training and re- gaining of all personnel at the various levels; the establishment of a supervisory structure; the adjustment of administrative and financial measures; and the enactr t of up-to-date legislation and regulations. Each çountry has done all this for men e preparation of its malaria eradication plan, and all these efforts have produced th invaluable documents that serve as guides for the campaign activities.

At ths national level, the malaria eradication programme has sought and obtained the collaboration of the entire community. The different agencies within the national health service, medical and paramedical groups, the schools, the armed forces, the clergy, social security institutions, private organizations, and the public in general all give their support to the campaign, thereby making this public health endeavour a programme by the nation and for the nation. At the international level, collaboration has been extensive and fruitful. An unmistakable demonstration of this is the fact that all the countries without exception have offered maximum facilities for the utilization of their programmes as observation or training areas. Brazil, Jamaica, and McocLco have joined with the long-established and traditional School of Malariology of Venezuela to create other international training centres. And added to all these splendid efforts is the generous support offered by four other countries (the Dominican Republic, Haiti, the United States of America, and Venezuela) in the form of financial contributions to a Special Malaria Fund.

Extent of the Problem

There are some countries and other political units in the Americas in which indigenous malaria is not known to have occurred or where such transmission as was present in the past has disappeared without specific eradication measures. These countries and units, their area, and the last official population estimates are . shown in Table 2.

In addition, there are others that are at present free from indigenous malaria as the result of active measures to eradicate the disease. Table ) shows their area and population estimates, together with the original area in which malaria trans- mission had occurred and the population therein.

Table k shows the extent of the problem by population as of J>1 July 1958. From these tables it can be seen that Argentina, Brazil, Venezuela, British Guiana, Guadeloupe, and Surinam claim eradication in parts of their original malarious area.» 2 The total area from which malaria has been eradicated is 407 744 km , inhabited by an estimated 4 531 000 persons.

Table 5 summarizes the achievements to date and gives an indication of the worfe still to be done for the eradication of malaria from the Americas.

Present Status of National Malaria Eradication Services

The service in charge of the campaign against malaria, designated in this report as the "National Malaria Eradication Service" (NMES), has undergone important changes with, respect to its standing in relation to the other services of the national public health administration. These changes are directly related to the change in concept from malaria control to malaria eradication. Control programmes, on achieving their aim of reducing malaria as a major public health problem, came to be amalgamated with other related activities. This trend saw less emphasis being given to malaria work, and in some cases the term "malaria" was no longer used to designate these sections, in spite of the feet that the disease continued to be an important health problem. In some countries, for example, the old and well-known "Malaria Service" became the "Vector Control Department" or "Section of Arthropod Control" or was Incorporated with other activities to form a "Department of Rural Endemics" or became the basis for a "Regional Department of Public Health". Today, wi-tti the acceptance of the eradication concept and the all-out drive for eradication, the NMES is emerging again as an entity and assuming major importance in relation to other health services.

The position of the NMES in 1958 is shown in Table 6, together with the official name of the service. The table shows clearly the high stature now held by the NMES within the respective National Public Health Services (NPHS).

In some places (British Honduras, Grenada, St Lucia) the malaria eradication programme is the direct responsibility of the NPHS because the small volume of activity does not warrant a specific department.

The State of Sao Paulo in Brazil, in accordance with a special agreement with the Federal Government, has an independent malaria service which implements its own eradication programme, although that programme is co-ordinated with the national plan. Por this reason, the tables presented in this report make two references to Brazils one for the country as a whole, excluding Sgo Paulo, and the other for SSo Paulo itself.

A new aspect in the administration of malaria eradication programmes is the establishment of Advisory Committees or Councils, which at present exist in nine countries (Bolivia, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Nicaragua, Paraguay and Peru). The intensification and extension of the eradication programmes have led to the establishment of such bodies principally for advisory and co- ordinating purposes, although in two other countries (Brazil, Mexico) they have been invested with the authority to take decisions on both technical and administra- tive matters. These Councils are presided over by the Minister or National Director of Health, or a similar official. Their composition varies from country to country, but generally they are made up of representatives of the Ministries of Education, Social Security and National Defence, the universitiesj medical associations, and international agencies which collaborate in the programme (PASB/WHO^ UNICEF, and 工CA). In sorae instances there are also representatives of the Ministries of Labour and Finance, the clergy, and private enterprises. The Director of the NMES is also a member of the Council.

In view of the importance of health education and public information^ these activities are the responsibility of specific units^ usually sections, but in seven countries they reach the level of a department. It is also important to point out. the steps taken for the maintenance of transport vehicles, for which a special section has been established under the Administration Department or, in a few cases, under the Department of Spraying Operations. In two countries the office in charge of transport is at the departmental level and is referred to as ‘ the Department of Logistics. In some programmes local training activities are the responsibility of a separate office, but in others this also has the status of a department. Only Mexico and Venezuela have Research. Departments.

With regard to their executive organization, the NMES may be divided into two groups: those decentralized, as in the majority of countries (Argentina, Bolivia, Brazil including Sao Paulo, Colombia, Ecuador, Haiti, Mexico/ Peru, and Venezuela) and those centralized, as in Central America, Paraguay, and other political units. In the first instance, the area of operations has been divided into "zones", each with an organization similar to that of the Central Office (Sections of Spraying Operations, Epidemiology, Health Education, Administration, Transportation, etc.).

Parallel to the increasing importance of the NMES within a respective NPHS has been the acceptance of the desirable practice of confining the activities of the NMES to malaria eradication exclusively. The situation existing in 1958 is seen in Table 7, which shows that in nine countries and two other political units the NMES is devoted exclusively to malaria eradication. Of the remaining countries, six include activities related to A'édes aeKYPti eradication and other yellow fever operations. Two others extend the scope of the NMES to the control of insects in general. This is excellent progress, considering that only three countries in 195^ had an NMS devoted only to malaria.

There is now no country in the Americas, with the exception of Cuba, which does not have a concrete plan for the coverage of the entire area in a single operation or by progressive stages. The same is true for all other political units with the exception of Dominica and the sparsely populated dense jungle interior of British Guiana. Dominica is hastening to complete a plan for total coverage with the intention of beginning eradication operations before 1 January 1959.

Progress toward malaria eradication in terms of operating total-coverage pro- grammes Is seen in the following summary of Table li

Other Political Countries Units Total

With indigenous malaria 18 11 29

With operating programme of total coverage on J>1 July 1958 13 9 22

To begin operating programme of total coverage by 1 January 1959 4 1 5 # Without programme for total coverage 1 1 2

Table 1 shows that in most of the Americas the period of total coverage will be completed by October 196l.

Legislation

The adoption of legislative measures is still a further indication of the interest shown by the governments of the Americas in malaria eradication.

* British Guiana, one of the pioneers in eradication, has eliminated the disease from its coastal area but has only a control programme for the jungle interior. The most outstanding achievement is the introduction of the concept of eradication, in lieu of control, in the legislation of 15 countries. Some lav/s contain vary advanced provisions, e.g.: obligation to report on construction or renovation of dwellings> and on migratory movements among the population; obliga- tion' to request authorization to paint or wash sprayed walls; and prohibition against occupancy of unsprayed premises.

The obligation to report malaria cases has also been given special attention. A limit of 24 hours has been established in the legislation of 12 countries and 11 immediate" notification is required in one country and in three other political units• In the rest, there is a seven-day limit, with one exception, which has a 30-day limit. At present nine countries and one other political unit require a blood smear for parasitological confirmation.

The majority of the legal provisions studied establish the obligation of authorities, organizations, public and private firms, associations, and the popula- tion in general to co-operate in malaria eradication.

Table 7 gives the comparative summary of the various provisions of antimalaria legislation in the Americas• The references used include the latest legal measures enacted as well as earlier provisions that have not been revoked.

Personnel

The information in Table 8 is presented in order to give a rapid, realistic indication of the manpower at present employed, being trained, and needed as of yi March 1958 for the eradication of malaria from the Americas•

It must also be appreciated that the duties within a specific category may- vary from one NMES to another. Por this reason the presentation of data has been restricted to personnel whose functions are believed to be comparable. Table 9 shows some of the professional and technical personnel employed as of 31 March 1958• There are, of course, other professional and technical personnel not included in Table 9, , microscopists appear in Table 11 in relation to evaluation activities.

Some categories of personnel employed in the spraying operations other than those in Table 9 are shown in Table 10. In brief, some 7724 persons are at present employed in the actual task of getting the insecticide on the walls, and 2)2), mostly for the Colombian programme, are still needed. There are on the average four to five spraymen to the brigade and a sector chief is responsible for the work of four brigades. This ratio, of course, varies between countries and within countries, depending on operational and administrative factors*

The malaria eradication services have full-time personnel for the collection of blood smears in the search for cases of malaria. The number of such personnel, those responsible for their supervision, and the raicrosoopists available for the examination of blood smears for the year 195S are shown in Table 11.

There is variation in the background and training of evaluators and their supervisors, and in some programmes their duties include activities other than the routine collection of blood smears from persons with fever or a history of fever. As indicated in Table 9, there are in addition physicians who devote their time to the planning, organization, and supervision of the work of those employed in the evaluation operations.

Field Operations

The shift from control to eradication programmes has resulted in an almost complete cessation of antilarval operations and associated engineering work. In only one country and six other political units are the NMES continuing antilarval activities which do not have malaria eradication as their aim. Fundamentally, therefore, the interruption of malaria transmission is based on the intensive application of residual-action imagocides, complemented where necessary with the use of modern antimalarial drugs.

Spraying Operations

In most of the NMES, spraying operations are being planned, conducted, and supervised by a special office or department. With few exceptions, they are generally directed by engineering staff that report directly to the executive chief at the national or zone level. Techniques regarding the surface to be sprayed inside the houses differ according to the after-feeding resting habits of the prevailing vector species. The general rule is to spray all indoor surfaces, walls, and ceilings up to a height of 3»5 metres, which is the height a sprayman can reach from the floor using standard equipment. All surfaces of furniture which could be resting places are also sprayed.

DDT and dieldrin, primarily in wettable powder formulations (75 per cent, and 50 per cent, respectively) are the two insecticides generally used at the intended dose of 2 g DHT (technical) and 0.6 g dieldrin (technical) per square metre* In French Guiana a limited use of BHC is also made.

As a general rule БПГ is sprayed twice a year, whereas dieldrin is sprayed only once. However, several exceptions exist where DDT is applied only once a year or, as in Guadeloupe, three times and in certain areas of Venezuela, four л times. •

Table 12 summarizes the number of houses planned, to be sprayed in 1957, the number of those actually sprayed, the approximate amounts of the insecticides used, and the date of initiation of total coverage. Pew conclusions can be drawn from this table, inasmuch as it shows figures on antimalarial programmes in very different phases: (a) eradication programmes with a year or more of total coverage, such as in Argentina, El Salvador, Guatemala, Mexico, Guadeloupe, and. St Lucia; (b) eradication programmes with less than one year of total coverage, as in Costa Rica, Ecuador, Nicaragua, Panama, Paraguay, Peru, British Honduras, and Grenada; (c) eradication programmes in the preparatory phase, as in Bolivia, Colombia, Dominican Republic, Haiti, Honduras^ Jamaica, Surinam, and Trinidadj and (d) control programmes still in progress, as in Brazil, Cuba, and Dominica.

The number Qf mounted squads, those travelling on foot, and those with transport of more than one type is an interesting feature of Table 13„

In most countries the actual spraying is carried on throughout the year, but in some there is a trend to concentrate it within a shorter time. Pressure sprayers are the standard equipment in the majority of countries, but a few services use stirrup pumps and knapsack sprayers. The organization and management of transport in malaria eradication programmes have different patterns. In the majority of cases a special section or department in the national malaria service is responsible for the allocation and supervision vehicles. There is in Mexico, as stated previously, a Logistics Department to of handle exclusively all matters regarding motor vehicles and other means of trans- portation used in the malaria eradication programme. In all cases the operation of motor transport is decentralized to the field unit which it serves.

Maintenance still constitutes a very important problem. Central workshops utine inspection and upkeep of motor vehicles are not yet generalized. In for r0 one instance, at least, this function has been given to private contractors. The number of vehicles and various types of transport used in spraying operations or for other purposes in the malarie eradication programmes under way are presented in Table 14.

Epidemiological Operations

Ш the Americas, epidemiological operations generally begin with the "pre- eradication survey" carried out during the preparatory phase; they continue with "evaluation operations" during the attack phase (total coverage), and subsequently with "surveillance and elimination of residual foci" during the consolidation phase.

With respect to the results of reporting and case-finding for 1957, Table 15 has been arranged to show cases reported by the same group of areas used in Tables 4 and 5, namely those in which malaria has been eradicated, those under surveillance those with malaria not yet eradicated but sprayed regularly, and those with malaria not eradicated jind in which spraying has not yet started or is irregular and in- complete .

Table 15 shows also the number of known cases according to the source of reporting, as follows: (l) private physicians, hospitals, clinics, etc»; (2) routine investigations of fever patients in hospitals, clinics, etc.; (5) house-to-house visits; (4) voluntary collaborators; and (5) other sources.

Emphasis should be laid on the very effective service being rendered by

voluntary collaborators. Of the J>1 blood smears collected by thera, Zj60, or 8.8 per cent., were positive whereas of the 446 862 smears examined as a result of house-to-house visits 93)2, or only 2.1 per cent., were positive. This is one of the reasons why the implementation of voluntary collaboration is being strongly supported throughout the Americas.

Entomological Operations

Up to early 1958, no physiological resistance to the insecticides had been confirmed in any of the anopheline vectors in the Americas, except A. quadrimaculatus in a small area of the United States of America where fortunately malaria had disappeared in previous years. An investigation to determine the persistence of transmission in some localities in El Salvador revealed in the local vector, A. albimanus, a high physiological resistance to dieldrin and a moderate resistance to DDT. With one exception, all these localities are situated in the cotton area, where large amounts of chlorinated insecticides have been used for several years to combat agricultural pests. Though this episode is to date but a small and isolated one, it confirms the urgent reasons that led to Resolution XLII of the XIV Pan American Sanitary Conference, and it is a clear and sombre warning for the future if the programmes do not continue to be developed according to established procedures and within the set time limits.

Use of Drugs

The eradication of malaria is dependent primarily on the effective usage of the residual insecticides, which is the basic and fundamental measure in eradication programmes. The importance of the use of the new antimalarial drugs, properly- applied, both therapeutically and prophylactically, must not, however, be overlooked, as a valuable adjuvant, facilitating the collection of blood smears as a routine part of the case-finding process, and cutting short the infective period of the cases found; but in addition there are situations in which a sound, programme of drug administration may complement or substitute residual insecticides where the latter are inapplicable or inefficient.

Most countries and other political units continued to use drugs in 1957 as a part of their antimalaria activities. The patterns of this usage are not comparable one with another, but an indication of the different drugs used, the quantity employed, whether they were used prophylactically or therapeutically, and the number of persons receiving drugs is shown in Table 17. In several areas of Brazil, the Pinotti method (administration of chloi>oquine by its addition to common salt) continues to be used, but figures giving an indica- tion of the population believed to be protected in this way are not given for the year I957. In the. actual plan for malaria eradication, this method will be used in the whole Amazon Basin.

Pyrimethamine has been used prophylactically in Venezuela, Grenada, and Trinidad and Tobago,

Role of the Organization

The Organization established a specialized unit engaged exclusively in promoting rjid co-ordinating the continent-wide activities, located at the beginning in Mexico City, in March 1955. One of its principal tasks was the preparation of technical standards for the development of the various eradication operations. For two years the main activity consisted of assistance to the countries in preparing their plans of operation and in organizing the training of personnel required for the programmes. The preparation of the plans of operation produced documents that contain not only the background data on malaria in each country but also the most complete details expected in each operation.

In January 1957, the ME Unit was transferred to Washington, and within the organizational structure of headquarters, was invested with the necessary functions and authority and with direct access to the Director, to deal exclusively with this single important problem. This step thus created a pattern equivalent to that suggested to the countries for the management of their own malaria eradication programmes. At the same time, mensures were taken so that all the branches in the Regional Office would give the malaria programme first priority and provide the specialized unit with all the support necessary to obtain the quickest and most effective action possible. Later, three additional technical advisers were assigned, one specialized in transport management and. vehicle maintenance, and the other two in administrative procedures.

乒 programme as extensive, ambitious, and dynamic as that of malaria eradication has required great and varied efforts on the part of the international organization responsible for its promotion and. co-ordination. EB23/2X page 40

Technical Advisory Services

A malaria eradication programme is essentially an aggressive operation based on techniques that are well known but whose application must be planned in detail and carried out with precision. Technical advice had to be organized under a structure that would respond to this requirement, A system was, therefore д established that functions at three levels.

At the country project level> a team of international consultants, composed generally of a malariologist as team leader, an engineer specialized in spraying operations, and one or more sanitary inspectors, is responsible for giving day-to- day operational assistance•

The second level is represented by the Zone Office, whose chief is responsible for assistance in political and administrative aspects, and which has^ in addition, a technical unit composed of a highly experienced malariologist^ a sanitary engineer, ал entomologist, and, in certain cases, a consultant in administrative methods and another in statistics» This zone technical unit is responsible for supervising the activities of project consultants, and for giving technical assistance at a higher level•

The third level is represented, by the central unit in Washington, which is responsible for establishing technical standards, for maintaining general technical supervision and co-ordination at the continental level, and for maintaining technical contact with Geneva headquarters (Division of Malaria Eradication), with UNICEF and ICA,

The number of international personnel engaged in the malaria eradication pro- gramme in the Americas as of 31 August 1958 is shown in Table 18 classified in six groups: medical officers^ engineers, 20; entomologists, 4; sanitarians, 4l; administrative consultants, 4; and others,斗，including advisers in health education parasitology, transport, and statistics. Of the total of 105^ 95 are in active service and 10 are in training• A volume of personnel such as this has made it necessary to devise means for filling vacancies that occur for numerous reasons. A pool has been created for this purpose^ that is, a reserve force that permits rapid replacements as vacancies occur, without going through the time-consuming procedures involved in normal recruitment and training. Training

Among the Organization's most important activities have been those designed to furnish means for the training of personnel required for -Ще national services; prepare the staff of advisers referred to above, and maintain a high standard of operational efficiency. Por this purpose, new international training centres have been established and regular and special courses, as well as seminars and workshops, have been organized.

The training of personnel for the international service also deserves special mention, since it represents a rather new aspect of the Organization's activities in this field.

The traditional procedure for recruiting international consultants has been to seek thera among leading professionals of the national services. However, as has been seen, the rapid expansion of the malaria eradication programme demanded such a considerable number of specialized, personnel to Reinforce the national staff that it practically cancelled out the possibility of obtaining consultant personnel by the usual method; there was no alternative but to train them. In the inter- national field this was an unprecedented experience, imposed by circumstances. A programme was, therefore, established to recruit professionals (medical officers and engineers) who have a master's degree in public health or sanitary engineering, excellent references, and at least two years' experience in public health work, and then to have thera take a short but intensive period of training consisting of: (a) a 12-week basic course in malariology and raaiaria eradication techniques at one of the four centres mentioned below; (b) four weeks • work as assistant to the national director of a malaria eradication programme, or to a zone chief, in order to acquire executive experience and judge the problems from the national viewpoint; (c) a minimum of four weeks' work as Junior consultant to a senior consultant, in order to appraise the problems from the international viewpoint and gain experience in methods of advising on their solution.

In addition to utilizing the facilities of the School of Malariology in Maracay, Venezuela, which has trained so many distinguished malariologists in the past,, it was necessary to develop co-operative programmes with the respective national authorities for the establishment of other training centres in Brazil (at the School of Hygiene and Public Health, SKo Paulo), Jamaica {in co-operation with ICA), and Mexico• These centres now serve to train professionals not only from the Americas but from all.parts of the world, particularly the Jamaica centre, where the'courses are conducted in English. Up to 30 June 1958> 15 courses for professionals had been given at the Maracay School (since 19^). In Mexico, since • * . • • “ * 蠢 early 1957* three courses»have been given for professionals and three for sanitary inspectors (sector chiefs). The centres in Jamaica 'and Sao Paulo began to function early in 1958, and have already given the following courses： in Jeiraaica, one for professionals and two for sanitariansi in sKo Paulo, one for professionals and one for entomologists (the latter as an extension of the regular entomology course).

In addition to the regular courses at the above centres, special courses for professionals have also been organized. The first, given in Guatemala, in English, started in October 1957, with the co-operation of ICA; it was attended by JO participants from 11 countries and five other political units in the Americas, Europe, Asia, and Africa. The second course was held in Colombia and the 'third in Haiti, in French, both held during 1958, for professional personnel of these programmes. These special cours雜 conformed to the same teaching plan as that followed at the regular courses..

Seminars and workshops constitute another important phase of the training. Two seminars have been held: one in Cali, Colombia, in July 1957, on laboratory techniques applicable to malaria eradication, and. the other in Panama (with the collaboration of the Environmental Sanitation Division of ViHO) in June 1958, on susceptibility and resistance of anophelines. Collaboration was also given in two seminars organized by ICA that selected malaria eradication as a principal topic. The first of these, held in May 1957 in Lima, Peru, was on health education, and the second, in March-June 1958 in Belo Horizonte, Brazil^ was on audiovisual aids.

Three workshops on vehicle management and maintenance were organized with the collaboration of UNICEF; the first in April 1958 in Lima, Peru, for the countries of South America; the second at the end of the same month in Tegucigalpa, Honduras, for the countries of Central America》 and the third In August 1^58 in Trinidad (in English), for the Caribbean area. TABIJE ]_• STATUS OP MALARIA ERADICATION CAMPAIGN IN THE AMERICAS, 1958

Status of Programme Eradication by total coverage of malarious areas

Eradication Country or other Period of conversion Period of total coverage by total Eradica- political unit coverage of tion by Date completed or will be Date completed or will be malarious areas areas Control Date started or will start completed Date started or will start completed

Argentina Yes - • April 19^9 August 1949 September 19斗9 (a) Bolivia Yes - - 1 July 1957 30 June 1958 1 July 1958 June 1962 Brazil (b) - Yes December December 1958 January 1959 一 1957 (a) Sao Paulo Yes - 1 December 1957 31 August 1958 1 September 1958 1 March 1962 Colombia Yes 一 - - 1 January 1958 7 September 1958 8 September 1958 8 March 1962 Costa Rica Yes - 1 January 1956 30 June 15 July I957 31 January I96I 一 1957 ** Cuba ** ** ** ** *# ** Dominican Republic Yes - - 1 №irch 1957 30 June 1958 1 July 1958 June 1962 Ecuador Yes - 1 September 1956 28 February 1957 18 March 1957 31 March 196I El Salvador Yes 一 - - February 1955 30 June I956 1 July 1956 31 December 1959 Guatemala Yes - - 1 February 1955 July 1956 1 August I956 15 September i960 Haiti Yes - - 1 October 1957 August 1958 September 1958 51 December I962

Honduras Yes - June 一 1956 January 1958 January 1958 January 1962 léxico Yes - - 7 September 1955 December 1957 2 January 1957 31 December i960 Nicaragua Yes - - July I956 October I957 11 November 1957 (c) (a) Panama Yes - - 1 January 1956 July 1957 19 August 1957 19 August I96I Paraguay Yes - - 1 January 1957 29 October 1957 30 October 1957 29 October I96I Peru - Yes - January 1957 November 1957 15 November 1957 (a) Venezuela Yes - - 19^5 I95O I95O i960 Other Political Units

British Guiana - Yes (d) Yes⑷ January 1945 January 19^9 19^7 1949 (d) British Honduras Yes - - 1 February 1956 31 December 1956 b February 1957 yi December I96I Dominica - - Yog August 1958 December 1958 January 1959 January 1963 French Guiana Yes - - - - May 19^8 1955 � Grenada Yes - - July 1956 February 1957 February 1957 January i960 Guadeloupe Yes - - 1955 1956 I957 i960 Jamaica Yes - - April 1957 December 1957 January 1958 December 1961 # * • Panama Canal Zone Yes - - April 1956 • » » • • • St Lucia Yes - - 1 January 1956 30 June 1956 1 July 1956 j51 December 1959 Surinam Yes - - November 1957 April 1958 2 May 1958 I96I Trinidad and Tobago Yes June 1957 December 1957 January 1958 December I96I

(a) To be determined. (d) Refers only to the coastal area. 一 Nil. (b) Not including the State of Sao Paulo. (e) Eradication in the coastal area, but control ** Report not received. (c) Programme temporarily interrupted. programme for sparsely populated interior„ …Data not available. (f) Reimportation in 195、 spraying recommended. EB25/2X page 45/46

TABI£ 2. COUNTRIES AND OTHER POLITICAL UNITS IN WHICH MALARIA IS NOT KNOWN TO HAVE OCCURRED OR HAS DISAPPEARED WITHOUT SPECIFIC ERADICATION MEASURES

Country or Other 2 Estimated Population Area iri km Political Unit as of 1 July 1957

10 187 740 19 877 ООО

Canada 9 974 375 16 589 ООО Uruguay 186 926 2 690 ООО Antigua 442 55 ООО Bahamas 11 ，96 120 ООО Bermuda 55 42 ООО Falkland Islands 11 961 2 ООО Montserrat 83 17 ООО Netherland Antilles 9б1 I9O ООО St K1tts-Nevis-Anguilla 596 55 ООО St Pierre and Miquelon 240 5 ООО St Vincent 389 80 ООО Virgin Islands (Br.) 8 ООО Virgin Islands (USA) 24 ООО

TABLE，. COUNTRIES AND OTHER POLITICAL UNITS WHERE MALARIA HAS BEEN ERADICATED

Country or Other Original ífelarious Areas Area in кщ2 Population Political Unit Area in km^ Population

014 ООО Total 10 098 948 179 993 ООО 2 )22 691 45

Chile 741 767 6 681 ООО 55 287 112 ООО United States 546 170 ООО 2 257 809 42 366 ООО qf America 9 751 547

Barbados 4)1 250 ООО 4^0 228 ООО

Martinique 1 102 255 ООО 500 45 ООО

Puerto Rico 8 897 2 280 ООО 8 865 2 26) ООО TABLE EXTENT OP MALAKIAL РГЛВЕЕМ BY POPULATION IN THE AMERICAS, 1958

j Area V7Í1±l malaria eradicated Area under surveillance Area with malaria not yet eradicated Prvm 11 + -i on Country Total population or other estimate oí tñe Three or more years Less than three years Regularly Not regularly- political unit original without indigenous case without indigenous case sprayed sprayed 1957 тетТ m 1С； аÎS Population Spraying continued Population Spraying continued Population Population

Total 177 795 000 86 41б ООО 4 531 ^00 1 493 ООО 53 865 000 26 527 000 Argentina 19 858 000 1 473 ООО 247 000 No 711 ООО No 515 000 Bolivia - 13 3 27) 000 1 102 ООО — 1 102 ООО Brazil 58 538 000 29 495 осо 638 000 Yes — 一 19 921 ООО 8 93б ООП S较。Paulo 2 730 000 2 678 ООО - 鶴 一 一 2 678 ООО Colombia 13 227 ООО 9 787 ООО - 一 9 787 ОСО Costa Rica 1 035 ООО 4SI ООО - • 一 451 СТО ** ** Cuba 6 4ic ООО ** ** ** ** ** Dominican Rep. 2 698 ООО 2 417 ООО - 一 2 417 ООО Ecuador 890 ООО 1 955 ООО - — — 1 一 955 ООО El Salvador 2 350 соо 1 385 ООО - _ _ 一 1 385 осо Guatemala 3 430 ООО 1 糾8 ООО - 一 一 1 抖8 осо Haiti 384 3 ООО 4 096 ООО - 4 cm Honduras 一 1 770 ООО 1 282 ООО — — _ 1 282 ООО Mexico 一 31 426 ООО 15 588 ООО - ог^ 一 一 15 588 Nicaragua 1 3)1 с^о 1 ООО - » 071 - ООО 976 огк-, Panama 95 960 ООО 910 осо - - — огл 一 91" Paraguay 1 6)8 ООО 700 ООО - 一 D 00 э Peru 9 923 ООО 2 878 ООО - • _ г 一 2 878 :00 Venezuela 6 ООО 4 479 ООО 3 065 卿 Yes 4 690 (юо Yes 945 ООО - Other Political Unit s British Guiana ООО 515 460 ООО 423 ООО N0 3斗 (У/、 3 ООО British Honduras 84 ООО 82 ООО — 一 82 ООО r*ominica 62 ООО . 51 ООО - _ 一 51 ооо French Guiana 29 ООО ООО — 25 一 25 Yes _ Grenada огю 26 ООО - ООЛ 一 一 26 Guadeloupe 250 ООО 210 ООО. 5斗 осо ... 127 ООО Yes 49 ООО Jamaica 1 59斗 ООО 1 296 ООО - _ 一 1 296 Panama Canal Zone 55 ООО DO广 - 一 40 St Lucia 一 91 ООО 68 001 _ _ 68 ООО Surinam 251 ООО 250 ООО 124 ООО No 126 roo Trinidad & Tobago 765 roo 713 осю - 161 ООО j No 552 ООО 1 ！ 9> Includes areas not sprayed under a plan of total coverage 於 Report not recei./ed b Not including the State of Sg?o Paulo •. • available Data not -Nil TABLE 5. PRESENT STATOS OP THE ERADICATION CSF MALARIA BY ABEA 1 AND POPULATION IN THE AFRICAS, JULY 1958

Status Area Per dent. Population Per oent.

Total 59 826 S60 100.0 У11 665 000 100.0

Malaria never indigenous or has disappeared without specific eradication 25 155 653 239 825 000 63.5 measures

Malaria eradicated 2 7^0 6.8 49 5^5 000 IXI Under surveillance 140 242 0Л 1 49) 000 0.4 Malaria still present but organized programme of 8 877 996 53 865 000 14.3 total ooverage under way 22.5 Malaria still present but eradication programme in 2 618 310 26 52斗 ООО the preparatory phase 6.6 7.0 Transmission known to oecur but no organized programme 505 624 б 斗13 ООО 1.7 of total coverage under 0.8 way

Not including Greenland TABLE 6. THE ORGANIZATION OP NATIONAL MALARIA SERVICES IN THE AMERICAS, 1957

Country or other Position Activities other than political Official паше of service of malaria eradication unit service

Argentina Dirección de Paludismo y Fiebre/ Amarilla Primary Campaign for the erad- ication of Aëdes aegypti Bolivia Servicio Nacional de Erradicación de ia Primàry Malaria None

Brazil— Campanha de Erradicaçao da Malaria Primary Serviço de Profilaxia da Malar!gb Secondary None Prevention of Chagas’ disease and schistosomiasis Colombia Servicio Nacional de Erradicación de la Autonomous Malaria None Costa Rica Departamento de bucha Contra insectos Primary Trasmisores ** None Cuba

Dominican Division de Malariologia Primary Campaign for the erad- Republic ication of Aëdes aegyptij and insect control Ecuador Servicio Nacional de Erradicación d象 la Primary None Malaria

El Salvador Division de Lucha Anti^Paludlca Primary- AntAëdes aegypti cam- paign Guatemala Servicio Nacional de Erradicación d珐 la Primary Eradication of Aëdes Malaria •..—— aegypti and vaccination against yellow fever Haiti Service National d,Eradication de la Primary None Malaria

Honduras Servicio Nacional de Erradieâcion dç la Primary- Anti-Aëdes aegypti oam- Malaria paign Mexico Comision Nacional Para la Erradicasion Autonomous None del Paludismo

Nicaragua Servicio Nacional de Erf»adieación de Xa Primary Anti-Aëdes aegypti cam- Malaria paign Panama Servicio Nacional de Erradicación â« la Primary Control of yellow fever Malaria (vaticination and Aëdes aëgypti eradication) i Paraguay Servicio Nacional de Erradicación del Primary None ! Paludismo

For footnotes see page 52 TABLE 6. THE ORGANIZATION OF NATIONAL MALARIA SERVICES IN THE. AMERICAS, 1957 (continued)

Country Position or other Activities other than Official name of service of political malaria eradication unit service

Peru Servicio Nacional de Erradicación Primary None de la Malaria Venezuela Division de Malariologia Primary- Aëdes aegypti erad- ication, control of Triatomidae, flies, rodents, etc. Other Political Units

British Guiana Mosquito Control Service Secondary Aëdes aegypti and bancroftial. filarlas is control British Honduras Health Department Primary Yellow fever and other public health activities Dominica Anti-Malaria Activities under Primary Insect control in Sanitary Department general French Guiana Service de la Lutte Antipaludique Secondary Yellow fever campaign et Antimarile and destruction of other anthropods of public health import Grenada Medical Department Primary Other public health activities Guadeloupe Service Départemental de Secondary Disinfection and Désinsectisation disinsecting in general Jamaica Malaria Eradication Programme Primary- None Panama Canal Health Bureau. Сала! Zone Government Secondary Pest mosquito and Zone culicoides control, all phases of environmental sanit- ation, and sanitary engineering and entomological support for maritime quarantine

Por footnotes see page 52 TABLE 6. THE ORGANIZATION OF NATIONAL MALARIA SERVICES IN THE AMERICAS, 1957 (continued)

Country or other Position political Official name of service of Activities other than unit service malaria eradication

St Lucia Malaria Eradication Frogramme Primary Anti^Aëdes aegypti campaign Surinam Malariabestrijdingsdienst Primary None Trinidad and Malaria Division Primary Aëdes aegypti erad- Tobago ication, general insect control and quarantine activities

3t 一 Not including the State of Sao Paulo, b „ —Soon to be changed to "Serviço Especjal de Erradicaçao de Malaria". 卜* Report not received. TABLE 7. COMPARATIVE ANTIMALARIA LEGISLATION IN THE AMERICAS, 1958

(dgt-pgQbc^ycd-s I ctíqno,OÏHqndb«âoTiIÏUIOQ ctíIctís(Dq;enoозсбапрд-оц ! ~ ”зваприоcdoïu'H§a — --mun (Duoщi (бтоz oscdqoщ i ЗЙ (q(CL))

^ 一CQ - Tcdso 凌 BSTá s - pire olncdá JOPBATcdcoНЫ - эапо-сэрйпо Вгча)гг2эиэ • > Subject Áoán^ecIBpu fm l 贞 PBPJUTè Й^адоJOPBnoо w tísTpfJ xiouôBp

1«-

• -tJMln-

** X X X X X X X Has special legie- X X X X X X X X X X X X X X X X X X X X i lation - - X Obligation to X X X X X X X be X X X X X X X X X X X X X• X X combat malaria X Declaration of X X X X X malarious zones

Declaration of the X X X X X X X X X X X X X problem as being of national interest

Application of tftie X X X X X X X X X X X X X X X concept of eradication X Obligation to X X X X X X X X X X X X X apply imagooides X X X Obligation to permit X X X X X X X X X X X X X X X X access to h6uses X Obligation to X X X X X ** X X X X X X X X give drugs Control of distri- X X X bution and dispen- sing of drugs

Obligation to report X X the construction cr rencvation of dwellings X X Compulsory case X X X X X X X X X X X X X X X X X X X X X reporting 30- Time limit (No. ci (�) (0〕： 7：0)7 p) days) With blood sample X X X X X X

Obligation of patient X X X X X X X X to take treatment Рог footnotes see fallowing page TABLE 7. COMPARATIVE ANTIMALARIA LEGISLATION IN THE AMERICAS, 1958 (continued)

l ictfTon i^o^ cdH

Obligation of X X X patient to permit blood extraction

Sanctions X X X X X X X X X Obligations of X X authorities, firms, and individuals to co-operate

Exemptiez from X X X X X X customs duties

Obligation to spray X X aircraft and ships

Postal franking X X X X X X privileges

Obligation to report X X on painting or washing of sprayed premises

Reporting on X X X X X X X X X migratory movements

Prohibition against X ** occupancy of unsprayed premises

Obligation to carry- X X X X X X X X X X X X X X X X X X X X X Ji. out environmental sanitation activities

(a) Not including the State of Sao Paulo (b) Information taken from V Report (o) Immediate reporting but without set time limit X Yes - Nil ** Report not reeeived Data not available TABDE 8, PERSONNEL EMPLOYED, IN TRAININQ, AND STILL HEEDED IN THE AíERICAS AS ©F J>1 MARCH 1958

Title Employed In training Vacancies

u 709 214

Physicians 194 斗7 9 Engineers 90 44 Entomologists 19 - Entomological assistants 88 m 9 Chief microsoopists 50 mm 9 Assistant miorosoopists 259 11 55 Administrators 58 - 9 Administrative assistants 1 Statistioal assistants 60 m» 7 Disbursing officers 41 ш 8 Storekeepers 76 m 19 Assistant storekeepers 78 Ъ Draughtsmen 69 _ 2? Secretaries 364 _ 69 Sector ohiefs 532 邛 56 Squad ohiefs 1 2^8 31 211 Sprayraen 5 486 7 1 732 Evaluation inspectors 89 18 57 Evaluators 951 15 209 Mechanics 87 tm 26 Assistant raeohanics 95 - 27 Drivers 607 - 250

Motor: boatmen 55 • 70 Boatmen ? _ 74 Watchmen and messengers 188 52 Labourers 454 - 15 Others 376 6 122 TABUE 9. PROFESSIONAL AND TECHNICAL PERSONNEL EMPLOYED IN MALARIA ERADICATION PROGRAMES IN THE AMERICAS AS OP 31 MARCH 1958

Country or Other Total Political Unit Pbysloians Engineers Entomologists Entomology Personnel Aides 376边 Total 178 20 88 Argentina 5 Bolivia 1 ⑴25的 Brazil (a) SSo Paulo 參》參 • • • i Colombia 5将 17 11 i Costa Rioa 5 1 i 1 Cuba 6 »» ** ** Dominican Republlo 打810123401085鉍》 2 i 1 Ecuador 11 h El Salvador 2 • i 4 Guatemala 5 i Haiti 2 5 i Honduras 3 г i Mexico 60 Nicaragua 3 18 6 1 Panama 2 2 Paraguay- 4 1 Peru 15 1 Venezuela 6 25 2 — Other Political Units

British Guiana British Honduras 2 Dominica French Guiana • Grenada Guadeloupe S 1 Jamaica Panama Canal Zone St Lucia 2 Surinam 1 Trinidad and Tobago 18 1 1 16

Not including the State of StSo Paulo Nil Data not available Report not received ЕВ 幻/21 page 57

Country or Other Political Unit s¿ SJOSOVA SJOS3Я A JO JO jo JO I «o* .02 ¿M ¿N I •s s tíw 4» CM CI о о Ï

骀^ 4 9786I24..54 724 523 72 350 56 1 256 212 31 • 1 755 606 250 55 70

Argentina 160 18 9 29 2 7 56 9 Bolivia 38 278 10 22 24 192 4 33

Brass il— # 2 56Ô 1> S 吶 112(1212.14JIÍ 10 •；â 96 825 27 31 27 22 153 1 384 194 63 108 2 2 3 12 2 1) «« •• 5 *« «« 《54¿3>04gi4938j931383^;544302JJ »«

iai 26 6 26 26 15 256 14 41 16 308 8 49 46 8 40 352559 15 74 21 76 13 8 51 59 22 10 201 » 2 884 102 111 520 25 76 142 5 19 Ю 149 6 25 5 129 4 16 24 689 18 96 95 1 712 48 84 60

Other Political Units British Quilina 57 British Honduras 53 10 Domlnloa 16 2 19 6 8 304915W487 忉 15 1 2 2 40 1 6 3 240 16 刃 42 51 2 10 22 2 杯 79 12 11 125 18 25 1

— Not Including the State of Зло Paulo - Nil

Report not received EB2V21 page 58

TABLE 11. PERSONNEL EMPLOYED IN EVALÜATI(»Í OPERATIONS Ш THE MALARIA ERADICATION PROGRAMMES OP THE AMERICAS AS OF，1 MARCH 1958

- Country or Total Evaluation Inspeotors Evaluators Mloroeooplst* Oth«r Polltloal Utolt No. of No. of No. of No. of At V&OATW In At УЛОЛП— In At vaoan- In At vacan- In pz'eeen't OlVB training о1м training pr«8ént olas training present el«s braining

Total 1 »o 585 147 57 18 953 484 15 290 64 11

Argentina 106 10 - 19 - - 7* 6 - 15 4 -

Bolivia 5 30 2 - • • 22 - 5 8 2

Brazil- 參參* 參鲁參 參• • «•參 «•參 參華參 ««參 «•參 參•參 •參* 3ao Paulo 24 4 - - 24 4 -

ColooblA 88 183 18 - >2 18 63 120 - 25 31 Costa Rloa 20 3 4 1 12 2 4 •• - 5 - Cuba ：1

Dominloan R«publlo 18 V - 11 5 - 2 Eouador • • 5? 14 丨» EOL Salvador - 4 - - 25 - - 5 - -

Quatenala 71 - 1 - - 20 - - 16 - -

Haiti 63 58 - 3 - 57 - 3 - -

Honduras за 16 6 - - • 17 10 • 15 6 6 M«xloo 154 ат7 - 58b - - 57 275 - » 2 - Nioaragua 26 - - - - 19 - - 7 - •

P&naom 38 - - 2 - - 25 - 11 •

Paraguay- 16 - - 6 10 - -

Peru 31 9 - - - - 20 - - 11 9 - Venezuela 444 40 — — — 361 - - 43 - - Other Polltloal Uhlta British Oulana 2 - - 2 - - British Honduzma 96 7 85 4 Domlnloa a - - - - • 2 - - - - flu 1 а гш “â V X vtiwu uujkcuab 4 Orenadik 4 - 1 垂 • • 1 • 1 (Kiad«loup« 5 - - - - - a - • 3 Jaomloa 40 - - - - - 26 - - 14 - _ Panama Ouml Zon* 4 • • 2 о С St Luela К • • • • • • 3 1 Suriimn 1 9 - 1 1 - 5 - - 3 •

Trinidad and Tobago • 1 » - - 31 - - 7 - -

• of ЗЗко b ’

Report not reoelved «••Data not avallabl* TABLE 12. HOUSES SPRAYED AND INSECTICIDE USED IN THE ANTIMALARIA CAMPAIGN Ш THE AMERICAS, 1957

Times Number of houses Type and quantity of insecticide sprayed used Planned per DDT, Dieldrin Other Date .f Countly or Other to be year Actually technical technical； in Kgs initiation Political Unit sprayed sprayed in Kgs in Kgs, i of total coverage One Argentina 14 203 20 681 34.519 September 1^49 Two АЛ 995 ' 41 155^ Bolivia ««參 1 July 1958 Brazil • • • 1 722 741.]L 005 570 January 1959 Sao Paulo 535 889 : • • • 40 900 1 September 1958 Colombia One 135 450 . 132 480； 62 880 8 September 1958 One i C^sta Rica 42 969; 21 650 15 July 1957 Two 67 059 ： Cubá -A—A- ~/Hr Dominican Republic * • • * • « 1 July 1958 One 245 950 257 102 Ecuador 25 380 : 18 March 1957 Two 40 996 18 927丨 29160 ! El Salvador One 181 348 191 284. А7П 28 630 : 1 July 1956 Tvj* 151 670 115 366 126 329： ‘ ! Guatemala One 272 177 290 352 - 33 280 : 393 \ 1 August 1956 Dieldrex 100 多: Haiti One 771 996 13 638； - 1 600 : September 1958 Honduras • i • • • 參• • ««参 January 1958 One 258 714 Mexico ； ! Two 2 103 971 2^ 1710'；80 67 000 . 2 January 1957 Nioaragua One 2 129ООО 26 400 15 521 - : 6 7 11 November 1957 Panama One 70 122 7 53 431 - ！ 1 6 19 August 1957 Paraguay- One 16 205 16 291 — ! 30 October 1957 Опэ 323 015 294 570 Peru 108 Two 35 160 I 290： W 15 November 1957 Venezuela Two 129 287 128 900： 106 644丨 117 902 1950 Other Political Units

British Guiana One I 9 132 7 509' 3 245 :January 1947° ' British Honduras 41 One 17 655 17 〇82, 2 160 4 February 1957 j 59 Dominica One H с 3 382 3 182： 474 3 January 1959 ¡

French Guiana One 14 000 12 073 3 950 544 May 1948 One 7 129 7 BHC 7.5% Grenada 237: 3 750 February 1957 Two 6 536 4 153: s One 19 987 19 525 Guadeloupe Two 12 181 ; 12 170 13 915 1957 Three 482 482； One 121 Jamaica 837, 27 400 Two 140 000 30 243' January 1958 • • • • • • Panama Canal Zone Two 參《 • 518 j St Lucia Two 12 800 02 200丨 4 950 1 July 1956 One 24 673 24 673; Surinam 46 13 BHC Two 2 586 2 586 ! 18 460 2 May 1?58 One Trinidad and Tobago 116 ООО 103 059丨 30 390 4 310 January 1958 Two 5 364!

SL Not including the State of Sao Paulo

、Programme temporarily interrupted с Refers only to the coastal area d

Reimportation in 195U, sprayin recommenced

-Nil ...Data not available

îHi “ " Report not received TABLE 15. NUMBER № SERAYINa SQUADS BY МСЮЕ OP TRANSPORTATION IN ЖЕ MALARIA ERADICATION PROGRAMMES IN THE AMERICAS, 1958

Total By With number of By motor boat transportation Country or other squads motor or Mounted On oí more than political unit working vehicle oanoe squads foot one type

Total 1 624 692 lb 510 148 200

Argentina 29 29 姆 _ _ Bolivia » _ _ _ Brazil (a) 一. 參《 • * «參« • •參 • • • 争參》 S§b Paulo 39 36 3 • Colombia 387 • 151 40 196 _ Costa Rica 16 » • • •• _ 16 Cuba ** ** ** ** ** **

Dominican Republio 26 26 _ • 鋒 Ecuador 41 9 2 10 _ 20 El Salvador 49 1 _ _ 48 一 Guatemala • _ _ ^ Haiti 7斗 28 •• зо 16 _ Honduras 26 • • 26 Mexico 5斗0 161 7 249 123 Nicaragua 19 - _ 19 Panama 25 8 5 2 10 Paraguay- 18 11 k • 2 1 Peru • 117 117 _ « • Venezuela 82 41 5 mm Other Political Units

British Guiana 6 2 2 2 British Honduras 10 ) 1 6 Dominica 2 一 $ French Guiana 6 崎 «а • 6 Grenada ш • 2 2 • Guadeloupe б 6 • • _ Jamaica 刃 麵 Panama CAnal Zone 35 1 1 一 一 1 St Lucia 4 Surinam 12 6 _ 3 • Trinidad and Tobago 18 18 - «

(a) Not including the State of SKo Paulo - Nil ... Data not available ** Report not received md^/dL page 62

TABLE 14. TRANSPORTATION SYSTEM IN MALARIA ERADICATION PROGRAMES IN ОБЕ AMERICAS, I958

Vehicles in service or which will be in service Country or other Station political unit wagons Out- Beasts Total Jeeps Trucks Other and auto- Piok- Motor board of mobiles ups boats motors burden m卿巧•：芡艿刃g **铋邠51站u50秘初刃f253 6551167s 鄉咖矽 1 Й 1 • 31*«521| Total………… 5. : • ？ 62 65 41 2 96З Argentina 8 8 (a) Bolivia r^ 2 一 :6197J23291582380112W8 1 182 Brazil (b) «651*4245442 • 3• • ；-g⑷ и, Sao Paulo si 巧11Í38艽285021四1611^1825• 8 * - mm Colombia 36 9 0(c) Costa Rica * Cuba * * I * 171 2 ** ⑷ 5⑷.⑷538 r'486-⑷ Dominican Republio - - ？ 想 Ecuador о 923 El Salvador - 1 Guatemala Haiti 2 -355817 Honduras 2 Mexico 1 6 10 (e) 1 Nicaragua L l<\8 - 2 Panama 614 2 1 Paraguay 幻芡 Peru 1 18 _ 1 1 Venezuela 45 Other Political •Ж.1Ш ‘ ч in m Units British Guiana • 1 2 /f\f V/ 7 ? • 1 1 - /I\/t\/l\ ho British Honduras 3 4)/41/vl/ 5 Шт 1 Dominica 1 14 1 3 117 5 2 h French Guiana .1 1 1 1 2 g Grenada 2 2 57431610162 3 • _ 3 Guadeloupe JÍ\/\JÍ\ î 7 3 12 --2 ч)/ч|/\)/ Jamaica I - 2 15 Panama Canal Zone -63 g 3 7 1 _ St Lucia - 3 1 3 g Surinam 2 2 Trinidad and Tobago 2 1 9 6 7 ça)--Slx-^ank -trucks emd two notor«eyeles b (h》Two traileirs ) ) Not including the State of Sao Paulo (i) Si« rowboa^bs \o) To be acquired 、 * Includes nwtor boats, outboard (d) Rented as. necessary motors and others (e) Ten buses -Nil (f) One oarrier-cyole and one tender ».. Data, not available (g) Three motor-cycles ** Report not received EB23/21 page 63

TABI£ 15. CASE-FINDING FROM VARIED SOURCES IN MALARIA : IN THE AMERICAS, 1957

S о Private Routine House-to-house Voluntary piiysicians, investigation of Other Form of Infection Nature of cases hospitals, fever cases in visits collaborators clinics, etc, hospitals, etc. Total of Country or other SORTIS 8PTTS SOPTTSччо*оpositive й mruâToIBJ Political Unit cases э<ат{чсс1цwnoussTPUщ I юггсатл eATPTSOЭАТ+>т(оооd влт+iTsoхвлт. d л peoTpsod它•deonpulod日 I s у jo aocçonàcpmz N рэхти

JO •№

areas with malaria eradicated a 29ÎG 1 这：4灼 8l( ) .11 444 54 861 93 85 10 Total 1 9 6 122 .86 91З 7*7 4 20 485 12 811 k 8 8 2 Argentina • 4 •>02^• Brazil(b) 98 ё; 29 5Í 861 •ë *7Í 75 2 Venezuela .66 428 (a) British Guiana 1 2 11 2 Guadeloupe • 81 Surinam • consolidation phase) 38 216 84^1^7 : Ш;ий71:8434S94 Р53仍 8 7о 352 56 )15 17 46 8 26⑷ Total • 27 482 6Qi51- ：刃.3-1 816 S>e721¡ 1 155 40 495 12 4 2 & 6с Argentina 2 6 Venezuela 91 521 56 315 г 7 French Guiana 6 • 站 15 15 8 Guadeloupe 6 1 24 25(c) Trinidad and Tobago 1 25 5 25 S18: 4 In areas with ma aria not yet eradicated but sprayed regularl: Not specified* » 5 9 ^^••57]02 2次《71書 6(^.*9(9<8о 2 魟-:：访12354 572 552 616 446 862 8 964 32 651 20 779 Ю 715 639 Total 592 93 • 20) 2 1 621 552 56O 46 761 Argentina »6(228 110 5： 121 11 11 686 • • 5 957 706 53 : Bolivia : • b : • 5 • Jlol^^^-61:28 Brazil( ) 16025*ь-гл -Ю1Я963! 1 153 1 О)) 92 Costa Rica 二 73 - 18 58? 17 825 311 1 535 890 630 Dominican Republic 6 53) -32 )96 236L52 о о 71 76玷：邡仂-- 仍 656 1 675 808 8)5 Ecuador 4 196 11 587 17 802 2 - - 4 816 4 104 5 5 504 544 6 655 3 649 2 9^9 El Salvador 2 • 452 9 042 62 516 7 596 1 318 8 1 247 3 812 1 792 -17:61- Guatemala 8 206 6 794 49 424 5 759 2 4 217 5初 103 87 Honduras -»0:-沸1255915191 125 6 464 721 190 896 о15 564 • 4 387 )856 453 Mexico 4 664 142 992 • - •»4 9 Nicaragua 6 6 2 1 обо 7 550 4 796 2 565 Panama 528 5 067 18 181 4 562 1 62 2 12 2 204 2 Paraguay 5 15斗 11 2 140 5 206 2 - 639 - 659 Peru 3 21 Л 287 6 • 2 1)9 9 848 004 2 751 665 77 Venezuela 3 10 为 160 856 107 107 1 1 - British Guiana и. 1 212 212 5) 121 4 British Honduras 1 - Т 21 8 115 2 270 11 ) 2 1)4 Grenada 8 • 8 -

1

- ю EB23/21 page 64 TABI£ 15. CASE-FINDING FROM VARHD SOURCES IN MAIARIA ERADICATION PROGRAMMES IN THE AMERICAS, 1957 (continued)

S о of Private Routine physicians, investigation of House-to-house Voluntary of Infection Nature of 丨 hospitals, fever cases In visits collaborators Other Country or other clinics, etc. hospitals, etc» Political Unit SOPTTSp"FTa>JonlruâoT^J

POTJnoфлт-pTsou d фл-рч/риооэлт-pTsoвл-prFwo. Фл-Hp-Heod d d écpmдфслцпa й у Jatqnm Jo-ОЙёлазN а *ог •

Not specified Guadeloupe 76 284 6 710 1 145 165ОД198770 2 003210 2 1 224 767 8 056 1 1 13 Zone 80^ 251 77 77 6 72 37 St Lucia 441 9 16 Surinam 288 87 44 ^ Trinidad and Tobago 770 599 88 577 C0wwrag 3e In ar 7 spraying •tart< 502468315J142 Total 131 979 9 792 14 210 925 591 690 790 23 04) 57 2) 8 170 3 36 982 26 895 9 3)5 228 24 Brazil(b) 5 58 077 9 756 750 427 )99 991 18 411 - - - 28 I67 21 216 6 454 29 Sao Paulo 3 545 3 525 16 1 Colombia 73 056 169. 597 266 239 2 497 - - 614 » 2 556 700 759 58 24 Cuba » »« »• Haiti 25 084 1 964 • 57 23 1 1 987 8 1 829 136 Nicaragua 25 567 - 666 14 210 1 476 171 - 7 156 746 294 4 j British Guiana - ««� Dominica 150 - * 二 - - iôô •

1 i>79" One case no- classified. Not Including the State of Sao Paulo. Twenty-five cases not classified. Nil Data not available* Not specified by form of infection. Report not received. TÁBtE 16. ENTOMOLOGICAL OPERATIONS IN MURIA ERADICATION PROGRAMMES IN ЖЕ AMERICAS, 1957 Organized and functioning Determination of the base-line susceptibility of local vectors Country or laboratories other political No. unit Location Species Result Species Result Species ~Result ïype of test used in the laboratory Total 39 Argentina pseudo- Susceptible Busvine-Nash pimctipennis Bolivia • • e Brazil (a) cruzii Susceptible darling! Susceptible aquasalis Susceptible Busvine-Nash ЗЗо Paulo 6 Various Colombia 1 Bogota Costa Rica • • • San José 參《參 • • • • • • Cuba 糾 絲 -ÍHÍ- •ÍHf Dominican Republic 1 Cdad. Tmijillo Ecuador 1 Guayaquil El Salvador 1 San Salvador albimanus (b) pseudo- Busvine-Nash punctipennis Guatemala Haiti Honduras 1 5 Mexico • 1 (c) pseudo- Susceptible albimanus Susceptible aztecus Susceptible Fay punctipennis 1 • • • » • • Nicaragua • Managua Panama Panama albimanus Busvine-Nash • « • » • • Paraguay 5 Peru 1 pseudo- Susceptible WHO punctipennis Venezuela Maracay albimanus Susceptible aquasalis Susceptible albitarsis Susceptible Busvine-Nash Other Political Units

British Guiana Georgetown 參參參 British Honduras albimanus Susceptible

Dominica 參 參鲁* French Guiana Cayenne aquasalis Susceptible darlingi Susceptible Busvine-Nash Grenada • • • • • • •參參 О О • Guadeloupe albimanus Susceptible aquasalis Susceptible Busvine-Nash Jamaica Kingston • • _會參 暑• • Panama Canal Zone albimanus Susceptible

St Lucia • * Surinam • • • Trinidad and Tobago 1 Port-of-Spain L (a) Not including State of Sao Paulo Data not available (b) See reference in the text ^/Hf Report not received (c) One in Mexico City and one in each of the 14 zones TABLE 17. DRUG USAGE IN MALARIA ERADICATION PROGRAMES IN THE AMERICAS, 1957

" ft Quantity in Number of Name of drug and Countries using Use of drug basic type drug kg persons

4-AMIN0QIJIN0LINBS

Camoquin Brazil- Therapeutic • • « British Honduras Therapeutic 10, io Colombia Therapeutic 21,40 (Therapeutic 0,40 677 Costa Rioa (Prophylactic 5-50 14 982 Ecuador Therapeutic 6 227 El Salvador Therapeutic 18.00^ Paraguay Therapeutic 1.80 3 ¿56 Sao Paulo Therapeutic & • • • Prophylactic • • •

St Luoia Therapeutic & «參推 Prophylactic Trinidad & Tobago Therapeutic 2.48 5 645 Chloroquine Brazils- Therapeutic 1 200 ООО Colombia Therapeutic 55^80 79 684 Grenada Therapeutic 0,69 797 Guatemala Therapeutic 19.99 23 5^8 Mexico Therapeutic 57.24 71 161 • • • Panama Canal Zone Therapeutic

Venezuela Therapeutic 1 418.00 • •眷 v o О 卜 •

Aralen (synonym Argentina Prophylactic O S 655 • of chloroquine) British Honduras Therapeutic О

(by injection) Costa Rica Therapeutic O 476 CV I €X ) О ч El Salvador Therapeutic •參• r H (by injection) El Salvador Therapeutic C \ 參• • • • • • SSo Paulo Therapeutic & • Prophylactic

Nivaquine (synonym (Therapeutic • • * 250 French Guiana • • • of chloroquine) (Prophylactic в参參 Panama Therapeutic 2.50 1 510

St Luoia Therapeutic & •參參 Prophylactic • • • i Sao Paulo Therapeutio & « »參 Prophylactic Resochin (synonym Panama Therapeutic 3.78 2 646 of chloroquine)

Not inoluding State of Sao Paulo Drugs distributed Data not available TABLE 17. DRUG USAGE IN MALARIA ERADICATION PROGRAMMES IN THE A№RICAS, 1957 (continued) —i Name of drug and Countries using Quantity in Use of drug Number of basic type' drug kg persons

8-AMIN0QÜIN0LINES Primaquine Ecuador Therapeutic 0.01 50 El Salvador Therapeutic 0.03 157 Guatemala Therapeutic 0.27 1 279

Ifexioo Therapeutic 1.01 • •奉

Panama Canal Zone Therapeutic • •参 • « • (Neo) Qulpenyl Argentina Therapeutic 0.06 205 • • # (synonym of SSo Paulo Therapeutic & • • • primaquine) Prophylactic Rodopréquine French Guiana Prophylaotio • • • 3 126

Pamaquine Guatemala Therapeutic 0.02 126 Plasmoquine British Honduras Therapeutic • ф m • t • (synonym of pamaquine)

DIAMINOPYRIMIDINES Pyrimethamine Grenada Therapeutic 0.15 797 Mexico Therapeutic 2.52 УТ 468 Trinidad & Tobago Therapeutic 0.50 5 643 Venezuela Prophylactic 106.00 105 9斗3 Daraprim (synonym Ouatemla Prophylactic о.оз 250 of pyrimethamine) St Lucia Prophylactic • • • • • «

BIGÜAN3DES Paludrine St Lucia Therapeutic & «參爹 • • • Prophylaotio

9-AMINOACRIDINES Atebrin (synonym St Lucia Therapeutio • • • 參參《 of mepacrine)

Metoquina (synonym Argentina Therapeutic 0.22 150 of mepaorine) Paraguay- Therapeutic t • •

Venezuela Therapeutic 12: ¿Ó •參華 Chinacrine (synonym Guatemala Therapeutic 0.79 282 of mepacrine)

CINCHONA ALKALOIDS Quinine British Honduras Therapeutic 10,00 參• * 1 ,., Data not available TABIE 18. INTERNATIONAL STAFF POR MALARIA ERADICATION IN THE A№RICAS, J>1 AUGUST I958

Medical Entorno- Sard» Adm. Level Bngineere Others Officers logists tarlane Cons.

Projects 19 13 32 _ 1 health educator

Zones (Technioal 2 ) 1 laboratory Advisory Servioes) mm adviser

工nter-Zone _ 錄 1 Regionalî

(a) ME Wash. Office 2 2 1 (b) ÎE-Panama 2 1 1 _ 1 motor vehicle (c) Evaluation Team •m • 1 Consultant (d) Training Centres 2 m 1

Total - in service 350 18 УГ 3 ? j Total - in training 2 2 m» 杯 1 1 statistiolan

GRAND TOTAL 32 20 4 41 4 4 f 1.5 EASTERN MEDHERRANEAW REGION

General Picture

Following the establishment of the WHO Regional Office in 1949, WHO malaria pilot projects were the first programmes to be undertaken, as malaria had been a major public health problem in the region. Projects were started in East Pakistan, 工ran, Iraq, Lebanon, Saudi Arabia and Syria and national governments gave support Xo their activities, particularly as the results obtained by DDT residual spraying impressed them favourably.

The successful results obtained in eliminating malaria fron, eertain rural areas Where та1аг1а was hyperendemic or meso-endemic, and the governments' activities in extending the residual spraying campaigns, opened the way for these governments to allocate more funds to malaria control programmes. l^e World Health Assembly resolution that the objective of malaria control programmes should be the ultimate elimination of the disease, and UNICEF support in eontributing to malaria eradication programmes most of the supplies and transport needed, opened the way to assist these governments to convert their control programmes into eradication, based on new eradication methods and procedures.

Extent of .the Problem

The Eastern Mediterranean Region comprises 24 countries and territories, with a total population of about 1 2 ООО 000, of which approximately ООО 000 live in 9 malarious areas. The efforts maintained for some years past were able to protect about 30 ООО 000, that is to say, only about 20 per cent, of those exposed to malaria

riSk In Kuwait and Aden ‘ ‘钮如 Colony, malaria is not known to have occurred, or haS diSappeared without specific eradication measures (see Table 2). In Cyprus and GaZa Strlp mlaria been ' eradicated through the effort of public health workers (see Table 3). In the remaining 19 countries, the status of malaria eradication activities is as shown in Table 1. In the world sketch map my be seen the status of Alaria eradieation as at November 1 8. It will be observed that eradication 95 programmes are being implemented in Iran, Iraq, Israel, Jordan, Lebanon and the United Arab Republic (Syrian Province)； control activities are still being carried out, but the pre-eradication stage is being approached in Ethiopia, Eritrea, Libya, Pakistan, Sudan, Saudi Arabia, Tunisia, and Somalia (Italian- Trusteeship).

The extent of the malaria problem by population in the countries of the Eastern Mediterranean Region, where malaria programmes are being carried out, is shown in Table 4. Table 5 presents the status of the eradication of malaria by population in the region. The total area in these countries covers almost 13 ООО 000 km and the total population is about 192 ООО 000. Of these, about 75 per cent, or about 145 ООО 000, are exposed to malaria risk.

Present Status of National Malaria Eradioatlon_^e^loe£

Table 6 gives the position of the national malaria services in the countries of the region where antimalaria activities are being carried out.

It will be noted that the service is autonomous in the case of Iran and Jordan, where it falls directly under the Ministry of Health. A similar status is expeoted to be given to the Ethiopian service, and a law has been prepared to this effect. In the United Arab Republic (Syrian Province), Lebanon and Israel, the malaria services are part of the national health service and the chief executives are directly responsible to the National Director of Health. In Iraq, the malaria eradication service is a section of the Directorate-General of Endemio Diseases Department； but the Director-General of the latter has been acting as a counterpart to the WHO Senior Malaria Adviser, and he was thus invested with the authority appertaining to the Director-General while working under the Direсtor-General of Health.

In all the above malaria eradication programmes there exist advisory malaria eradication committees, presided over by the Minister of Health, and composed of various other ministries and institutions in the country concerned with the programme. Representatives of international agencies attend these committees as advisers (WHO, UNICEF artd ICA).

The functional structure of the national malaria eradication services differs from one country to another for various reasons, but the standard set-up includes a spraying operations unit, an entomological unit, and an administration unit. In 工ran and some other countries the Malaria Institute acts as a technical advisory body to the National Malaria Service, and is responsible for evaluation, year-to-year planning, and training activities. The executive organization in 工ran and Iraq is decentralized at provincial level, whereas in Lebanon， Jordan^ United Arab Republic (Syrian Province), and Israel, the executive responsibility is maintained at the сentre•

Legislation

Twenty countries have some form of antimalaria legislation, although inoomplete and not adapted to eradication requirements. Special legislation on malaria exists in the United Arab Republic (Egyptian Province), Israel and Tunisia, Legislation requiring the combating of malaria exists in Israel. Compulsory oase reporting exists in United Arab Republic (Egyptian and Syrian Provinces), Israel, Jordan and Lebanon, but without emphasis on timing. In Lebanon, there is legislation compelling authorities, firms and individuals to co-operate with the antiraalaria programmej and in Israel legislation includes obligation to carry out environmental sanitation activities (antilarval work).

Field Operations

Spraying operations ШЖГ-дшю—дщмя.ч^п—i имт •__. MU |Ц| I.imi>iii>>j • Table 7 gives the number of cycles carried out every year, the type and quantity of insecticide used, and the date of initiation of total coverage. From the available data it can be seen that EOT is the insecticide most widely used, mainly in the form of 75 per cent, water dispersible powder. Dieldrin and BHC are used on a smaller scale.

Tables 8 and 9 give details of the spraying squads and transport used in spraying operations. In this region a combination of circumstances affects the field organisation of spraying operations. These are the relatively large per capita surfaces to be sprayed, the frequently long distancés between villages, and the need - based on epidemiological and climatio considerations - to carry out house spraying during fairly short operational cycles. Many of the spraying squads are locally engaged for periods of two or three months； and though there is an effort to maintain experienced workers from season to season, the temporary nature of such employment and the fact that it often coinoides with seasons of agricultural work often make this difficult. In most programmes, 2-5 sprayraen work under the supervision of a squad leader, wh® is employed during the rest of the year in other antimalaria activities. In a few cases, where the squad leaders are also casual workers, two or three squads, under the supervision of a regular employee, make up a field unit. The vast majority of sprayers used in this region are of the compression type, but a few stirrup pumps are used. In Saudi Arabia motorized sprayers have boon found economical under certain circumstances.

In most of the countries, though roads in the malarious areas are poor or non- existent, the distances between villages necessitate the movement of squads and supplies by truck whenever possible. Even so, as much as one-third (and in extreme cases, one-half) of the working time is used in travel between sites of work. The field vehicles have to work under very rough conditions and operation and maintenance costs are relatively heavy. In prograiranes entering the consolidation phase, vehlolss must also be provided for the needs of surveillance services.

Epidemiological Operations

Epidemiological operations have been fairly extensive in all the oountries where the malaria programmes are proceeding. In certain areas of Iraq, the United Arab Republic (Syrian Province),工ran and Israel, active surveillance procedures are being implemented or have been carried out for some time.

Entomological Operations

Entomological studies are proceeding in the region and special attention is given to tho recording of susceptibility of anophelines to the insect!oides used. Resistance to insecticides has been reported in the areaj details are shown in Table 10.

Use of Drugs

Table 11 gives details of the various antimalarial drugs used in different countries of the region. FTOLE OP INTERNATIONAL ORGANIZATIONS IN MALARIA ERADICATION IN THE EASTERN MEDITERRANEAN REGION

the SSig•生 Organization Technical Advisory SeryioeA

The development of the Malaria Eradication Special Account, and the increased activities of the Eastern Mediterranean Region countries in converting the malaria control programmes to eradication, necessitated the strengthening of the Malaria Eradication Co-ordination Unit (№CU) of the Eastern Mediterranean Regional Office. The personnel of this unit is now composed of the following»

1 Senior Regional Malaria Adviser 1 Regional Malaria Adviser 1 Regional Malaria Public Health Engineer 1 Regional Entomologist (still vacant) 1 Administrative Assistant 2 Secretaries 3 Typists 1 Draughtsman

ïn order te fecîï-tate and ëxpèdite üfe admAiástuatlve wortetf thiEünlt» Ш Senîd? Jdvàœr hae

Ъеш msOBOTtr&l to tàkë ne.oeœary aottoi* in й!1 mafetere coriiSem&ig aaîaala Шс1 to cepart dlreetiyto tte RegJcnel Director. Bull cow ordination ot work with oth^r .sections of the EEBtfeWí Mediterránea© Regional Offíôe ië being maintained at tfeê S6»© time.

A number of international staff are employed in antimalaria programmes in the region, as shown in Table 12.

Training

A Regional Malaria Training Centre will be established during 1958 in Cairo; it is expected to give regular courses for national personnel working in the eradication service and for those recruited from neighbouring countries. The trainees will include doctors, engineers, entomologists and other personnel.

Sixty fellowships and nine study tours have been granted to malaria workers tn X957 and 1958. Twenty-seven more fellowships and five study tours are proposed to be given in 1959 to workers within the region. Co-ordination

The Regional Office has convened regional malaria meetings to enable directors of malaria eradication services of neighbouring countries to discuss progress reports and exchange information on technical problems such as vector resistance, nomadism and frontier malaria.

The first Regional Technical Meeting on Malaria Eradication was held in Baghdad in December 1957, and was attended by participants from Cyprus, Iran, Iraq, Jordan, Lebanon, Saudi Arabia, Somalia, United Arab Republic (Egyptian and Syrian Provinces), as well as by observers from UNICEF, US ICA, UNRWA and the Rockefeller Foundation.

Since the Eastern Mediterranean Region has common frontiers with the European and Southeast Asian Regions, participants from countries of the Eastern Mediterranean Region (Iran and Pakistan) were invited to attend the Bangkok Conference held in December 1957; also participants from Iran and the Syrian region of the United Arab Republic were invited to the South-East Europe Malaria Conference held in Bucharest in June 1958. TABLE 1. STATUS OP MALARIA ERADICATION CAMPAIQÎ IN THE: EASTERN MEDITERRANEAN REGION

W». Status of programme Eradication by total coverage of malarious areas Country Eradícn. Erad • Control Period of conversion Period of total coverase or by. total by Date Date Date Date Territory coverage areas started or cotiipleted started or completed of mal. will start or will be will start or will be areas completed completed Bahrein Fthlopla & Eritrea Yes 1959 Iran Yes 1957 I960 I960 1964 Iraq Yes 1957 1957 Israel Yes I956 Jordan Yes

Lebanon Yes 1956 I960 Libya Yes 1959 Muscat & Oman Pakistan Yes Sudan Yes Saudi Arabia Yes Tunisia Yes Trucial Oman United Arab Rep. (Egypt) United Arab Rep. (Syria) Yes 195T 1959 Yemen Fr, Sorœtli-. land Yes Somalia Yes Aden Protect.

=N0 information TABLE 2, COUNTRES AMD TERRITORIES IN THE EASTERN MSDXTERRAffiAM REGION IN WHICH MLARIA IS. NOT. КЫОШ TO HâVE OCCURRED OR HAS DISAPPS/ШЕБ WITHOUT SPECIFIC ERADICATION MEASURES

J "•—•g- 1 Country or Territory 1 "" "" ( Estimated Population Area in йп

Kuwait 205 ООО* 15 540

Qatar 40 ООО* 22 OU

Men Colony 143 ООО* 207

TOTAL: 388 ООО 37 761

TABLE 3. COUNTRIES AND TERRITORI:'Í:S IH ras EASTERN MEDITERRANEAN REGION WHSRE blMARIA HIS BEEN ERADICATED

Country or Original Malarious Areas 2 X 2 Territory Area in Km Population Area in Km \ Peculation

Cyprus 9 251 529 000 9 25L ！ 529 ООО

• • Gaza- Strip 202 330 ООО 202 ！ ззо ooo

TOTAL: 9 453 в$9 ООО 9 453 1 859 ООО i

p.957 estimates unless otherwise noted as follows： mid-year 1956 estimate from the 1957 UN Deco^cphic Yearbook TABLE EXTENT OF MALARIA PROBLEM BY POPULATION IN THE EASTERN MEDITERRANEAN REGION, 1958 Area under Area with malaria Population surveillance not yet eradicated 01 хпе Less than 3 years Not Regularly Country or Total original without indigenous regularly sprayed?： territory- population 1 malarious case sprayed Spr, Population Population eont Population

Bahrain 124 000 110 000 х i i Ethiopia and Eritrea 20 ООО 000* 12 ООО ООО 0 244 ООО 11 756 ООО Iran .18 945 000* * 12 ООО ООО 2 448 000 No 5 855 ООО 3 697 ООО

Iraq 6 538 000 4 ООО ООО 4 ООО ООО Nil

Israel 1 924 000 1 92杠 ООО (1 85斗 ООО) Yes 70 ООО Nil

Jordan 1 471 000* 1 185 ООО 0 15 500 969 500 + (200 ООО) Lebanon 1 450 000* 300 ООО 215 ООО 40 ООО + (45 ООО) Libya 1 118 000* 100 ООО 0 100 ООО Muscat and Oman 550 000* 550 ООО

Pa listan 84 777 000* lb ООО ООО о

Sudan 10 26) 000衫 10 263 ООО 0 J> 479 ООО 6 784 ООО

Saudi Arabia 6 056 ooo* 5 ООО ООО 0 212 ООО 4 588 ООО + (200 ООО) Tunisia 3 8oo ООО 2 616 ООО 0 (900 ООО) 1 716 ООО

Trucial Oman 8o ООО* 30 000х United Arab Republic Egypt 2斗 020 ООО 14 675 ООО 0 1 307 ООО 4 405 900 + (8 963 ООО) Syria 4 обо ООО* 1 500 ООО 0 1 242 ООО 258 ООО Yemen 4 500 ООО** 3 500 ООО French Somaliland 68 ООО* 60 соо* T Somalia ( tal.) 1 300 ООО* 255 ООО 0 220 ррО 355 ого Aden Protectorate 660 ООО ббо ООО

TOTAL 191 68杯 ООО 144 728 ООО rSSSSSSSSSaBSSSSESSSSSS：S=SSB«SSSSSSS3S8SSS=:=S =： i'il 1 I'i Я—«¿«ssssssiri.' i S=5=5SSS:SfS:=:=S3SS=r=SS , 1957 estimates unless otherwise noted as followsx * mid-year 1956 estimate from the 195? United Nations Demographic Yearbook ** 1956 census *** 19^9 estimate x Estimated by ME No data available â 一 Figures in brackets » population covered by antilarval ©Derations TABLE 5. PRESENT STATUS OP THE ERADICATION OF MALARIA BY aHEA AND BY POPULATION IN THE EASTERN MEDIÏEHEA№IN RiiGION, 1958

Status Population Per cent.

Total 192 931 000 100

Malaria never indigenous or has disappeared without specific eradication measures 47 34Д 000 24.5

Malaria eradicated 859 000 0.5

Under surveillance U 302 ООО 2.2

Malaria still present, but organized programme of total coverage under 1 way- 11 862 500 6.2

Malaria still present but malaria programme in the preparatory phase Л9 653 500 25.7

Transmission known to occur but no organized programme of total coverage under way 78 910 ООО 40.9

lotal 192 93V ООО 100.0

•

1 I ,,. TABLE 6. THE ORGANIZATION OF NATIONAL MIARIA SERVICES IN EASTERN MEDITERRANEAN REGION

г- Country or Official name of service Position Other activities of territory of service service Bahrein

Sthiopia and Malaria^Eradication Autonomous Eritrea Service

Iran Malaria Eradication Autonomous Environmental Organization sanitation

Iraq Malaria Eradication Secondary Department

Israel Antimalaria Division Primary-

Jordan Malaria Eradication Service Autonomous

Lebanon Malaria Eradication Bureau Primary-

Libya (Libyan American Joint Public Health Service) (UJHiS)

Muscat & Oman

Pakistan Malaria Institute, Dacca and Karachi

Sudan . (Directorate of Medical Services)

Saudi Arabia Antirnalaria Service

Ünited Arab Republic Malaria Control Section Secondary (Egypt)

United Arab Republic Malaria Eradication Primary (Syria) Service (MES)

Tunisia (Service Central de 1曾Hygiène Publique)

Trucial Oman

Yemen

； No information ‘By decree awaiting ratification TABLE 6. THE ORGANIZATION OF NATIONAL MAIARIA SERVICES IN EASTERN MSDrCEHRANSAN REGION (continued)

Other activities of Country or Official name of service Position service territory of service

French Somaliland (Direction du Sefvice de Santé)

Somalia (It* Adrnt) National Malaíia Service

Iden Protect. (UK) (Protectorate Health j Service)

No information

* By decree awaiting ratification page 82

TABIS 7. KOUSSS SPIUYED АЗ、Ш INSïîiCïIGIDES ÜS3D IN THE iffiïMlI^lB. CAMPAIGNS Iîi THE EASTERN МЕШТЕКШШШ REGION, 1958

Times Number of Type and quantity of insecticide Date of sprayed Houses used initiation Country- per actually DDT 1 Dieldrin y-BHC of total year sprayed in teim s of (gamma coverage technical product isomer) kg kg kg Bahrain Г" 1 i n H г >

S \

Ethiopia and 1—• I t o VT \ 1 40 000 2 646 6Л Eritrea 1 80 506 5 4Л8 154 Iran 1957 1 388 070 1958 1 661 Д99 37 9.70 1961 1956 ) 576 380 за 903 733 Iraq 1957 ) 1-3 7Д6 363 476 411 343 27 1957 1958 ) О Israel ч О M H - О ч О

Jordan 1956 1 1957 1 vO 卜 r- f IT s 0 O N H Lebanon 1Г Ч 1 1 33 672 17 000 470 1Libya 1956 1 (DDT) Muscat and Oman v O M

Pakistan £ >

1

<} 37 308

V-T i 964 Sudan v O 2 И H со . U t V O 1 92 696 172 5,124 Saudi Arabia 1956 1957

Tunisia 1957 5 000a Trucial Oman 1 О U n UAR (Sgypt) v O U 4 < 2 \ 0 1 1Д7 500 62 936 5 Д25 1957 1 腿(Syria) 141 302 129 503 - - April 1958 1 163 214 163 681 1959 Yemen French Somaliland

Somalia 1956 1 1957 1 Aden Protectorate 1956 ' 10 952

01 For l^.rvièidirig only TABLE 8. NIMBER OF SPBAYING SQUADS BY MDDE OF TRANSPORTATION IN THE MA.IARIA РЮGRAMMES IN THE EASTERN MEDITERRANEAN REGION

No. of Type of Spraymen Ту^е of % work time Year Courrtay squads sprayer per squad transport in travel

Bahrein 30 Ethiopia (WHO) 1957 8 Compression Л Р1окщ>в Stirrup ！ Pickup & • *鲁 Iran 1958 400 С 卿re'ësion 10 foot Pickup St 29 Ira4 1957 740 CooQ>ression 4-5 foot

Й Organized Conçression Pickup 0.5

？？ Isrfeel 參 * in each village Pickup • '•'m Jordan 8 Corapresston 5 Lebanon 40 Compression 2 Pickup 參麵參 Libya .» * 0 • • »

Muscat &

1 i Stirrup 4 Oman- - 鲁•會 Pakistan W: Pakistan E. * Qatar Sudan 22 Conçression Л Pickup 15-50 S. Arabia 1 Gonqjression 162 Truck Se motor Ttmisia No house spraying ч л Trucial Oro^Ln v O Foot • •春 œ UAR (Egypt) v O about 400З Compression 2

O N Pickup v O UAR (Syria) \ л IDO Conçiression 5 s O С »

Yemen ч л Fr. Somali- land . 30 а >

Gaza (UAR). \ л v û 6 Foot, с о Stirrup Somalia (It.) ч О ч л • 22 truck

Aden /… Protectorate 1956 10 Stirrup & 6 Pickup 螓普• knapsack Bi/cycles, Cyprus 1956 462 Knapsack & Д-8 conç>ression foot, donkeys

1 In municipalities only 0 > Squad breakdown unknown ^ Includes larval control TABLE 9, TRANSPORTATION SYSTEM IN MALARIA ERADICATION PROGRAMMES Ш EASTERN MEDITEEEilNMN REGION

Total Trucks Jeeps Country Year motor 3 ton . Pickup or ’ Motor Bicycles Oldier vehicles or over) trucks equiv. cycles

Bahrein 6 W 191919 575757565857所刃所958958957姊95 84W86MW6 Ethiopia m* (¥H0). 5 2 846丄 Iran 1 1 L !06 _ Iraq 30 Israel Jordan Lebanon 623Д7115 _ 9 Libya Й19191919191919191 Muscat & Oman Pakistan West Pakistan East Qatar 12 • Sudan • Í Saudi Arabia A 8 611 m Tunisia 2 mm

Trucial Oman 3 6 UAR, Egypt 1 2 10 UAR, Syria 27 20 Yemen Fr„ Somali- land . Gaza (UAR). Somalia (It.)

Aden 3 2 Protectorate Cyprus Motor vehicles not reported Donkeys

i x 1 sedan, 16 stationwagons

2 7 utility cars, 1 stationwagon

Some very old

“ 3 stationwagons, 2 limousines

stationwagons TABLE 10. PRESENT POSITION OF INSECTICIDE RESISTANCE IIÍ miARIA VECTORS

(October 1958)

Population Assessment .1 [nsecti-| Country or i Susceptible living in 3f suscep- Resistant 1 3ide to other politi- vector area of tibility vector í íhich I. cal unit species resistance resistance nade? species ！bhe y arel resis- (estimated) bant ！

脈0 Aden Colony- No Aden Protect. Ko Bahrain No Cyprus Ko Ethiopia and Eritrea Yes A. pharoensis A. gambiae .,• - • • Fr Somaliland No e Gaza Strip No A. stephensi| DDT 1 Southern Д00 000 工ran les A. hyrcanus A. macixlipennis Iran • (typicus)

A. superpictus 1 1 Southern 800 000 Iraq Ies A. sacharovi A, stephensi DDT A, superpictus Iraq

• •• ••- Israel Yes A. superpictus ¡ A. sergenti I Jordan Ies A„ sergenti superpictus A. . Lebanon Yes Libya lío Muscat and Oman Но Pakistan Yes A. fluviatilis A•philippinenás A. stephensi DDT Dharhan 250 000 Saudi Arabia Yes A. stephensi Somalia (It.) Yes A gambiae A funestus A pharoensis Sudan lío Trucial Oman í¡0 Tunisia ÏÏO Ibited Arab Eep « Sgypt Yes A ,pharoensis Yes A • sachar ovi Syria No Yemen __T* w TawaP orí^ I V I 1 TABIE 11. DRUG USAGE IN MALARIA ERADICATICSÍ PROGRAMES Ш THE EASTERN MEDITERRANEAN REGION .

Number Group and паше Mode of Quantity of of drugs used Country Year distribution kg persons

4-ajninoquinolines, amodiaQuine Ethiopia 1957 malaria field stations • • •

Israel 1956 area malaria inspectors 0.6) 1035 4-aminoquinolines, chloroQuine Iran 1957 surveillance agents • • » • • • 8-amInoquinolines, primaquine

8-apinoquinolines, pamaquine

Diamino-pyrimidines, pyrimethamine Ethiopia 1958 malaria field stations • t • • « » Biguanides, pro^uanil

9-aminoacridines, mepacrine

Cinchona alcaloids, quinine TABLE 12, INTERNATIONAL STAFF IN ANTIMALARIA PROGRAMMES IN THE EASTERN MEDITERRANEAN HEGION 1958

Adm. Laboratory Country or Medical Entomo- Sani- Total Cons. technicians territory- officers logists tarians

1 5 Ethiopia and Eritrea 2 1 1 .i, i !丨 1 l Iran

1 6 Iraq 5 1 .1

2 Jordan 1 1

1 2 Libya 1

Sudan 1 1 1

3 Saudi Arabia 2 1

1 Somalia (It.) 1

1 4 Tunisia 1 1 1

United Arab Republic 1 Egypt 1

5 Syria 1 1 2 1

TOTAL 11 8 8 1 5 -L 1.4 EUROPEAN REGIOTí_

General Picture

Epidemiological circumstances and the good development of rural health services and of preventive medicine have, after the advent of residual insecticides, greatly facilitated the achievement of very marked reduction of the endemicity of the disease to the extent of practical eradication in certain countries, even without the adoption of specific programmes of eradication. In other words, eradication has been reached following the use of simple control measures. While this is a happy circumstance for some countries or territories, such as the Netherlands, Italy and Corsica, in others the achievement of a very low degree of endemicity has tended to slacken interest in the field of malaria, and has even reduced the budgetary allocations in this connexion. The consequence has been .the maintenance in a number of countries of a state of endemicity, making a favourable though not final situation chronic, and in some instances, resistance to residual insecticides has developed in vector species anopheles as in Greece. The attached world sketch map and Table 1 give the present general situation.

Extent of the Problem

There are Ш countries and seven political anIts with a total area of 2 5 121 516 km and an estimated population of 2^0 0林杜 ООО in which malaria does not occur or has disappeared without specific eradication measures, {see ТЫЫе 2). In several countries malaria has been virtually eradicated through a country-wide control вгоgramme using residual insecticides (Table 5). Table 4 indicates the extent of the malaria problem in other countries of the region, and Table 5 gives the present extent of malaria in the region as a whoïe.

At the beginning of 1958, three countries - Yugoslavia, Moroeoo ¿Ad Algeria *.wep© for financial reasons reluctant to adopt a programme of eradication. In the case of Algeria there were also political reasons which made it difficult to embark upon such a progranrae, ând in all threé the policy of polyvalent health services was in vogue, which made it difficult to set up an independent malaria eradication service. By the end of 0.958, however, these three countries had expressed their readiness to adopt a programme of malaria eradication with WHO assistance. EB225/21 page 89

Pour countries - Romania, Spain, Portugal and Greece - had practically achieved full coverage of endemic areas by the beginning of 1958, and a striking reduction in malaria endemicity had been achieved. They were, however, lacking the organization and the necessary impact to make the final thrust towards eradication, mainly in terms of surveillance, and were thus continuing a situation of chronic hypo-endemicity with the constant danger of the reappearance of malaria foci, and of the development of resistance to insecticides in vector species. These four countries are now ready to speed up the last phase of eradication, by setting up or by reorganizing on a stronger footing a proper system of surveillance in areas of endemicity, with assistance from WHO,

f) country, Turkey, is in the attack phase of eradication; Albania is in ne the process of converting its control programme into an eradication programme, while the USSR and Bulgaria are well advanced and orientated towards eradication (Table k).

Of the countries with indigenous malaria, 10 new have operating programmes of total coverage, including four which have been in operation for two years or more. One country (Algeria) has no programme for total coverage at the moment, and one (Morocco) has a programme for total coverage by 1961.

Present Status of National Malaria Eradication Services

Table 6 gives the position of the National Malaria Services in the 13 malarious countries of the region. It will be noted that in no case is this service autonomous, and that in only three is the service concerned solely with malaria. Nevertheless, it should be noted that the antimalaria services enjoy a greater independence at the peripheral level where the antimalaria stations or the provincial antimalaria services are in easy and direct contact, either with the central antimalaria organization, or with the provincial directorate of health.

Some form of antimalaria legislation exists in 17 countries. In l6 countries the notification of cases of malaria is compulsory but without much emphasis on time. Provision for the declaration of malarious zones is made in two countries. In only one is the application of insecticides and the power of entry into houses made compulsory, and in only two is it obligatory for malaria patients to accept treatment. Field Operations

Spraying Operations

Table 7 gives a summary of the latest available information on the spraying programmes in the region, with the number of houses sprayed and the insecticides used» In Table 8， further details are given regarding spraying squads and their mode of transportation, and Table 9 indicates the use of various modes of transport.

Epidemiological Operations

In many countries of the region the final step towards eradication, namely that of consolidation involving surveillance opérations, has been reache<3 In i # most cases so far the method used has been that of passive surveillance by notification of cases• However> active detection of cases is also now being organized in some countries in order that the fact of eradication can eventually be established in accordance with the principles laid down by the WHO Expert Committee on Malaria. Entomological Operations

A considerable amoimt of study has been carried out on the susceptibility of vector species to residual insecticides (Table 10). It was in a country of this region that the first confirmed ease of resistance was recorded, namely in Greece # where A> sacharovl was found resistant, first to DDT and later to dieldrin and ШС. More recently the same species has developed resistance to DDT in the Tarsus-Adana areas of Turkey； there, however, the species is still susceptible to dieldrin, as it still is also in a number of areas in Greece.

Use of Drugs

Table 11 gives details of the various antimalaria drugs used in different countries in the region•

ROLE OF INTERNATIONAL ORGANIZATIONS IN MALARIA ERADICATION IN THE EUROPEAN REGION

In the past countries of the European Eegion have with on笱 exception received no direct assistance in antimalaria operations, the exception being that of Turkey # which has been aided by WHO and UNICEF for the past two years• Technical Advisory Services

The Regional Health Officer for Malaria was appointed in the European Regional Office of WHO at the beginning of 1958 in order to enable the Regional Office to give the required technical stimulus and leadership to malarious countries. The Organization has provided the services of a short-term consultant to Turkey on a number of occasions during the last two years. Provision has also been made for consultant services to a number of other countries. A pre-eradication survey team has recently started work in Morocco, and a similar team is likely to be sent to Algeria in 1959.

Training

A training programme is being assisted by the Organization in Morocco. Training of various categories of personnel for international service has been organized in a number of European centres during the last 18 months。 This includes a course for raalariologists in London, one for entomologists in Amsterdam, one for sanitarians in London two for laboratory technicians in Rome and one in Basle. f In addition, the malariologist trainees were sent to the Turkish programme for .field study under the direction of a WHO consultant-tutor. A number of fellow- ships have been granted to national personnel from this and other regions to study in European centres as； for example, the Ross Institute in London, the 工stituto Superiore di Sanità and the Malaria Institute in Rome, and the Anti-Malaria Organization in Greece.

Co-ordination

A number of technical meetings and conferences for various groups of countries in the region have been organized in recent years. The Third Conference for Countries of South-Eastern Europe took place in Bucharest in June 1958, and the First Conference for Countries of South-Western Europe took plaoe in Lisbon in September 1958. It is intended to repeat such conferences in the future, either on sub-regional or regional level. Further action in the co-ordinating role of the Organization is exemplified by the development of programmes in Morocco and Algeria, which was essential, not only for the co-ordination of eradication programmes in the European Eegion, but also for the co-ordination of those in North African countries of the Eastern Mediterranean legion. TABLE 1. STATUS OF MALâEIâ EÏUDIC.....ТЮЗ CAMPAIGN

Status of programme Eradication Ъ/ totsO. coverage of malarious areas

t Period of conversion j Period of total coverage j—. —... j Country or by total ^rad. Date Date Cón— Date Date territory coverage oí j completed completed ：丨 by . trôl started or started or malarious 1 or will be or will be jareas will start will start areas j completed completed i t —. tJ -- 1 Albania Yes < 1956 1 1958 1958 1962 ！ i .....i _ 1 1 r J • •_•• •_•••__•- j 1957 Bulgaria Yes 丨 1957 1962

i Czecho- -хч^ j 糾 slovakia i ； • Franceî i i Algeria Ies

i rfreece Yes 1952 ¡ 1957 1957 1962

： Hungary ** ** 脣簧

t Morocco (pre-óra|iicati on sur vey stated, in October 1958) ¡ Ies 195S j 1960 1961 1964

Portugal Yes 1949 1956 1956 1960

Romania Ies 1955 1958 1958 1962

• j Spain i Yes 1947 1955 1956 1960 ！ í Turkey i íes * 1956 1 1957 1957 1962 i . ‘ 1 T1 i USSR j Ies 1955 1955 1959 J i i I 一_it 111 1 1 T i ！ " ' : • •丨丨 Yugoslavia Ies j 1959 1959 1958* j 1963 t i 1 Practically a full coverage of residual malarious areas was accomplished since 1958j the conversion was aime с at strengthening the eradication service and providing, for proper surveillance. '、No data av;:iláble TABLS 2. COUNTRIES MD TERRITORIES IN WHICH МШИЛ IS NOT KN0_ TO HAVá OCG—JRRSD OR HAS DISAPPEARED >JITH0UT SF-;CIFIC ERilDICATION M1ASURSS

Estimated Area in km? Country or territory- population

458 4 Andorra 6 000* 83災ЛЗ137Д256 5 о Austria 6 983 000论 1 9 Belgium 8 92Л 000诀 100 000* о ^ Channel Islands 3 Л дбб ooo* ю.6Î6 Denmark о 35 000* 3 Faeroe Islands 4 Finland 4 333 000 5 3 2 France (ex. Corsica) ЛЗ75 5 000 Germany 71 406 ООО* Gibraltar 25 00J 2 175 600 Greenland 27 000* 103 000 Iceland 164 000 70 283 2 885 000 Iïslaad 588 Isle of Man 55 000 15 000 157 Liechtenstein 586 Luxembourg 312 000* 316 Malta and Qo2D 319 000 Monaco 20 OOCHHf 3 Д96 000 323 917 San Marino 14 000 61 Л49 682 Sweden 7 368 000 Switzerland 5 117 000 41 288 2Д4 016 United Kingdom 51 Д55 000 2 30Д Azores 317 000 797 Madeira 267 000 311 730 Poland 28； 180 000

1 Total 2k0 O ^ 000 5 121 516

1957 estirantes» uniees otharwieê noted.

Mid—year 1956 estimate from the 1957 United Nations Demographic Yearbook

1956 census TABLT5 3. COUNTBIES WHERE МШИЩ. MS BEEN ERADICATED

Country or 2 1 Original mslarious areas Area in km Population territory- 2 Area in Jem Population

Corsica (France) 8 747 244 000 2 850 (?) 145 000 Italy 301 226 48 279 000* 65 000 (?) 4 000 000 Netherlands 32 Л50 10 957 000** 1 847 000

Byelorussia x (USSR) 207 600 8 000 000* 2 000 ooo

Ukraine (USSR) 576 600 Ф 600 000* 8 000 oocT

TOTAL 1 126 623 108 080 000 15 992 000 i— i, ..j,

1957 estimates unless otherwise noted as follows î * mià-jreer 1956 estimate froia the 1957 United Nations Demographic Yearbook ** .

1956 ceneus '

195紅 census X Estimated, by Division of Malaria Eradication, WHO, Geneva TABLE Д, EXTÎSOT OF MALARIA PROBLEh BY POPULATION

11 1 j —… f" Area with mala-! Area under Area with malaria | 1 Population ria eradicated I survaillance not yet eradicated 丨丨 Total 工 of the 3 or more yrs j Less than 3 Regularly Not , years without sprayed regularly ; Country population original without indi- i ⑷ malarious genous case indigenous oase sprayed ¡ area Population Spr.: Population Spr. Population Population;

cont^ oont ！ .j iLlbania(1957) 1,421. ООО* 1.300 000 810 000 no 490 000 j

Bulgaria i 7 593 ООО* 2 ООО 000 1 500 000 no 500 000 yes - ¡ (1957) 1 Czechoslo- j 13 229 ООО* 30 ООО 30 000 yes - i vakia (1956) •…•.」 ¡France 370 000 ！ (Algeria) 9 800 ООО* 3 ООО ООО _ +(500 000) 2 130 ООО! ！ (1957) ！ ¡Greece(1957) 8 031 ООО* и 500 ООО 1 458 380 no 2 098 410 no 943 210 “i ¡ Hungary- 9 833 ООО* 1 500 ООО …？. .1 322 ООО * Morocco (1957) 9 648 ООО* 3 500 ООО - - 2 678 ООО +^00 000] b ‘ Portugal 8 325⑴屮 1 860 ООО 1 635 000 no 168 000 no 57 ООО • (1957) 1 ítÍ03Tiania(1957) 17 579 ООО* 6 ООО ООО 4 782 000 no 1 218 000 yes •

¡Spain (1957) 29 Д31 ООО 8 ООО ООО 7 963 000 no • 37 ООО - ！ 3 578 ООО !Turkey(1957) 24 797 ООО* 8 578 ООО j - 一 一 3 a а х я x 'uS3R 151 600 000* 25 ООО 000 ； 20 ООО оооno 3 ООО ooo no 2 ООО ООО J '• Jl 1 197 ООО ¡Yugoslava (_ 17 886 ООО 5 181 ООО 3 984 000 no

j TOTAL 130 9 173 ООО 70 449 ООО 41 322 000 7 825 ООО 14 994 ООО 4 808 ООО ！ ！

1 1957 estimates unless otherwise noted as follows: mid-year 1956 estimate a Excluding Byelorussia and Ukraine where malaria has been eradicated (Table 3) X Sstiraated by ME c Figures in brackets = population covered by anti-larval operations ,,,..Data not available Ъ ¿bccluding Azores and Madeira (no malaria, Table 2) TABLE 5. PRESENT STATUS С? THS HíLáDIüATION OF УЫАШ.

BY POPUIATIOIT IB ÏHE EüROPMN RùQION (FOVEî^EH 1958)

Status Population Per cent.

Total 657 297 000 100

Malaria never indigenous or 570 856 000 86.85 has disappeared without specific eradication measures

Total original malarious area: 86 4Л1 000 13.15

Malaria eradicated .57 314 000 8.72

Under surveillance 7 825 000 1.19

Malaria still present, but 14 994 000 2.28 organized programme of total coverage under way-

Malaria still present but eradication prograrime in the preparatory phase

Transmission known to occur but no organized programme of total coverage under way- 4 808 000 .73

Unknown status (Hungary) 1 500 000 .23

Total “ 86 Ш ООО 13.15 TABLS 6. Т:3 QaOÀKlZATIOîï OF EâïIOML MAIARXA SERVICES

Position Country- Official najiie of service Other activities of of service service

Albania Section Antipaludique Secondary- None Bulgaria Section du paludisme et Secondary Helminthiasis， entomo- maladies parasitaires logie médicale, environmental t sanitation

Czechoslovakia Service hygiénique et épideriiiologique

Frances Service antipaludique de Secondary None Algeria Algérie

Greece Directorate of ïîalaria Priinaiy Tropical diseases and Tropical Diseases

Hungary

Hbrocco Service Central Antipaludique

1 Portugal Service d Hygiène rurale Primary- Aëdes eradication, et defense antipaludique rural sanitation, helminthiasis, etc.

Romania Section du Paludisme Secondary Helminthiasis, leishmaniasis

Spain Servicio Nacional Secondary Leishmaziiaela Antipaludico

Turkey Direction Nationale Primary None Générale des Services dEradication du paludisme

DSSR Institut de Paludologie Secondary Medical parasitology Parasitologie Médicale et helininthologie

Yugoslavia Service épidémiologique Secondary- CoMdunicable diseases Institut d*hygiène Sanitation Rural Hygiene TABLE 7

Times Type and quantity of Number of houses insecticide used sprayed Date of Country- Tear Planned DDT initiation per Actually Dieldrin to be téchnical г- BHC of total year 3prayed technical sprayed kg kg kg coverage Albania 195? 1

Bulgaria 2 122 558 Ч Л cr ^ V D M H < 3 N O VJ X 2 15 390

Czechos- 1956 1 lovakia Algeria (France) 1957 1-2 18 47Д 1 902

Greece 1957 1-3 897 755 24 593 2 273 9 957 j

Hungary- (No routine antimalaria work is done)

Morocco 1957 26 259 Portugal 1956 3 UUh 263

Romania 1956 1 178 727 76 785 23 983

Spain 1957 1 1 500

1958 1 > 1 500 v O v n i > Turkey- vr v 1 1 802 500

USSR ч л N O 0

ч О ч л - J 1-2

Yugoslavia 1957 ДО 120 TABLS 8. SPRAYING SQUADS

• ：—~r Number Type Spraymen Type % work ! Country Year cf of per of time in squads sprayer squad transport travel

Albania

Bulgaria 1956 75 Compression 2 Jeep or 20 & knapsack horse cart

Czechoslovakia 1956 1 Compression 12 Pickup • • • & stirrup

Fr. Algeria

Згеесе 1956 115 Compression 3 Pickups St. • •參 bicycles

Hungary-

Compression 4-6 Foot, bicyclej • • * Italy 1956 •參眷 truck

Morocco 1956 Coiïç>ression 3 Foot к 眷•參 & motor truck

Netherlands 1956 1 Compression 2 Pickup

• «參 Portugal 1958 r variable Compression • • • • • •

Romania 1956 28 Knapsack 15 Truck 20

Spain

Turkey 1958 1630 “ Compression 5 Pickup к foot • • • ». i USSR 1957 No data

ïugoslavia 1957 169 Compression 2-U • • • «•拿 к knapsack i TABLE 9. TRANSPORT FOR ANTIMALARIA ACTIVITIES

• —wa^NvAMr тяттшшвтт Total Trucks Jeeps Pickup Motor- Bi- Country- Year motor (3 ton or trucks Other V vehicles or over) cycles cycles ó -'Л - С Albania

1 Bulgaria 1956 15 - 12 - 59 12

Czechoslovakia 1956 2 - 1 - 1 - ！2

Algeria (Pr.)

3 Greece 1957 94 - 48 283 •

Hungary-

5 6 Morocco 1958 ’ 30 - 20 8 - - 2

Netherlands 1956 2 - 1 1 2

Portugal

7 Romania 1956 26 19 5 - 25 15

Spain

8 Turkey- 1958 158 - 123 - - - 15

USSR 1957 N 0 data

Yugoslavia

1 « Horse-dravm carts 2 « TaxlR "truolf 3 » lo part-time 4 « ÏO part-time 5 All old models

6 葙 2 ÇVs 7^1 bo^t, I ambulance, 13 carts 8 « Stationwagons TABLE 10. PKES3NT F0SITI0K OF INSECTICIDE RESISTMCE В! M'HIa VECTORS (October 195Ô) Country or Assossment of Susceptible Resistant Insecticide to Area of Population living in other poli- susceptibility vector vector which they are resistance area of resistance tical unit made? species species resistant (estimated)

EURO 1 Albania YES A. sacharovi A.maculipennis (typicus) A.hyrcanus A.superpictus Algeria NO Bulgaria YES A. maculipennis (typicus) A.messeae Greece YES a•maculipennis Most of the (typicus) A.sacharovi DDT and 絲 coastal area 2 ООО 000 k.superpictus dieldrin of Greece Hungary NO Italy ÏES A c3.aviger e A.labranchiae A.maculipennis (typicus) A.sacharovi ii. superpictus A.labranchiae atroparvus Morocco NO Netherlands NO Portugal NO Romania ÏES A.labranchiae atropaxvns A.maculipennis (typicus) i'umesseae A.sacharovi Spain NO Turkey- ÏES A• maculipennis (typicus) A. sachar ovi DDT Tarsus-Adana 600 000 A.claviger A melanoon A.rnessea# e A.superpictus USSR YES A.maculipennis ^typicus； Yugoslavia ÏES A.maculipenni s iiypicus ) 1: ! 1 Dieldrin resistance characteristically extends to ВШ,- and to aldrin, chlordane and other "cyclodiene derivatives”. TABLE 11 • ANTIMALARIA ERUOS USED

1 1 J 1 г - • • _•• •…j ！ Drugs used ïear Use of drug I Quantity No. of Country and mode of leg persons Group and name Trade name distribution

4-aminoquino1ines ш Amodiaquin

4-aminoquinolines, chloroquin Aralen Bulgaria 56 DDT teams and • • • • • • hospitals

Greece 56 surveillance 6 350 • • • agents «

Romania 55 treatment • • • • • • •

Turkey 57 treatment and • • Ф • •書 surveillance agents

Aralerx Yugoslavia 57 surveillance • • • » • • teams

8-aminoquinolines # priraaquin Oree <5 e 56 surveillance 1 490 •攀參 agents • • • • • • Turkey- 57 treatment

8-aminoquinolines, pamaquine Bulgaria 56 ... DEJT teams and • • • • • • hospitals

Yugoslavia 58 surveillance • •鲁 • • • teams

rhodoquin plasmocide USSR 57 local medical • • 9 參• • personnel

Albania 57 treatment • • • •參參

chinocide USSR 57 local medical • • • * • • personnel

Diaminopyrirnidines # pyrimethamine Greece 56 mobile teams 0 145 4 707 • • • Greece 56 surveillance 0 162 agents

Turkey 57 surveillance 參• 》 •拳《 agents j i Yugoslavia I 53 _ surveillance в ф • • • • teams TABLE 11. ANTIMALARIA DRUGS USED (continued)

Drugs used Year Use of drug Quantity No. of Country Group and name Trade name and mode of kg persons distribution

Biguanides proguanil paludrine Bulgaria 56 DDT teams and • • • • •參 hospitals paludrine Romania 55 prophylaxis • • • • • • and treatment USSR local medical 57 • • • • • • personnel Yugoslavia 57 surveillance • • • • • • teams

9-aminoacridines, mepacrine atabrine Albania treatment 55 • •• • • • atabrine Bulgaria 56 RDT teams and 眷•參 hospitals atabrine Romania 55 prophylaxis and • • * treatment • • • USSR 57 local medical ••• personnel

Cinchona alcaloide, quinine Bulgaria 56 DOT teams and • • • hospitals «眷* Greece 56 surveillance tao》7 agents 1, ._ _ t 1.5 SOUTH-EAST ASIA REGION

General Picture

The evolution of the campaign against malaria in the South-East Asia Region follows certain specific trends. In the first four decades of the century this effort was restricted almost entirely to certain urban areas and certain specialized communities where there were aggregations of labour, either permanent, as in tea and rubber gardens, or temporary, during specialized construction of engineering projects such as railways and irrigation works. With the discovery of the use of DDT Bombay State and Ceylon took the lead in establishing large-scale rural malaria control with the use of residual insecticides. Ceylon embarked upon a nation-wide campaign against the disease, securing almost total coverage within the next two years. The vastness of india, the multiplicity of autonomous states, the different degrees of evolution of organized rural health services, and the inadequacy of financial resources some- what retarded the progress in that country, until large financial support by bilateral agreements (ICA) made it possible for the Government of India to embark upon a national malaria control programme in 1955. In Thailand, fruitful results followed co-operative effort made in 19鸣-51 by the Government and the Organization in a hyperendemic malarious area； later the country was able to embark upon a total coverage scheme with bilateral assistance (ICA). In Afghanistan, and Burma UNICEF collaborated with the Oovernraent and WHO in providing assistance with the supply of imported commodities like insecticides, transport, etc., with similar results. In Indonesia the problem was more complex on account of the insufficiency of trained personnel, the lack of information on the extent of malaria prevalence, and the lack of financial resources} to these some technical difficulties were added later, such as resistance on the part of one of the vector species. In spite of these diffi- culties a malaria eradication plan has been prepared and the operations will start in April 1959.

Today, with tlic exception of Bhutan, Maldive Islands and fortus^se India, the oal of eradication haa been acoepted as the objective Зл the campaign against the K disease by all countries of this region.ae shówn in Table 1. Proposals for -the accomplishment of this objective are various stages of negotiation and development with the countries concerned. Group conferences, seminars, fellowships, etc. have been and are being arranged with a view to the attainment of this objective. Training institutions, such as the Malaria Institute of India, Malaria Institutes in Indonesia, and the Malaria Training Centre in Thailand have been utilized for the benefit of all the countries. Instruc- •bional visits are arranged to field projects in these countries, where substantial progress has been made.

Extent of the Problem

There are no countries in the Region in which malaria either does not exist or has been totally eradicated. There are, however, a few zones in some countries such as India, Ceylon, and Thailand where eradication has been achieved.

Table 2 shows the extent of the problem by areas as on 30 November 1958, and Table 3 the extent of the problem in terms of population. Prom these tables it can be seen that India, Ceylon and Thailand have eradicated malaria in certain parts of their original malarious areas. In considering the areas or population free from malaria the criteria of malaria eradication, as recommended by the WHO Expert Committee on Malaria in its Sixth Report have been taken into account, except in Thailand, where special criteria were applied. Thailand, however, has taken recent steps to reorganize its surveillance measures. Table 4 summarizes the achievements to date in the South-East Asia Region and gives an indication of the work still to be done for the eradication of malaria.

Present Status of National Malaria Eradication Services

The National Malaria Eradication Services follow somewhat different patterns in the various countries of the Region depending primarily upon the degree of evolution of their rural public health services. In Burma, Ceylon, India and Indonesia and Thailand the NMES may be said to be "of the primary level", that is, its chief executive, while controlling hit own special department, is responsible to the National Director of Health Services. In India, where there are a number of autonomous States, the chief executive of the State Malaria Eradication Service is responsible to the State Director of Health Services. There is provision, however, for a very active and effective co-ordination of the national programme； this has Е32Д/21 page 107 been dons in the past through the Director of the Malaria Instituto of India； recently another appointment has been made, that of Director of the National Malaria Eradication Programme, which is an office distinct from that of the Director of the Malaria Institute. In no country in which malaria eradication is in progress is under contemplation will the NMES be at secondary level. In Afghanistan the or MES is autonomous under the President of the Malaria Institute, i.e. at level I. In Nepal the NMSS will be autonomous and will be subject to the policy control of an autonomous Malaria Eradication Board.

Indonesia provision has been made for the constitution of a similar Board. In Attempts are being made in some States in India towards an integration of the Malaria Service with the rural public health service. While this evolution may pave the way for an effective maintenance once eradication is achieved, "¿here are indications that the active attack phase of eradication may suffer soEewbat from a too preraaturs integration with ths Rural Health Administration. It seems desirabls: in order that the objectives may be fully accomplished during ths attack and consolidation phases to continue to urge the need for maintaining a separate whole-time Malaria Eradication

Service.

Advisory Committees for the implementation of the malaria eradication programme hav-. been constituted in the various States of India and under the Govcrrjr.ent of India at the centre.

The №ES proposas to establish within its fianctional structure in Indonesia well-defined sections for spraying operations, epidemio]ogical evaluation and administration. In most other countries these duties are undertaken by culti-. purpose workers. On account of the lack of personnel trained in sanitary ea inccrin £ E or as sanitarians in most countries of the region, the spraying oporations are supervised by sanitary inspectors or malaria inspectors or ovsrsoers. This gap is made good in some countries by the provision of international staff.

-able 5 shows the organization of the National Kalaria Eradication Service in the Southeast Asia Region as fore sean by JO November 1953, or by 1 April 1959, in Indonesia. The activities of malaria services in this region are entirely restricted to malaria eradication; additional personnel however, are attached in seme co^trlcs for allied activities such as the control of filariasis. The question of decentralization is of considerable importance in big countries like India. Decentralization is in fact the policy there, but the States retain the provision for overall co-ordination by the centre. In most оШег countries, while there are regional, zonal or provincial organizations for implementing the programe in their respective areas, a strong element of control of the programme is exercised by the central organization.

Legislation

There has been a certain disinclination on the part of some goverments to enact any sort of legislation pertaining to the malaria eradication programme* However, in Ceylon legal provision has been made to enforce insecticide spraying to permit entry into houses and to make obligatory the carrying out of environmental sanitation measuresj in Thailand the declaration of malarious zones, the compulsory spraying of houses , the compulsory notification of cases, and the obligation of patients to permit blood examination and to accept treatment are covered by law; in Afghanistan case reporting will become compulsory in 1959. During the further progress of malaria eradication scheraôs the question of legislation will have to be taken up with the individual countries. Where passive surveillance is employed legislation will become necessary to facilitate the notification of cases.

Personnel

With the exception of spraymen and squad chiefs or superior field workers, all personnel employed in the eradication services are engaged for duty throughout the year. Since the eradication plans are restricted to a limited period of time, there are difficulties in securing for these workers the rights and privileges of permanent service. In some countries the lack of permanency is counterbalanced by giving the personnel higher emoluments than similar qualified men in other government services. In some countries, as in some States in India, they are given certain additional privileges such as leave etc” as if they belonged to a permanent service. Some countries, such as Ceylon and Indonesia employ their spraymen and squad chiefs all through the year. In others, such as India, Afghanistan, Burma， Thailand and Nepal, the spraymen and squad chiefs aie employed only during the spraying season and for a short period in advance to cover the preparatory phase. Such temporary employment, however, militates against the retention of all the. trained personnel from year to year. On the one hand, the need for timing the spraying season to begin just before the commencement of active transmission is technically of great iiaportance5 on the other, one cannot retain a large number spraymen and squad chiefs in employment when no service would be needed of them. of By and large, however, it has been the experience in this region that a good pro- portion of the spraymen and squad chiefs employed and trained in one year are available for re-employraent during subsequent years. Those who are freshly recruited in any particular year are given the necessary training before they start work. Table 6 gives details of the technical personnel who will be employed in the malaria eradication programmes when all the current programmes are actively imple- mented in all the countries of this region, i.e. with effect from April 1959.

The numbers of technical personnel have necessarily to be adjusted to their availability. Thus, however much one would like physicians to be employed as malariologists, there is an extreme paucity of available persons in this category in every country of the region. Physicians are employed, therefore, in the barest minmum. Sanitary engineers or sanitarians are very scarce in the region. Their places are being filled by malaria inspectors or supervisors (or mantris in Indonesia) Entomologists too are relatively scarce, except perhaps in India.

Table 7 shows the field personnel to be employed in spraying operations in malaria eradication programmes in the region as on 1 April 1959.

About 63 95S persons will be employed in the actual task of getting the insecticides on the walls； on the average, for every four or five spraymen there is one squad chief, and for every five or six squads there will be a brigade chief or zone chief or sector chief.

Operational evaluation during the attack phase is made by the technical personnel, employed all through the year in шалу countries.

As regards surveillance, in most countries the additional staff are employed almost exclusively from the tme when surveillance procedures are instituted; but in some cases the surveillance personnel are employed even at the beginning of the attack phase； the advantage of this method is that there will be increased staff available for supervising the spraying programme 5 also the staff Kill get trained in surveillance procedures and thus be ready to be used when surveillance begins• This obviates the need to ask governments for the provision of additional staff, at a time when the transmission of malaria has been greatly reduced and when it might appear to a layman that， if шything, there should be a reduction in the financial provision, rather than an expansion of personnel•

Table 8 shows the personnel employed in surveillance operations in sc«rie of the countries in the region. In India and Afghanistan the same staff are employed in the attack phase as during surveillance, with some readjustments.

Spraying Squads

Table 13 shows available data on spraying squads in South-east Asia regional antimalaria prograrañes» In India and Afghanistan stirrup-pump type sprayers operated by two men have been very extensively used, though at present they are being to some extent replaced by compression sprayers. In Ceylon knapsack sprayers are used. Elsewhere compression sprayers are used exclusively in the national programmes. The number of squads employed in each programme depends on the average house size, the travel time between villages and the length of spraying cycles • } In India these factors combine to enable the operator(s) of one sprayer to finish as many as 40 or 50 houses in a work-day and 5000 in a spraying cycle, while ir^ Afghanistan one sprayer may finish ten houses in a work-day and 500 or 600 in a spraying cycle. Most programmes use squads of three to five spraymonj in Afghanistan and Thailand squads of 10 and 12 spraymen respectively are used.

Transport

Various forms of transport are used for the spraying operations №enever e possible this consists of motor vehicles which carry both spraymen and materials； smaller units are conveyed in jeeps； in some areas, which are sparsely populated and have no regular means of conmunication, foot brigades are employed. In Afghanistan camel transport is used. In Nepal pack mules will be employed for carrying materials within each sector or zone. In Indonesia, itiich consists of a large number of islands, the employment of a "navy" will have.to be considered. Е®23/21 page 111

Table 1Д shows available data on the numbers and types of vehicles used in antiraalaria activities • In India and Burma spray-teams move entirely on foot, elsewhere they are transported as.necessary in pick-ups or trucks. Bicycles are extensively used in Ceylon and Thailand. In the latter two countries where large areas are in the consolidation phase, transport provisions reflect also the needs of surveillance services.

Operations Fiel___•.• ,n d i i f i ч m m • • •• With the exception of three areas where antilarval work is carried out, namely Pul-i-kumri, Kabul and Kandahar town in Afghanistan, malaria eradication is to be achieved by the indoor spraying of residual insecticides•.

Spraying Operations (see Table 9) DDT is still the insecticide of choice. In Indonesia and in the ¿ikyab coast of Burma, where A. sundaicus, an Important vector species, has developed resistance to DDT, it is replaced by dieldrin. It is intended that dieldrin will be used in all the zones in Indonesia which adjoin the coast and which will first be included in the eradication procedures; in other áreas DDT will be employed.

A further factor in the choice of insecticides arises out of the duration of iheir residual effects. For instance, in Indonesia, in accordance wi让 the meagre data now available, it is proposed to use either a six-month frequency cycle of 2 DDT in a dosage ^f 2 g/m , or an eight-month cycle of dieldrin isi a dosage cf 2 0.6 g/m . The operational costs will naturally depend on the duration of insecticidal efficacy. Further work is contemplated to assess 让is factor more precisely before deciding on the insecticide to be used and its frequency of application. , In Nepal dieldrin will be continued in areas where it has been already employed, and also in other areas to the extent to which stocks are available in the country. In an unsprayed areas DDT- will be егф1оуос1. In Thailand and in Ceylon Dieldrin has been mployed in some areas, but DDÏ is still the insecticide of choice.

The question of toxic hazards arising out of the use of dieldrin has assumed some importance. It is the consensus of option that while elaborate methods of personal protection of the spraymen may not be practicable in all countries, some basic precautions must be taken； for example it should be ensured that every sprayman has a bath at the end of the day's work, with a liberal supply of soap, under the immediate supervision of a squad chief, if not of the brigade or sector chief5 .also the use of long pants) shirts with long sleeves, and helmets with overhanging protection for the face is regarded as necessary •

Total and efficient coverage are a sine qua non for the successful achieve- ment of malaria eradication• Geographical reconnaissance and mapping are being carried out in this region in the newer programmes| use is made also of data alreacfy made available in census or other operations as regards the location and the numbering of houses.

The maintenance of sprayers and the correct techniques of spraying procedures are specially emphasized both in training and throughout the duration of the programme• All these are included in "Operations mnuals" which are prepared for most of the countries. India has a good manual of this type. Indonesia and Nepal will soon have mnuals prepared» In Burma^ Afghanistan, Ceylon and Thailand, where the programmes have been in operation， the details are incorporated in departmental instructions issued from time to time•

A salient feature of the newer programmes has been the acceptance by adminis- trations of the fact that malaria eradication must progress in stages in contiguous compact areas where there is evidence of some degree of inalaria transmission, and that there is no place in malaria eradication for piece-meal, slipshod spraying programmes restricted to foci of administrative or political importance, or everi to areas where there is a prevalence of hyperendemic malaria. The question is not how much malaria is prevalent, but whether there is any malaria prevalent5 all areas in which the answer to the second question is in the affirmative are to be progressively included in the eradication zones and procedures » This will involve in some instances the complete scrapping of spraying operations hitherto in progress in certain areas by way of malaria control, and an entire reorientation of prograrom^s to the requirements of malaria eradication. Health education in the various features of malaria eradication forms an Important part of the service. Ш11е provision is made in some cases for a full- time health education officer stationed at the centre to arrange propaganda procedures in all progranmes, health education will also be part of the duties of every member of the eradication staff. The philosophy of eradication, the method of action of the various techniques, the importance of not omitting any house or room from the spraying operations, the precautions which each householder should take during the spraying and for quite a few months after it by way of not covering up the spraying surfaces with a coat of lime, plaster, paint, mud, etc., the hazards to domestic animals arising out of spraying insecticides - all these should be Included part of the training of the various categories of personnel, and they should be as required to educate the public on these aspects.

Epidemiological Operations

In this region, active surveillance procedures are considered feasible in the last year or two of active spraying prograpmes, bywhidi time there will be a considerable reduction in the reservoirs of infection. In some countries the surveillance personnel are ençloyed even earlier for purposes of training. The surveillance procedures include the detection of fever cases, the taking of blood slides from them, the microscopic examination of the slides taken, and the epidemiological investigation of positive cases to determine the source of infection, whether indigenous, sporadic, induced or introduced or imported. All fever cases are given a single dose treatment of a Д-ajninoquinoline drug. bi some cases of confirmed malaria this dose is followed by a course of an 8-aminoquinoline. In other areas pyrimethamine is also distributed together with the 4-aminoquinolines.

In all countries except Ceylon and Indonesia surveillance is proposed by the active method, i.e. by the employraent of personnel belonging to the NMES to make house-to-house visits at stated periods of a fortnight, one month or two months. In Ceylon surveillance is practised mainly by the passive method, using the personnel of dispensaries or other treatment centres which the householder is required to visit when he gets fever, and where he must accept treatment and in return give blood slides for microscopic examination. In Indonesia it is proposed to try both these methods before determining which of thera would be the more suitable in different parts of the country; possibly both may be adopted.

Table 10 shows the results of some surveillance procedures which have been in progress in some areas of the region..

！ Entomological Operations

The behaviouristic pattern of the vector species and iiieir susceptibility to insecticides, the relation of the vectors to man and the human habitations, have to be studied during the preparatory phase and to some extent throughout the duration of the programme.

In certain countries entomological operations are carried out by staff ençloyed throughout the year. In Indonesia it is proposed to have separate personnel for evaluation, which will include entomological operations. The main emphasis will be on the compilation of data on the basic factors Of malaria reproduc tion rate, e,g, the numerical density of the vector in relation to man at night, the anthropophilic index, the degree of endophagy and endophily, the daily survival rates and the susceptibility to insecticides. International teaais will be assigned for these special studies. Table XI shows the results of susceptibility tests for various vector species carried out in the region.

Use of Drugs

The personnel of the NMES in general carry antimalarial drugs with them for distribution to fever cases which they find during their visits to the villages, either for spraying purposes or for supervision or for evaluation. As previoisly indicated, the greatest emphasis is laid on the use of drugs in surveillance procedures (Table 12).

Role of International Organizations in Malaria Eradication in the South-East Asia Region

—,_ » я — • Il •• I_ _丨1 I m «M. V Historical Background

The concept of malaria eradication may be said to be somewhat new to this region• Some countries originally thought that good control measures were a necessary precursor to eradication, and that the phasing would need to be staggered over a long period to give triera time to harness their personnel and financial resources. However, the increasing hazard of resistance has compelled attention to the growing urgency of the need for acceptance of eradication as a specific objective within a reasonable period of time, •which should not extend beyond the barest minimum needed to facilitate the harnessing of the country's resources. In 1956 UNICEF agreed to support the first phase of the eradication programmes in Burma and Afghanistan. In the same year the Ninth Regional Committee adopted a resolution approving the Regional Office proposals in principle and recommending further negotiations with the countries.

In the meantime, Thailand had already progressed towards eradication with the active assistance of the International Co-operation Administration. Ceylon had-such an efficient control programme that without specifically pre-planning for eradication, the Government thought that eradication had been nearly achieved in a great part of the country5 this led to the discontinuance of spraying early in 1955, even in the absence of an adequate provision for surveillance. Unfortunately a resurgence of malaria followed, which made a resumption of the spraying programme necessary, with suitable methods of surveillance, ICA are providing substantial assistance towards the cost of insecticides and other ûiported commodities.

In 1953 detailed negotiations were held between the Indonesian Government, ICA and Ш0 for a planned malaria eradication programme ； the Government has accepted this joint programme, to be spread over a period of 11 years from 1959. The biggest stride in the region was made by the adoption by India of a malaria eradication plan from 1958, This programme visualizes the conversion of the existing national control programme into one of eradication over a period of three years of intensive attack from 1958 to I960, and a further three years of consolidation from 1961 to 1963. The ICA have agreed to provide the necessary insecticides, transport and antimalaria drugs. The Organization has provided part of the insecticides required for the 1958 programme.

Role of the Organization

Since 1950 the Organization has provided advisory services through the establish- ment of demonstration and training teams in collaboration with governments.

At the Ninth Regional Committee the Regional Office drew up tentative plans for each country in order to achieve eradication over a period of time. These were adopted in principle.by the Regional Committee. The Regional Office used these plans for individual negotiations with the countries. The constitution of the MESA in the Organization gave further impetus. The most important contributions made by the Organization towards malaria eradication are briefly indicated below.

Technical Advisory Services

It has been increasingly recognized that organization is the most important requirement in malaria eradication. Given a good organization, whatever funds are made available may be effectively utilized and malaria eradication can be accomplished, in limited areas as the first step in their further extension to the country as a whole. No matter how much money is provided, no progress can be possible in the absence of proper organization. On this account, the need for organization has been repeatedly stressed in every programme； this advice has been strengthened in many countries by the posting of Ш0 personnel to render technical advisory assistance at zone, province and country levels. Senior technicians including malariologists, entomologists and sanitarians are provided, and an experienced malariologist is made available as country adviser. In addition to such advisory services, WHO also provides special teams to study various aspects of malaria eradication, such as the determination of the basic factors of malaria reproduction in the pre-eradication phase, their evaluation during the attack and consolidation phases, and any special problems regarding insecticide susceptibility or other matters which may arise in the course of the programme.

Every country in this region has an area representative. Miile it is not his role to engage himself in the technical conduct of the malaria eradication programme, his position as the representative of the Regional Office in the country is fully utilized in all administrative aspects and in bringing about liaison between the Regional Office and the government concerned. The WHO field staff in each country are Urged to look upon him as their guide, philosopher and friend in all administra- tive matters and in their personal relations with their colleagues in the Organiza— tion, ICA and UNICEF on the one hand and their national counterparts on the other.

In the Regional Office itself the malaria unit has been very considerably strengthened； in addition to the Senior Regional Malaria Adviser another Regional Malaria Adviser and an entomologist have been' appointed, supported by adequate administrative staff.

In addition, two inter-country programmes have been undertaken to study certain aspects of surveillance in malaria eradication.

Finally, the description of the organization of the WHO as regards advisory- service to the countries of the region would be incomplete without reference to the personal part played by the Regional Director in constantly stimulating the highest administrative authorities in each country and in maintaining a continuity of their interest and support for the eradication programme•

Table 15 shows the WHO staff who should be employed in malaria eradication in the South-East Asia Region as in April 1959.

Training .

Training of personnel includes the following.

International Personnel. These are trained in international courses and given further in-service training.

National Personnel. In every country the central and state or provincial organiza- tions deal with the training of national personnel, in which they are assisted by- teams of international members of various disciplines. This is followed by field training and above all by a continuous in-service training throughout the duration of the project. Fellowships are given to national personnel to attend various training institutions, both national and international. While the training of higher personnel is extremely important, the training of sprajrmen, squad and sector chiefs is no less important； this training is undertaken in the field by the national personnel assisted by international teams consisting of members of various disciplines (malariology, entomology and sanitary engineering).

Co-ordination. The steps taken for effective collaboration between the participating agencies, viz. the governments, the Organization, UNICEF and ICA have been referred to earlier. Other fruitful efforts of Ш0 in assisting the malaria eradication programmes include the holding of seminars and symposia and technical and policy conferences from time to time. Advisory teams. In accordance with the global policy of Beadquarters, one of the advisory teams of the Organization has. been made available to Investigate the degree of interruption of transmission achieved in various programmes and to make ‘suitable recommendations* Senior short-term consultants are employed to review the data compiled by the team and to assist its leader in the formulation of his recommenda- tions, •

Supplies, Drugs and medicine chests are provided to help the surveillance procedures in some programmes. Transport is provided for international advisory personnel, and in some cases for the project personnel also. In special cases insecticides are also provided but by and large the responsibility for the supply of insecticides, transport vehicles, sprayers and antimalaria drugs is undertaken by other international co-operating agencies such as the UNICEF and ICA. Frcm ffiSA funds, the Organization also provides assistance to certain programmes to meet a part of the local costs which may include partial reimbursement of salaries and allowances of national personnel.

Conclusion

While this region in comparison with others has the fewest countries, it has the larger population at malaria risk. In spite of the under-development of the countriesj they have all resolved to embark upon malaria eradication, greatly faptified by financial assistance from international organizations. This resolution on the part of the governments, and the magnitude of the problem, together xiith the financial resources which would be necessary, make it obligatory for international agencies greatly to augment their financial aid to the countries, if malaria is to be eradicated before the development of vector resistance to an extent which would militete against such accomplishment. If the problem is vast and the resources required to meet it are large, the dividends will equally be great. ЕБ23/21 page 119/120

TABLE 1. STATUS OF MALARIA ERADICATION CAMPAIGN IN SOUTH-EAST ASIA AS ON JO NOVEMBER 1958

Status of programme Eradication by total ooverage of malarious areas

Eradication by Period of conversion Period of total coverage Country or other total coverage Eradication Control political unit of malarious by areas Date started Date completed Date started Date completed areas or will or will be or will or will be start completed start completed

Afghanistan (a) Yes - - 1956 May 1958 May 1958 (b) Burma - Yes - Feb. 1957 (c) � (e) Ceylon Yes - - 1948 (f) 1955 (f) 1957 (f) (f)

India - Yes • April 1958 April 1959 April I959 Dec. i960 Indonesia - - Yes April 1959 Dec. 1964 1964 1966 (some prepara- tion is made in 1958)

• • Nepal • Yes" March 1959 (g)“ March 1962 (g广 March 196I (g)' 1964 or 1966 (g)" or 1962

Portuguese India • - - - — 一 一 Thailand • • • • Yes" 1953" 1958" 1958.' 1962"

Legend

(a) Some small malarious pockets are in the process of determination but this will, by and large, be in remote areas with little movement of population, and may not seriously affect the total coverage. Every effort is being made, however, to delimit them precisely and include them in the total coverage. (b) To be determined. (c) . . (d) Will depend upon political conditions and areas hitherto inaccessible becoming accessible for surveys and later inclusion of ( ) malarious areas in the spraying programme. e

(f) In Ceylon control from 1948 to 1955 was so effective in apparent eradication that there was a nation-wide withdrawal of spraying in 1955. This was, however, followed by a resurgence of malaria on account of certain previously undetected foci or transmission in the interior jungles. Nation-wide respraying has been undertaken from 1957. The period of completion of total coverage will be determined in the light of the progress assessed in the next year or two. (g) Proposals await formal final concurrence of government, but accepted in principle.

! Exact data not available. TABLE 2. EXTENT OF MIARIAL PROBLEM BÏ AREA IN SOUTH-EAST ASIA AS ON 30 NOVEMBER 1958

Area with malaria Area mth malaria not Area under surveillaiice Original : eradication yet eradicated Country or j Total area'malariou s other poli-： in km area^ Three or more years Less than three years ; Regularly Not regularly tical unit in km without indigenous case without indigenous case sprayed sprayed Spraying _5±呢，：M W Area in km^ Area in km' in кш^ continued continued Area in -ir- Afghanistan:» 650 000 Yes Burma (1957)： 677 950 503 900 Ceylon 65 610 No (in wet Yes Nil and inter- mediate zones) Portuguese India 4 194 India 3 288 876 Yes in some ;1 300 000 (1956/57): areas , and No i in certain other areas t Indonesia ：1 491 562 Mepal ¡ 140 753

,Thadia 514 000 No, in many ！ No. in many- 271 880 Nil ff957)丨 areas but in areas but in ；some areas Yes； I some areas where vigi- I ïes, uriaere 1адсе data ‘vigilance p>agЕВЙ/2e 1 warranted it ¡ I data war- 'ranted it

Not available TABLE 3. EXTENT OF MALARIAL PROBLEM BY POPULATION IN SOUTH-EAST ASIA REGION AS ON 30 NOVEMBER 1958 pagЕВ2Ч2e 1 i Area under Area with malaria not Area with malaria eradicatet Population surveillance yet eradicated Country 122 of the Less than three or Total Three or more years Regularly Not original years without population” without indigenous cases sprayed regularly territory malarious ；indigenous cases sprayed Spraying Population Population „ Population Population continued continued

Afghanistan 13 ООО ООО* 2 500 ООО 600 ООО Yes 1 710 000 190 000х (1958) x Hrntan ООО* 100 ooo 630 • • • 眷參參

Burma 20 05趄 ООО 12 500 ООО 0 0 9 500 too 3 ООО ООО (1958)

Ceylon 9 1б5 ООО 5 680 ООО 2 680 000 No 5 000 000 ф (1957)

India У92 ООО 390 ООО ООО 500 ООО No 1ба ООО ООО (1957) 500 ООО Yes 229 ООО 000 (will be included in 1959) Indonesia 8砵 ooo ооо* 75 ООО ООО* 0 0 1Э 000 000 65 ООО oot (1957) х Maldive 82 ООО** 70 000 « • • • «華 • • • 參參鲁 Islands Í х f Nepal 8 700 ООО* 4 500 000 0 1 i务 0 400 000 4 100 ООО х 645 ООО* 1 Portuguese 111 000 • • • i 參參參 • « » «參參• India ..... i Ь Thailand 21 076 ООО 12 ООО ООО 4 300 000 ) 7 700 000 \ • \ • ！ Total 5与9 792 ООО 502 461 ООО 6 980 000 1 600 ООО 1 1) 1957 estimates unless otherwise noted• Mid-year 1956 estimate (1957 United Nations Demop;ra^lc Yearbook) 1956 census X Provisional estimate but without adequate data a) Including 385 ООО population protected by antilarval operations b) Only in areas where surveillance data warranted limited resumption of spraying No data available TABLE Д. PRES3NT STATUS OP m ERâDIGAJION OF MALARIA BI POPULATION

Status Population Per cent.

Total 549 792 000 • 100.0

Malaria never indigenous or has disappeared without specific eradication measures Д7 331 000 8.Д

Total original malarious area 502 Д61 000 91.6

Malaria eradicated 6 980 000 1.3

Under surveillance 1 600 000 0.5

Malaria still present^ but organized programme of total coverage under way- 250 910 000 45.6

Malaria still present but eradication programme in the preparatory phase 239 500 000 43.6 (Total at risk in Indonesia, Nepal and 160 million in India)

Transmission кшжп to occur but no organized programme of total coverage 3 190 000 0.6 under way (Burma, Afghanistan)

Unknown status (Bhutan, Maldive Islands, Portuguese 281 000 0 India)

Total- 502 461 ООО 91.6 TABLE 5. IHE ORGAWIiAHON OF NATIOHAL MALARIA SERVICES IN SOU3H-EAST ASIA, AS ON 30 NOVEMBER 1958

Country or Position ^ ^ — __ . - _ , other political Official name of service 9Г Activities other than malaria eradication unit service

Afghanistan Malaria Institute Autonomous Body lotise control to a limited extent

Burma Malaria Institute Primary None

Ceylon Antimalaria Campaign Primary None

Portuguese India •參 • • •參

India National Malaria Eradication Primary Filariasis control (but with a separate wingl Programme

* Indonesia National Malaria Eradication Primary None Service Nepal Malaria Eradication Service Autonomous None. Malaria control measures were previously served by Insect -Borne Diseases Control Bureau. In the future plan the NMES will devote study to malaria

Thailand Division of Malaria & Primary Filariasis control (with separate Filariasis Control personnel)

•• No data * As expected by April 1959 (at present Malaria Institute) 『『A PROFESSIONAL ТЕСШЮЛЪ PERS0№IEL PLOYED Ш MALAIS SRM)ICATION TABLi 6 細 丽 . Ш SOUTH-MST ASIA AS Ш 30 HOvM Ю 8 5

Mtçmo.l.cgy and other chief* Engineers Entomologists auxiliary personnel Country or other Zon3 1 1 Physicians --i i - «и - - * ¡i • » politicfil mit Bispectors 36 (another 20 Mgiianistan 9 reserve)

Malaria assistants 22 Burma Malaria inspectors 97 Lab. technicians 22 Insect collectors 2

1 Public health inspectors 59 Ceylon Entomologist assistants 11 Lab. assistants lü

23 Lab. assistants 503 India Lab. technicians 50 Assistants (non-medical officers) 230 92C Senior malaria inspectors 〜

1 Malaria clerks 220 Indonesia îïalaria aides 4200

3 Malaria assistants 3 Hepal^ Malaria Inspectors 54 Malaria superiors 54

Superior field workers 54 pagEB2VJ4/2e 1

1ГО5 Portuguese India 310 Thailand

s7^iTg"the role of piysicians in Indonesia (Controlliers) As ejected in the month of April 1959 pagEB2<2e 1 TABLE 7. FIEID PERSONNEL EMPLOYED Ш SPRAYING OPERATIONS IN MALABIA ERADICATION PROGRAMMES IN SOUTH-EAST ASIA AS (Ж 30 NOVEMBER 1958 12ОЧ

Sector Squad Motor boat Total chiefs ohiefs Spraymen Drivers men о}э-н0и90Йсоэтоиео-еЛ л зэ-ноцеосбл адэтроц^о纫л sefoueocdA s9fou30(tíA Country boUTUTcdJC-pGHboUTUTS P hoUTUT:a5VI4->ЙЫ or q.ua>sa>Jd риэзэ.-ха¿ q.ua>so>Ja +»u9w(uad"p< boUTtrfaJè bou-HufcdJP q.u9seja-PV q.ua)sa>Jcd other political Jo Jo jo y unit ^o jo p

Afghanistan 884 857 Burma 897 75 285 3 040 Ceylon 308 10 62 206 India 33 981 8760»* 800**** Indonesia 2 114 14 350 1 750

Portuguese India 參• •眷 參禱 Nepal 824 54' 126f бзо Thailand 1 950 150 8oo

TOTAL 63 958

includes 2)2 mechanics of which 7 840 employed for five months only of which 500 employed for five months only

5权 out of 126 included in Table 6) to be employed all through the year also included in Table б ) rest for only six months TABLE 8. PERSONNEL EMPLOYED IN EVALQATION OPERATIONS IN THS MALARIA ERADICATION PROGRAMME OF SOUTH-EAST ASIA AS ON 50 NOVEMBER 1958

— Total Evaluation Inspectors Evaluators Microscopists Country or other No- of In At Mo. of In At N04 of In At No. of In At political unit pres- vacan- train- pres- vacan- train- pres- vacan- train- pres- vacan- train- ent cies ing ent cies ing ent cies ing ent cies ing

** - - - - 6 - - Afghanistan 69 -• - 63 -

** • • • • « • • - - Burma 375 - - 575 • -

107 - - • • •參 參• Ceylon 139 - • 32 -

India Stands .ncludec .in Tab .e 6

л * 雄 - - Indonesia - 7 - • - 175 .- 182 一

Portuguese India - 一

- Nepal - -

№ailand 1)00 - • 240 - • 1000 - 60 -

Data not available

* As expected ift 1959

Stands Included ill Table 6 wagebjrooЕВЙ/21 o

TABIE 9. HOUSES SPRAYED AMD INSECTICIDE USED IN THE ÁNTIMALABIA CAMPAIGN Ш SOUTH-EAST ASIA AS ON 30 NOVEMBER 1958

Country or other Times Number of houses jTyoe and quantity of insecticide used Date of oolitical unit Year sprayed initiation per Planned to Actually j DDT 丨 Dieldrin BHC gamma . Of total year be SDrayed sprayed ¡ technical technical isomer content coverage in Kgs in Kgs in Kgs Afghanistan 1957 1-2 260 000 1958.

Bhutan Burma 1958 1 2 468 662 Ó24 894 16 168 1957 exclud- ing inaccessible areas Ceylon 2- 1957 843 466 39 000 30 00Q 1 290 Resumed in 1957 • Portuguese India •參 India 1956/57' 2-4 |29 093 550 080 430 27 880 24 m 1959 Indonesia 1-2 ；Eradication will start in 1959 Nepal 1-2 Sradication will start in 1959 Thailand 1957 L A26 265 j 229 Ш 6 Ш 1958

No data TABLE 10. CASE-FINDING FROM VARIOUS SOURCES IN MALARIA ERADICATION PROGRAMMES IN SOUTH-EAST ASIA, 1957-1958

Country or Source o f cases Total of Form of infection Nature of cases other positive political Routine Private physi- cases unit investigation House-to-house Voluntary cians, hospitals, Other clinics, etc. of fever cases visits collaborators in hospitals etc.

No, noti- No. posi- No. of N0^ posi- No. of No. of No, posi- No. of No, posi- No. of I No. posi- fied tive slides tive visits slides tive slides tive slidesj tive vivax falci- mala- Mixed bn ported Sporadic Induced Indigenous taken taken taken taken parum riae

In areas with malaria eradicated Ceylon 1957 16 688 167 167 111 56 0 1)7 30 (in one focus only)

In areas under surveillance (consolidation phase)

India 1956- 14 121 10 10 5 (Others could not be traced, A population of 0.8 million under surveillance.)

In areas with malaria not yet eradicated but sprayed regularly

Afghanistan 8 979 1 0)5 Nature not determined. (Aug, 1957 • 1 0)5 835 199 A total of 599 З61 Sept. 1958) under surveillance. Ceylon 1957 62 277 3 276 26 992 3 З68 6 644 4 028 2 581 23 12 TABLE 11. PRESEÎ1T POSITION 0? BÍSECTICÜDE RESISTANCE Ш MALAIIIA VECTORS DI SOUTH-EAST ASIA (OCTOBER 1953)

,, 1- • • Country or Assessment of Resistant ；:[nsecticicl e to Population living in other poli- susceptibility Susceptible ； vector pr/hic h they are Area of resistance area of resistance tical iinit made? vector species resistant (estimated) species Afghanistan YES A. superpictus Bhutan NO Burma ÏES A. annularis A. sundaicus DDT Агакал 1 000 000 A. culicifacies A¿ leucosphyrus A. minimus Ceylon ÏES A. culicifacies India YES A; annularis A. stephensi DDT Erode (Madras) 40 000 A; culicifacies A. jeyporiensis condidiensis Ai fluviatilis A; leucosphyrus Ai minimus Ai philippinensis A; sundaicus A. varuna Indonesia* ÏES A; aconitus A; axiiiularis A； barbirostris A; farauti IT kochi“ • A; leucosphyrus Av maculatus Ai sundaicus DDT Northern Java 5 000 000 Ai punctulatus A. subpictus dieldrin A. umbros"us Maldive Islands NO Nepal ÏES A. ndrdntus *dpgeEB2<2 1 Porttiguese India NO Thailand ÏES mmjmis # Л Preliminary* reports‘have been received indicating-the development of dieldrin-resistance in A. subpictus malayensis^ A, vagáis and A. barbirostris in Eastern Java. ге,18галсе characteristically extends to BHC, and to aldrin, chlordane and other "cyclodiene derivatives' TABLE 12. MTEmARIA DRUGS USSD Ш PROGRAMME IN SOUTH-EAST ASIA AS ON 30 NOVSMBÜR 1958

Drugs used Use of drug Country Group and name and mode of distribution

1 ‘ Д-aminoquinolines, amodiaquine Ceylon surveillance agents

4-aminoqainolines , chloroquine Afghanistan surveillance, therspy and nomad posts Burma therapeutic India surveillance and therapeutic Indonesia therapeutic Nepal therapeutic Thailand surveillance and therapeutic

8-aminoquinolines y primacy ine Ceylon surveillance agaite India (îfysore) surveillance

8-aminoquinolines, pamaquine

Diamino -pyrimidine s, pyrimethamine Afghanistan surveillance and nomad posts Burma surveillance and therapeutic Thailand surveillance and therapeutic

Biguanides， proguanil

9-aminoacridines 5 mepacrine

Cinchona alc&Xoàde y quinine Indonesia therapeutic TABLE 13. SPRAYING SQUADS SOUTH-EAST ASIA REGION

No. of I^pe of Spraymen Type of % work time Country Year squads sprayer per squad transport in travel

Afghanistan 1958 86 Stirrup and 10 Foot and • _ • compression truck

Bhutan 鲁•攀 • * •

Burma 1957 760 Compression 3 Foot 25

Knapsack Truck Ceylon 1957 v û (XI 1 о H 1

О • • • M Ч Л > Knapsack Jeep

India 56/57 3 385 Compression Л Foot 25 Stirrup

Indonesia 1958 350 Compression 5 Foot and • • • pickup

Maldive Islands • •參 • •.拳 參• «

Nepal 1958 126 Compression 5 Foot and «參》 pickup

Portuguese India 參參參 • • « 書•奢

Thailand 1958 150 Compression 12 Foot and pickup ...

I ！

¿ío data available TABLE 14. TRANSPORT FOR ANTIMALARIA ACTIVITIES (SOyTH-EAST ASIA REGION)

Total Trucks Jeeps motor (3 ton Pickup or Motor Country- Year • vehicles or over) trucks equiv. cycles Bicycles Othex*

• Afghanis tan 1957 28

Bhutan 參參參

Burma 1957 97 - - 97 - _

Ceylon 1957 T6 - 36 26 72 -

1 India 56/57 ‘ 658 279 218 1)8 - - 23

Indonesia

Maldive Islands 參« • •眷*

Nepal • • •

Portuguese India • • • 2 Thailand 1958 159 16 59 72 崎 19s 12

Station-wagons 2 7 station-wagons ^ 5 carryalls ••• No data available TABLE 15. mo STAFF FOR MALARIA ERADICATION IN SOUTH-EAST ASIA AS ON 30 NOVEMBER 1958

Administrative Asst. Surveillance Medical Entomo- Level (General Service Engineers Sanitarians malario- Lab. technicians personnel Officers logists staff) logists

Projects 8 (h) 19 (a) - 8 (b) 1 斗(с) 10 (d) 12 (e) 2 4 12 (international) 10 ‘ (g) (f) 25 at local 14 rates

Regional 18" 2 - l - -

(a) Includes 3 in Indonesia under the United Nations EPTA and 1 vacant under EPTA, and 7 posts proposed for Indonesia in 1959, 1 post under Regular Budget in Nepal and 2 under MESAv 2 (MESA) Afghanistan, 1 under United Nations EPTA in Burma and 2 under MESA In India; (b) 1 for Burma, 2 for India, ) for Nepal and 2 proposed in 1959 for Indonesia; (c) 2 for Burma, J> for Nepal and 9 proposed for Indonesia in 1959; (d) includes 8 under №iited Nations EPTA and 2 proposed, under MESA for Indonesia in 1959; (e) 2 for Afghanistan, 1 proposed for Burma, 5 proposed for Indonesia in 1959 and 4 for India; (f) 18 for India and 5 for Ceylon) „ чSurVeillance Study (g) ЗЛ each for India and Ceylon ) (h) 2 for Afghanistan and 6 proposed for Indonesia• « out of 18 2 are of grade # 1.6 WESTERN PACIFIC REGION

General picture

The Western Pacific Region is composed of ЗЛ countries and ^k territories, covering an area of 22 288 b^k sq. km with 8^0 605 201 inhabitants.

Six countries within the Region have become Independent since World War II and have suffered from the initial difficulties of adjusting themselves to new social and economic conditions• In several of these countries internal political problems caused difficulty in operating in some malarious areas• Some territories are still under- developed, and many areas are still unexplored.

Apart from the Australian continent and the five countries on the Asian mainland, all the coimtr5.es and territories are situated on islands varying in size from large to very small. However, the topography is much the same, consisting of lowlands, foothills and mountains, the inland and mo unta-' nous areas often being accessible only by boat or on foot. In the lowlands the malaria endemicity is usually less Intense, and interruption of transmission is more easily obtained than in the hilly and mountainous areas, vhich have a higher endemicity and where transmission is more difficult to interrupt• The temperature and rainfall are such that malaria trans - mission takes place all the year round， except in the most northern countries like Korea and Japan• The peaks of transmission occur once, or frequently twice, during the year. It is interesting to notice that many of the countries and territories introduced antilarval measures quite early, Taiwan In 1901, Malaya in 1911， and several countries 1 and territories during the 1920 s. The control was, in many cases, limited to urban areas, but other areas of a certain economic value were included. During the war the malaria control vas neglected； when it was started again the imagocidal method was Introduced and control carried out on a larger scale, including rural areas.

f Daring the 1950 s most of the governments agreed to the idea of changing from control to eradication but, as will be seen in table 1, there are still some countries and territories vhich have not yet completed plans for eradication. The populations to Ъе covered are relatively 曰mall, but there are serious problems to be solved, such as Insufficiency of trained personnel, insufficient funds and, in some areas, diffic- ulties in interrupting transmission due to special habits ot the vector mosquitos. Further problems include those in relation to the human being and his environment, such as the frequent migration of people between malarious and non-malarious areas } the construction of new houses without notification to the authorities, poorly- constructed houses (sometimes without walls), and resistance of the public to having their houses sprayed.

Extent of the problems

Of the 1Л countries and 5紅 territories in the Western Pacific Region； one country and 18 territories, with a total area of 333 188 sq. • km and a population 6f 5 655 02紅 are situated east of the longitude 170°E, the so-called Buxton Line， beyond which anopheline mosquitos do not exist; these administrative units are known to be non- malarious (see Table 2). No information is available regarding malaria in the main- land of China, North Korea, the Mongolian People's Republic, North Viet Nam and in three small territories： Bonin Islands, Cocos Islands and Norfolk Islands. (The Mongolian People^s Republic appears to be free from malaria.)

The remaining nine countries and 13 territories for which information is avail- able cover an area of 10 375 116 sq. km with 190 iBj 000 inhabitants, 6f.vhom it is estimated that Mf 7^5 000 (24 per cent.) live in malarious areas. This includes a population of 1 ^67 000 living in Singapore which is the only unit in this Region claiming eradication of malaria (see Table 3). As regards countries where malaria is still present^ Tablé k shows the extent of the problem in terms of population» It lists all the malarious countries of the Region, including those from which no infor- mation is available• The indicated populations of original malarious areas in Australia and South Korea are tentative estimates only. In Australia they are those living in coastal areas of the Northern Territory and Queensland, but only for the Northern Territory are data on antirnalaria activities available.

Status of malaria eradication (Tables b and 5)

The present status of malaria eradication in the nine countries and 13 territories # where malaria still exists and for vhich data are available can be summarized as follows : In Japan the transmission period is short and the malaria problem has never been serious. Tarough general sanitation measures and the improvement of health services after the war this country is now very near to eradication， only 53 cases having been reported in 1957. China (Taiwan) and the Philippines, after several years of total coverage, have dl s continued spraying in most of the-îr original malarious areas, which are now under surveillance. Taiwan, where transmission appears to have been interrupted except in limited foci, is progressing steadily towards complete eradication and may be the first country in the Region to reach this ultimate goal. In the Philippines about two-thirds of the population in malarious areas came under surveillance in 1958. Spraying is being continued in certain areas where transnission has not been entirely- interrupted. These are developing areas where the spraying of remote dwellings of new settlers becomes a major problem. Ways and means to overcome these difficulties are under study and it is hoped that they will be solved in the not too distant future

Sarawak has implemented spraying progressively since 1952. Interruption of transmission has been achieved in many areas, and surveillance has begun in some of them as from 1958.

Cambodia has covered all its malarious areas in 1958, with the exception of a few remote areas of difficult access. From 1959， several regions which have been sprayed for a number of years will be covered by surveillance only.

Laos is planning to convert its present control programme into one of eradication in I960.

In West New Guinea, North Borneo, Brunei and Papua and New Guinea, pilot projects are under way as a preparatory phase for future eradication programnes.

Plans of operations have been prepared for South Korea and South Viet Nam and submitted to their governments, The plan for Korea entails a pre-eradication survey project, on the findings of which plans for operational activities will be made. Owing, however, to shortage of national funds, the implementation of this plan has been postponed until 1959. For Viet Nam, where extensive malaria surveys have already been carried out earlier, the plan entails an investigation by a consultant. Based on his recommendations, a definite plan of action will be worked out.

ïefinite plane túr malaria eradication have not yet been prepared for two countries - Australia and the Federation of Malaya - and ten territories - Brunei, British Solomon Islands, Hong Kong，Macau, New Hebrides, Noi^th Borneo, Papua and New Guinea, Portuguese Timor and West New Guinea. The Government of Australia has not yet revealed any plans for eradication activities, but the problem is known and could easily be dealt with by the Government itself. Negotiations are taking place between the Federation of Malaya and WHO for the implementation of a pilot project with malaria eradication as the ultimate goal. Ho information is available as to the plans of the Governments of the British Solomon Islands, New Hebrides and Portuguese Timor, and It is known that Hong Kong and Macau have not yet made any definite plans.

Present status of national malaria eradication services

Table б shows the place of the malaria service within the government administra- tion of six countries and six territories from which such information is available. It appears that only one country, which intends to initiate eradication activities in I960， has established an autonomous malaria service (Viet Nam South). In China (Taiwan) the malaria service is primary. The other countries have secondary malaria services.

The malaria service in several of the territories could, at territorial level, be called autonomous¡ but since most matters of administrative and financial impor- tance are referred to the metropolitan governments for decision, these services have been indicated as primary; five of the six territories have primary malaria services. Only one territorial malaria service (Macau) is part of another service (Department of Sanitation).

Legislation

Some forms of legislation, bearing on antimalaria operations but not directly related to eradication, exist in China (Taiwan), Japan， the Federation of Malaya, the Territory of Papua and New Guinea, West New Guinea, Hong Kong, and North Borneo. The reporting of malaria cases is compulsory in China (Taiwan), Japan, and Hong Kong. The declaration of malarious zones is obligatory in the Federation of Malaya. The carry- ing out of environmental sanitation activities is obligatory in Hong Kong and North Borneo, and in the latter there is provision for sanctions. It is hoped that countries where eradication programmes are now in the planning stage will incorporate the necessary legislation in their plans.

Persoxinel

Table 7 shows the number of professional and technical malaria staff available for five countries and elgjit territories. The number of all categories is very low, except in the philippines *nd China (Taiwan) • On the average, when all units are included^ one malariologist is provided for ^00 000 persons^ but if the Philippines are excluded^ the proportion is one malario- logist for 900 000. Apart from the Philippines, only Macau and West New Guinea have a sanitary engineer or a sanitarian, China (Taiwan) is well equipped with entomo- logista, Aereas Laos and Viet Nam have none.

The laboratory technicians and field technicians are in the proportion of one technician to a population of k6 200 when all units are included, but only one to 95 700 without the Philippines. The number of sanitary or field inspectors is very low

There is no doubt that extensive training of personnel for all categories is necessary, in order that the eradication activities can be carried out satisfactorily.

Table 8 shows the field staff employed in spraying operations in four countries and four territories from which such information is available. The squads consist of from two to five spraymen under a squad leader； a foreman or technician is responsible for the squads. The labourers are hired locally during the spraying season while the foremen are permanently employed. The operations^ as a whole, are under the responsibility of the senior executive staff， which is also responsible for surveillance when this is established in their area•

The only unit known to have specific personnel for drug distribution is North Borneo, where at present six persons are employed for this ptarpose for an area under operation of 60 000 people•

Table 9 shows the personnel employed in surveillance activities in the countries where such activities are under way.

Field Operations

Spraying operations

Table 10 shows for three countries and three territories the insecticides employed and the number of annual spraying cycles.

DDT is the only insecticide used in Ombodia. In Taiwan DDT is mixed with BHC. In North Borneo and Sarawak both DDT and dieldrin are used. In the Philippines only dieldrin has been sprayed for the last two years, but earlier DDT was used. The ! change-over took place owing to the people 8 objection to the unsightly marks of DDT sprayed on their walls. However, dieldrin, when sprayed only once a year, has been found not to interrupt transmission completely in most of the units； therefore the Philippine Government may decide to revert to the use of DDT in those areas where transmission persists. In the countries where the chief vector is A. minimus or k, minimus flavirostris, one spraying per year has proved sufficient to interrupt transmission. But in New Guinea and Borneo^ vhere the chief vectors belong to the A, punctulatus or the leucosphyrus groups, a single spraying per year has not been enough to interrupt transmission. In the mountainous areas of Cambodia^ vhere there is a population of about 300 000 transmission has not yet been stopped and it is expected that in the future two sprayings per year will be done there•

Transport

Data available on the number and types of transport used in antimalaria programmes are given in Table 11. In China the spray teams travel mostly on foot, and in Sarawak mostly by motor boats of different types; elsewhere trucks and jeeps are used where possible. The vehicles available in the Philippines and Taiwan are used also for surveillance activities.

Spraying squads (Table 12)

In many of the countries of this region, spraying squads work throughout the year, giving high individual output and efficiency. 0a the other hand, movement between settlements is extremely difficult and tedious in some areas where it has to be done on foot or by boat. Up to 6o per cent, of the working time in Sarawak and North Borneo is used up in travel. The multiple-outlet Lift and pressure sprayers developed in Taiwan have been found very useful for the spraying of long houses in Brunei and Sarawak. Stirrup pumps are used in Malaya； elsewhere compression sprayers are used.

Epidemiological operations

The stage of surveillance in malaria eradication operations vaB reached in most of Taiwan in 1956 and in large rarts of the Philippines as well as in some parts of Sarawak in 1958• The major proportion of MESA funds allotted to this Region is being used for assistance to establish satisfactory and well-organized surveillance programmes as from July 1958, both in Taiwan and in the Philippines, and for their continuous support t The surveillance system in Taiwan is an adaptation of an earlier system, established in 1956, which was based largely on passive surveillance through local health authorities. This passive surveillance did not prove to be satisfactory, and the present system, which is of the active type and very comprehensive, was established from July this year.

The Philippine system is based on units consisting of four canvassers, one senior canvasser, one mlcroscopist and one helper； there are 28 units, of which every four are supervised by a field foreman. The whole of this staff, except the 28 field foremen, is paid from MESA funds.

Passive surveillance in the Philippines depends largely on voluntary assistance given by public-spirited private citizens such as the village headmen (barrio lieut- enants) and school teachers. In each village (barrio) a malaria working group consisting of three to four such persons is established. They have been taught how to take blood slides and to give the single doses of antimalarial drugs. Thie system seems to work quite satisfactorily. Co-operation with medical institutions and public health services is also established.

In Sarawak the surveillance staff acts as a mobile epidemiological unit which investigates cases found through passive surveillance, and their surroundings, and carries out antimalarial measures as found necessary, including the spraying of new buildings. The senior staff responsible for the eradication programme as a whole is also responsible for the surveillance activities.

Passive surveillance in Sarawak is carried out through medical facilities existing in the area of surveillance, and is found tp be working satisfactorily.

The surveillance programmes, however, in their present set-up have been wrking for only a few months and it has not been possible during this short period to make any definite assessment a.9 to their efficiency.

Entomological operations

Table 13 shows a division of the Region into six main parts, from th^ point of view of vector distribution. The secondary vectors are mentioned as well as the main ones. In division A it has not been found difficult to interrupt transmission in the lowlands, where the main vector is A. minimus. This species is not found indoors after the spraying operations, but breeding places and outdoor resting specimens are still found, m the foothills and mountains, however, the interruption of transmission seems to be more difficult, probably owing to the secondary vector, A. leucosphyrus.

division В malaria transmission by A. minjmus flavirostrjs ha Ъеехх inter- Tn 日 rupted quite easily by residual insecticides in lowland areas. In mountain and foot- hill areas the interruption of transmission has proved more difficult.

In division С the main vectors belong to the A. leucosphyrus group. A. leucos- phyrus m Sarawak and Brunei does not cause any trouble and interruption of trans- mission i日 easily achieved； but A. leucosphyrus balabacensis in North Borneo has caused difficulties because it is also an outdoor biter and is easily deviated to or from animals• The A. punctulatus group in division D hae also caused considerable difficulties, and interruption at transmission seems to have Ьеш achieved only in a few areas, through bi-annual spraying and drug administration.

No serious difficulties seem to exist in the case of A, hyrcanus sinensis In division E} but actual eradication measures have not yet been taken in this division.

Division F includes the Federation of Malaya, where A. maculatus, the main vector, seems to be raising problems as regards interruption of transmission. The conditions in Portuguese Timor are not yet known.

No insecticide resistance has been found so far in any of the vector species in this region. Table shows the vector species which have been tested.

Use of atrugs

In countries and territories with difficult vector species, and in countries where mountainous regions have been shown to be problem areas with persistent trans- mission in spite of bi-annual coverage by insecticides, general drug administration is being resorted to as a supplement to the residual spraying of houses.

Mass drug administration, however, is still in an experimental stage, and is confined to pilot areas for the assessment of results. In Cambodia amodiaquine is given weekly; in West New Guinea and in North Borneo, chloroquine and pyrimethamine are administered twice yearly. The distribution, of chloroquine and pyrimethamine is effected in connexion with the twice-yearly spraying operations. It is reported, however, both from North Воггаео and from Cambodia, that only about 70 per cent, of the population receive the drugs, owing to absences or, in some places, to refusals.

Plans for testing Pinotti’з method with pyrimethamlnized salt in a mountainous area in Cambodia with 10 000 people have been worked out and are expected to be implemented early in 1959. A similar trial in West New Guinea with pyrimethamlnized salt is being planned for an area containing 10 000 people.

ROLE OF INTERNATIONAL ORGANIZATIONS .

Technical advisory services

Table 15 shows the distribution of WHO personnel in countries with malaria eradication projects or pilot projects.

Some eradication projects, such as those of Taiwan, Philippines and Sarawak, may achieve eradication by 1962 or 1963. Others, as in Portuguese Timor, British Solomon Islands and New Hebrides, may not start until 1962} these may have approached total eradication by 1967. International staff will be needed continuously. Consid- erable funds will be necessary until at least 1967 in order to achieve eradication of malaria in all the nine countries and thirteen territories within the Region.

Training

An international malaria eradication training centre is being established by the Philippine Government at the Institute of Malaria, Tala, Rizal, Philippines, with assistance from WHO and ICA. WHO assistance is Intended to strengthen the teaching staff by means of a co-ordinator of studies and a sanitarian. The training should start at the beginning of 1959.

From 1956 to 1958 six doctors, five sanitary engineers and an entomologist were awarded WHO fellowships in order to attend malaria training courses in other countries, or to make observation tours, Со-ordination

The importance of co-ordination of malaria eradication activities between groups of adjacent countries has been strongly advocated by WHO and is largely realized by the governments concerned; such co-ordination has been established in Borneo and on the Asian mainland, and is under consideration by the three territories in the New Guinea and Solomon Islands.

The Borneo malaria conferencee were initiated in 1956 as twice-yearly meetings between the Governments of Indonesia, North Borneo, Brunei and Sarawak. Indonesia vas represented for the first time in December 1957. Tbe meetings have established a good spirit of co-operation, although the plans made for joint activities in the border areas between Kalimantan (Indonesian Borneo) and the territories have not yet been, carried out.

The neighbouring countries of Laos, Cambodia, Viet Naun and Thailand, which have many problems in common, agreed to establish an Antimalaria Co-ordination Board in 1956. Burma and the Federation, of Malaya have Joined the Board. A WHO malariologist has recently been appointed as Secretary of the Board in order to strengthen these co-ordination activities. Close co-operation exists between Thailand and Laos. About 1^0 Laotian technicians have received training or are being trained at the Malaria Institute, Kuala Lumpur.

Direct assistance

It would appear that the direct international assistance to governments during the first part of the period of an eradication programme has been mainly devoted to the covering of the costs of equipment and supplies； during the later stages the assistance has often been utilized in the payment of national surveillance personnel, as at present in Taiwan and the Philippines, in order to ensure proper coverage.

FUTURE PROSPECTS AND CONSIDERATIONS

The threat of development of resistance may become more serious with time; great importance, therefore, must be paid to any delay in the interruption of transmission, and all forms of investigation must be carried out thoroughly. One of the obstacles to the achievement of interruption of transmission is the lack of co-operation by the public with the malaria services• It is considered that the strengthening of health education might overcome the "human resistance"•

Where necessary and possible, the strengthening of the malaria service within government administrations； the passing of adequate legislation pertaining to malaria eradication, the strengthening of co-orâination and co-operation between international agencies, and the further development of inter-country co-operation and co-ordination would further improve the conditions for malaria eradication work.

The danger of complacency, which usually develops when the effects of a campaign show striking decreases in malaria morbidity； must be stressed to governments, all cadres of malaria workers and the general population, if total eradication is to be achieved. Several c\f the problems mentioned above are fully appreciated by the governments concerned•

In spite of many technical, administrative and financial handicaps, antirnalaria activities are progressing veil In the countries and territories of the Region, and it is hoped in the course of ten years they may achieve the ultimate goal of • eradication. TABLE 1. STATUS OP MALARIA ERADICATION CAMPAIGN IN THE WESTERN PACIFIC REGION, NOVEMBER 1958

Status of Eradication by total coverage of malarious areas programme Period of conversion Period of total coverage

uoxi-BOXVV^I j o uof^oip^a g Date Date Date Date

Country or еЭваэло о started or completed started or completed SBao: 专

Territory- loa^uo o will start or will be will start or will be completed completed A q

Australia ！ North. Territory! X

Queensland ！ » • • 參• • * • »

Cambodia ！ X 1956 1958 1958 _參《 China (Taiwan) | x ""195^ 1956

China (Mainland) ••. • • • 參•雄 參• 》 • • • «參參 Japan i (Surve Lllan oe; Korea, North •參* •參》 • • • • • • 參參》 ... • • •

Korea, South 1 X i960 • • •

Laos f X i960 參•》

Fed. of Malaya | X 書》* • • • •參囊 •參參 Philippines 1 x 1954 1958

Viet Nam, North | • «參 參參參 參•書 參•參 Viet Nam, SouthJ 196o Papua and

New Guinea X 9 • • • • • • • • • • 9

West New Guinea X « _ • • •參 • • • 參• •

Macau X « * • • • • 參• • • mm

Portuguese Timoi] «參* 鲁в • •番 « • • • «參 Brunei X 1959

Hong Kong 1 X 參垂в « « « • • • * • •

New Hebrides 參•參 • • • 參》• • « • • • • North Borneo ! X 1959

Ryukyu Islands X • • * • • • • mm • • • Sarawak I 1958 t Solomon Islands j в參》 •翁拿 ！ .…•-...t • • •

X Yes …No data available WESTERN PACIFIC REGION

TABLE 2. COUNTRIES AND TERRITORIES Ш WHICH MALARIA IS NOT KNOWN TO HAVE OCCURRED OR HAS DISAPPEARED WITHOUT SPECIFIC ERADICATION MEASURES

1 Country or territory Estimated population Area in km'2

Mongolian People's Republic 1 010 poo 1 551 ООО

New Zealand 2 229 000 267 995 Cook Islands 17 000 Niue 5 000 259 Токе1au Islands 2 000 10 Western Samoa 100 000 г 927 Nauru 4 000 21 ** Fiji Islands 000 18 272 .* Pitcairn 352 145 5 Gilbert and Ellice Islands 000* 950 ** Tonga 000 牡 697 American Samoa 000* 197 57

Guam 000* 5)斗 20 Hawaii 000* i6 6)6 71 Pacific Islands (US Adm.) 000* i 779 584 Fr. Oceania 000* 3 998 65 New Caledonia 000* 18 653 75 s Johnstone Islands 66 46 2 s Midway Islands. 416 5 s Wake Islands 549 8

TOTALS 4 665 024 864 188

1957 estimates unless otherwise noted as follows :

mid-year 1956 estimate from the 1957 United Nations Demographic Yearbook

census 1956 л a 195O census WESTERN PACIFIC REGION

TABLE 5. COUNTRIES WHERE MALARIA HAS BEEN ERADICATED

Origirml malarious areas Country or • 2 Population Area in km territory (1957) 2 Area in km Population

Singapore 741 1 467 000 741 1 467 000 ЕБ23/21 page 151/152

TABLE 4. EXTENT OF MALAEIA PROBLEM BY POPULATION IN THE WESTERN PACIFIC REGION, NOVEMBER 1958 County Total г Population of the Area under surveillap.ce Area with malaria not yet eradicated or population original malarious Lyss than ) years without indigenous case Regularly sprayed Not regularly sprayed territory area Populatjon Spr. сont. Population Population a a Australia 9 643 000 50 000 450 No 900 Cambodia 5 000 000 1 000 000 0 947 000 53 000 China : Taiwan 9 86) 000** 7 000 000 6 69(000 No зоб ООО - China : Mainland 621 255 000 Japan 90 600 000 861 ooob 861 ООО No Korea, North 10 000 000 Korea, South 21 800 000 6 000 000^ 6 000 000 Laos 000 000 2 000 000 400 ООО 1 600 000 *** Fed. of Malaya 6 277 000 6 277 000 3 010 ООО )267 000 Philippines 22 690 000 8 500 000 5 300 ООО No 3 100 ООО 100 000 Viet Nam, North 14 500 000 Viet Nam, South 12 100 000 4 500 000 0 4 500 000 Papua 000*) 452 1 1 287 000*) 500 000 50 ООО 1 450 000 1 739 000 West New Guinea 700 000 700 000 0 120 ООО 580 000 3 Macau 203 000 � 00 000 Portuguese Timor 478 000* 400 000 Hong Kong 2 583 000 2 583 000 (2 269 ООО) 314 000 North Borneo 000 200 000 100 ООО 100 000 Brunei 66 000* 50 000 28 ООО 32 000 Sarawak 626 000* 500 000 40 ООО Yes 220 ООО 240 000 Solomon Islands 103 000* 100 000 New Hebrides 55 000 50 000 Ryukyu Islands 807 000* 807 000х Bonin Islands 177* Cocos Islands 1 000 Norfolk Islands 1 000 TOTAL 83^ 473 177 ^ 278 000 1 1957 estimates unless otherwise noted as follows : For Northern Territory only, no data available for Queensland * Mid-year 1956 estimate from 1957 United Nations Demographic Yearbook b Shiga Prefecture only, total not known ** x 1956 census Estimated by RO WPR *** 1957 census Data not available Figures in brackets = population covered by antilarval operations TABLE 5. PRESENT STATUS OF THE ERADICATION OF MIARIA ВГ POPULATION IN THE WESTERN PACIFIC REGION, NpVEMBER 1958

Status PdBBlation Per oent.

ToteX 840 605 201 100 19Л 848 024 23.x No information available «... 645 757 177 76,9

Information available, <>!otal 19Л 848 02Л Ю0 Malaria never indigenous or has disappeared without specific eradication measures 150 103 024 77.1

Total original malarious area U 745 000 22,9

Malaria eradicated 1 Д67 000 0.75

Under surveillance 12 895 000 6,6

Malaria still present, but organized programme of total coverage under way Л 573 ООО 2.35

Malaria still present but eradication programme in the preparatory phase 6 893 ООО 3,5

Transmission known to occur but no organized programme of total coverage under way- 18 ，W ООО 9,7

Total: LA 745 ООО 22,9 TABLE 6. STATUS OF MALARIA SERVICES WITHIN THE GOVERNMENT ADMINISTRATION Ш 6 COUNTRIES AND б TERRITORIES IN THE WESTERN PACIFIC REGION, 1958

Countries and Official Name of Service Position of Other Activities of Territories Service Service

COUNTRIES • •• • Cambodia National Malaria Service Secondary None

China (Taiwan) Taiwan Provincial Malaria Primary Filariasis research Research Institute

Federation of Malaya Malaria Control Service Secondary

Laos National Malaria Service Secondary None philippines Division of Malaria Secondary Research on other insect vectors

None Viet Nam (South) National Malaria Service Autonomous

TERRITORIES Brunei Malaria Service Primary None

Hong Kong Malaria Bureau Primary None

Macau Macau Department of Secondary Sanitation None West New Guinea Division of Malariology Primary None North Borneo Malaria Service Primary None Sarawak Malaria Service Primary

—-

Autonomousj 1 country Primary» 1 country and 5 territories Secondaryj 4 countries and 1 territory TABLE T. PROFESSIONAL AND TECHNICAL PERSONNEL EMPLOYED IN ANTIMALARIA PROGRAMMES IN COUNTRIES OP THE WESTERN PACIFIC REGION, 1958

Estimated Countries and Malario- Entomo- Sanitary Sanitary Laboratory Population Territories logist • logist Engineer Inspector* Technician or Malaria Microscopist in Sanitarian Inspector Malarious Areas

CQÜNTRIES 1 000 000 Cambodia 1 - 7 6

2 T 000 000 China (Taiwan) 8 21 85 — 2 ООО 000 Laos 3 71

3 8 500 500 Philipplaee 45 h 28 28 376

8 4 500 ООО Viet Nam * 5 - • (South)

TERRITORIES 100 ООО British Solomon 1 “ Islands

1 2 50 eso Brunei <•> Hong Kong 1 13 2 583 ООО Macau i 300 ООО W^et Mew Guinea 2 1 i 6 9 700 ООО North Borneo 1 3 12 200 ООО papua ardUew Guinea 1 1 1 1 500 ООО Sarawak 4 10 500 ООО •28 853 ООО TOTAL 68 38 30 108 627

Proposed plan

1 of this figure, 12 doing epidemiological work and 20 entomological work

2 includes 52 microscoplsts, 16 surveillance technicians, 17 engineering staff supervising operations

)In this number, 100 roicroseopists, and surveillance technicians » are included

斗 15 microscopists and 40 field supervisors TABLE 8. FIELD PERSONNEL EMPLOYED IN SPRAYING OPERATIONS IN FOUR COUNTRIES AND POUR TERRITORIES IN THE WESTERN PACIFIC BEGION, 1958

Tochnioian Countries and Field Foreman Drug Squad Leader Spraymen Territories or Malaria Distributer Superintendent

COUNTRIES -

Cambodia - 22 64 m

China (Taiwan) 17 - - m 1 Philippines 138 5OO 1 000 ш»

Viet Nam (South) m 200 1 000 •

TERRITORIES

West New Guinea «w 9 42 ia» 2 North Borneo 10 50 б

Papua and New Guinea 19 - m - Sarawak 5 17 98 •

Total 182 758 2 254 6

Proposed plan

1 Under the Five-Year Supplement (FY 1958-1962) to the Joint Philippine- American Malaria Eradication Programme, squad leaders are permitted to dispense drugs where previously only technicians did.

2 Category of assistant malaria technicians for mass drug admini strati on• TABUS 9. PERSONNEL EMPLOYED DIRECTLY IN SURVEILLANCE ACTIVITIES

Field Countries and Supervisor Mlcroscopist Canvasser Territories or Technician

1 5 China (Taiwan) 65 54 (50)3 740 (110) 2 Philippines 128* 100 500

Sarawak 1 3 8

Total 194 157 1 248

1 of this figure, 10 employed in active foci, 10 in epidemiology and 20 in entomological work (11 of this number are paid under MESA funde) о Including 100 helpers

^ Paid from MESA funds

* One hundred field supervisors, 28 foremen TABLE 10. INSECTICIDE USED AND NUMBER OP ANNUAL SPRAYING CYCLES IN COUNTRIES AND TERRITORIES IN THE WESTERN PACIFIC REGION IN 1958

Countries and Annual Number of People Insecticide Territories Spraying Cycles protected

Cambodia DHT 2 s/sq.ш 1 ООО ООО

China (Taiwan) DDT 2 g combined with BHC O.OI7 g/sq,m 306 ООО

Philippines Dieldrin 0.6 д/sq.m 200 ООО

West New Guinea DDT 2 r/sq.m 120 ООО

North Borneo Dieldrin 0.6 ©^sq.m 50 ООО DDT 2 Vsq. m 10 ООО

Sarawak DDT 2 r/sc¿.m or 252 ООО Dieldrin 0.6 g/sq,m 8 ООО TABLE 11. TRANSPORT FOR ANTIMALARIA ACTIVITIES Ш THE WESTERN PACIFIC REGION, 1958

1 ; ! ; Total Trucks Jeeps Country Motor ? (3 ton Pickup or : Motor ： ！ ! Vehicles ！ or over) ！ trucks equiv, ‘ óyeles ； Bicycles Other

Australia i (N Territoiy) f i ； * • . } I Cambodia I ！ ！ China (Taiwan)¡ i j Philippines

j West New Guineai! í North Borneo i . i Sarawak -… I —_ "丨丨. M. ! I. Ill I

1 Light aircraft

Motor 二 oat s of different types page 1бО

TABLE 12. SPRAYIKG SQUADS IN THS WESTERS PACIFIC RSGICW, 1958

Total Type of Spraymen Type of % work time Countiy ！ number of sprayer per squad transport spent squads in travel

Pickup Australia , 1 Swingfog 2 * • • (N. Territory)

Cambodia 22 Compression Pickup 21

China (Taiwan) ¡ 312 Compression Mostly on 24 foot » i Stirrup Malsya … Compression philippines 500 Compression Viet Nam (South) i … West Hew Guinea 9 Compression 4-5 Pickup 30 or jeep

1 Brunei 1 LP and 6 Various • # f Knapsack j ! 1 North Borneo 10 Compression 5 Jeep and 60 foot i : ¡ Sarawak 17 Compression 5-6 Boat and 56 ! and LP foot

i -

…Data not available

1 Taiwan lift end pressure sprayers TABLE 15. THE SIX MAIN DIVISIONS OF THE WESTERN PACIFIC REGION ACCORDING TO VECTORS

Main vector Country or territory Secondary vector

A A. minimus Cambodia A. leucosphyrus (A. maculatus) Laos A. leucosçhyrus (A. maculatus) Viet Nam A. leucosphyrus (A. maculatus) China A. hyrcanus Macau A. hyrcanus

В A. minimus flavirostris Philippines (A. mangy anus)

С (Brunei A. sundaicus , , 口 丄』、 A. leucosphyrus leucosphyrus A (Sarawak -A：» smidalcu— s -(A. barbirostris) A. leucosphyrus balabacensis North Borneo A, sundaicus

D A• punotulatus group British Solomon Islands West New Guinea New Hebrides Territory of Papua and New Guinea

В A. hyrcanus sinensis Japan Korea Hong Kong A. minimus

P A. maculatus Federation of Malaya A. subpictus Fortuguese Timor TABLE 1杯.PRESENT POSITION OF INSECTICIDE RESISTANCE IN MALARIA VECTORS IN THE WESTERN PACIFIC REGION (October 1958)

Country or Assessment of Susceptible vector species Territory- susceptibility made?

Australia, Northern No Cambodia Yes A. leucosphyrus balabacensis A. minimus

China (Taiwan) Yes A. hyrcanus sinensis A. maculatus A. minimus A. iWm.tessellatu - •膨т^Л^ s

Japan No Laos No Malaya Yes A. maculatus A. barbirostris A. hyrcanus A. kochi A’ vagus

Korea, South No Philippines Yes A. hyrcanus niçerius A. minimus flavirostris A. philippinensis A. annularis A. tessellatus

Viet Nam, South No Brunei No Hong Kong No Macau No New Caledonia Yes A. farauti New Hebrides No North Borneo Yes A. leucosühyrus balabacensis Papua and New Guinea Yes A. punctulatus A. farauti A. koliensis A. subpictus TABLE 14, PRESENT Р0Б1Т1СЖ OP INSECTICIDE RESISTANCE IN MALARIA VECTORS IN THE WESTERN PACIFIC REGION (October 1958) (continued)

Country or Assessment of Susceptible vector species Territory susceptibility made?

Portuguese Timor No Ryukyu Islands No Sarawak Yes A. leucosphyrus leucosphyrus A. barbirostris Singapore No Solomon Islands No West New Guinea Yes A. farauti A. koliensis A. punctulatus it TABLE 15. WHO PERSONNEL ÏN MALARIA PROGRAMMES IN THE WESTERN PACIFIC REGION AS AT 1958

a J Countries and Malario- Entomo- Sanitary Engineers ATME and Consultants Territories logists logists and Sanitarians 1957 :1958

Countries j

Cambodia 1 1 .2 - :ATME Consultant

China (Taiwan) - - - ATME -

Japan .- - - » Consultant

Korea (South) 函 (1)* �** - -

Laos - - » 雄 - -

Philippines - .- • ATME - Consultant

Viet. Nam (South) (1) - j - - Consultant

Territories

West New Guinea • - - Consultant -

North Borneo 1 1 1 - ATME

Papua and Guinea - • - Consultant -

Sarawak 2 1 - - -

Antimalaria

Co-Ordination Board, 1 - • Saigon

Total 5

Assigned in Regional Office if* Assigned to North Borneo until planops is signed

а )ЛТМЕ = Advisory Team on malaria eradication SUMMARY OF PRESET STATUS OF MALARIA SRADICAYKM

(a) World sketeh map showing the status of malaria programmes by oountry

(b) Table showijag the status of malaria eradication by regions and population WORLD-WIDE STATUS OF MALARIA ERADICATION UP TO NOVEMBER 1958

EURO .\W\4i.W W Sx\.wwwv

• 1 AMRO WPRO оK\ w ъ^М-. EMRO •Kww- \\\w• WW

SE ARO

AFRO

•Xnwwv'

www>\\\\\ww • www- 4 \\\\\ 1 1 Salaria never present or died out without specific eradication measures YswwKwt w" Malaria eradicated

Advanced with zones where eradicated

1 1 With total coverage begun

[：^||：;：] With plan of operations approved or in preparation, but with total coverage • Still without plan of operations EB25/21 page 167/168

SUlffiiARY OF PRESENT STATUS Of ÍÍA.LARIA ERADICATION BÏ REGIONS Ш) POPULATION

г Malaria never indigenous or Population 丨 Population covered during has disappeared of original Malaria Malaria Total 1957 or 1958 Total •without specific malarious areas eradicated still present population Population still Region population eradication measures by spraying Ъу surveillance covered to be covered (spraying “ * ала Population Population Population antilarval ivithdravm) j —— onerations i African Region 150 095 ООО 15 533 000 334 562 000 0 13Л 562 000 25 214 000 533 ООО 25 752 ООО 103 310 000

Americas 377 665 ООО 239 S25 000 137 840 000 A9 545 000 83 295 ООО 53 З65 000 1 493 ООО 55 353 ООО 32 931 000

Eastern Medit e rr ane an 192 931 ООО Л7 3AA 000 1Д5 537 000 859 000 144 723 ООО 30 557 000 k 302 ООО 34 S59 ООО 109 86? 000 Region ‘ i - . . - . European Region 657 297 ООО 570 856 000 86 Ш ООО 57 314 000 29 127 ООО 15 372 000 6 077 ООО 1 21 94Р ООО 7 17S ООО

-- •丨 ,, ,, .- South East Asia ! 549 792 ООО hi 331 000 502 461 ООО 6 980 000 Л95 481 ООО 260 410 000 500 ООО 23厶 571 ООО Region 會 260 910 ООО ' 1 1 " Western Pacific 840 605 ООО Region <

(Data available 8Л8 ООО) 150 103 00。芥 LA 745 ООО 1 467 000* 11 Л20 000* 12 355 ООО畀 24 275 ООО芥 (19А х 芥 43 278 〇〇(/ 19 003 ООО并 (No Data available (645 757 000) .- ... :f Total: 2 768 385 ООО 1 070 992 000" 1 051 636 ООО"" 116 165 000* 935 471 000^ 397 338 0〇0并 25 765 ООО'" 423 ЮЗ ООО资 512 36S ООО 芥 !

X Includes : China, Mainland 621 255 Korea, North 10 000 Viet Nam, North и 500 Bonin， Cocos & ) 2 Norfolk Islandsj if- Excludes data for China Ilainland^ Korea, North Viet Nam, North Bonin, Cocos & Norfolk Islands III» PILOT PROJECTS

The definition of a malaria pilot project has many relative aspects, since the scope of such a project varies considerably according to the country or area. Generally speaking, the aim of a pilot project is to provide information as to Whether certain single or combined antimalaria measures will, if properly applied, bring about an interruption of transmission.

A pilot project must start with the usual preliminary survey which should provide technical information on the distribution, amount and seasonal variations of malaria, the nature, distribution^ density and main habits of the chief vector, and an appraisal of the most appropriate method of leading to a rapid interruption of transmission• There follow the actual trials of the measures which are indicated. The results of these trials should be very carefully assessed so that the recommendations made at the end of the pilot project are sound and workable,

The reliable execution of the pilot project cannot be anticipated before its results are assessed in the light of experience. This leads to the difficulty of classification. Broadly speaking, any 2-4 years' attempt at interrupting malaria transmission qualifies as a pilot project providing the following criteria are fulfilled!

1« Completion of a preliminary malaria survey.

2. Thorough application of method or methods adequate for interruption of transmission over a sufficiently large area.

Reliable assessment of results, including the analysis of any slow or disappointing effects of the applied methods,

4. Availability of a comprehensive report including detailed recommendations for future action.

A list of pilot projects undertaken in the African, Eastern Mediterranean, • South-East Asian and Western Pacific regions is tabulated below. A brief summary of some of these may be of interest. Zanzibar

This project has been in operation since July 1557, although the plan of operations was not signed until the autumn of 1958. The population figure of 2(50 000 represents the total populations of the islands of Zanzibar and Pemba, who are receiving complete dieldrin coverage. In Pemba (population 120 000), in addition to the spraying, total mass treatment by chloroquine and pyrimethamine is given monthly for six months, mainly with the object of dealing with the immigrant labour problem.

Southern Rhodesia

Since 1949, extensive malaria control has been practised by the Government, using BHC, with such good results that in 1955 total spraying was withdrawn in large areas and replaced by surveillance and barrier spraying• As a result of some breakdowns in control in the protected area in 1956, the Government asked WHO in 1957 to study the problem and advise on means to eradicate malaria. These studies are proceeding, and pilot surveillance operations, in a population of 400 000, will be undertaken in the southern part of the territory.

Liberia

A combined malaria and yaws campaign began in 1953# aided by WHO- In 1955 the malaria and yaws control projects were separated. In 1956-1957 mass chemotherapy- was carried out in selected areas, with somewhat uncertain results. In the second half of 1957 a widespread resistance by A. gambiae to dieldrin and BHC was recorded. In June 1958, the project was reorganized under a new international team, DDT spraying, in two cycles, has been substituted for dieldrin, and two zones, containing a population of 50 000, have been selected for chemotherapy.

Nigeria (Sokoto)

The control pilot project which began in 195^ in Western Sokoto has been 2 expanded from 1956 into a much larger scheme, covering 1Û 560 km vrîth a population mt. 5另 000 in 1957.The main vectors in this holo-endemic area are A> gambiae and A, funestus. Three types of insecticides were used, each over one zone of the area, viz. DDT, dieldrin and BHC at 2 g, 0.5 g and 0.25-0.4 g per m respectively. It was soon discovered that A, gambiae had developed a high resistance to dieldrin and a cross resistance to ШС, but not to DDT. Later investigations in the field disclosed that a small proportion of A. gambiae in some unsprayed areas had a gene of resistance to dieldrin and BHC, and the rapid increase of resistance in the mosquito population exposed to selection pressure became clear. After the withdrawal of dieldrin and BHC, the amount of malaria transmission again began to decrease under the sole use of DDT ¡spraying In sorae villages in the centre of the pilot project, 0 infants are now free from malarial infection; this augurs well for the future eradication of malaria in that part of Africa.

Senegal

This project began in 1955 In an area around Thiès, using DDT once yearly. It was expanded in 1955, 1956 and 1957, by which time it covered a population of nearly 500 000, It is proposed to carry out a series of chemotherapeutic trials in sprayed and non-sprayed areas,

Upper Volta (Bobo-Dionlasso)

In 1953, this project covered a population of 19 000, but by 1956 the .area was enlarged to comprise about 50 000 persons. The insecticides used at first were DDT and BKC; since 1955 DDT and dieldrin have been used. In the untreated sones, A. gambiae and A. funestus are the main vectors； in areas treated with DDT, A. nili is regarded as the main exophilic vector, while the importance of A. gambiae as an exophilic and.endophilic vector is less pronounced. A. gambiae has shown in the DDT zone an increased rate of outdoor biting, but at the same time a decreased sporozoite rate； this may be due to the irritant effect of DDT. In the dieldrin

zone, A. gambiae has developed a high resistance to this insecticide and to BHC, but not to DDT. It has been proposed to maintain the DDT spraying in 1958-1959 with the addition of chemotherapeutic trials。

Cameroons (South)

Beginning in 1953 in a small area around Yaoundé, this project has been enlarged by stages to cover 800 000 persons. In 1957 one half of the pilot project area was being covered by twice-yearly spraying with DDT and the other half by dieldrin once yearly. In the densely forested area around Yaounde, where A, mouchetl is the main vector together with A. gambiae> it has become clear that transmission can be interrupted by residual spraying alone; a system of surveillance is being started in this area in 1958-1959. In the extension areas, where dieldrin has been used, the results have been less satisfactory, particularly at the edges of the sprayed zone. A chemotherapeutic trial for 16 000 persons, using chloroquine once a month, is visualized for 1959.

Ethiopia

As a result of control projects begun with the aid of ICA in 1954, with the addition of WHO since 1956, operations have been conducted in three pilot areas up to 1958 to demonstrate the possibility of interruption of transmission by means of residual spraying, and to carry out pre-eradication surveys in unsprayed areas. The three pilot projects have proved that transmission can be interrupted at the higher altitudes, and it is intended to perform similar experiments in the plains, where, Judging from experience in the Sudan, it is hoped that success will be attained. This will lead to the gradual setting up of an organization to eradicate malaria from the whole country.

Sudan

Extensive residual dieldrin spraying operations have been carried out with WHD assistance since 1957, with gradual expansion of the areas covered. The chief problem in stopping the transmission is that raised by nomadic migrations, to which special attention is being given. In a pilot study of a population of 75 000 persons, where the annual spraying is done before the main transmission season, the villages are revisited at frequent intervals and supplementary spraying teams are employed to cover nomad camps, disturbed wall surfaces, and newly constructed buildings. In this way, it is hoped to achieve a complete and effective interruption of malaria transmission. Limited trials have also been made of mass chemotherapy by the weekly administration of chloroquine in labour camps under epidemic conditions. Sarawak

This project, the object of which in 1952 was to study the malaria situation and to carry out limited, control demonstrations, has now expanded so much that it has almost reached the stage of a country-wide eradication programme. DÓT has replaced dieldrin in all areas except where A. sundaicus is the chief vector. In some areas, where several years' spraying has brought transmission to a very low level, surveillance has begun and the withdrawal of spraying in the near future is envisaged. Mass blood survêys are being performed in all parts where previous limited surveys had resulted in the conclusion that the area was non-malarious ot* doubtfully malarious. Where no malaria, or very little malaria is found, surveillance is immediately instituted. Isolated foci are subjected to residual spraying. It is believed that residual spraying will succeed in interrupting malaria transmission, but some drugs are also being used to accelerate ¡the process.

• ' * • West New Guinea

The Government has carried out its own operations with the object of eventual eradication of malaï-ia; since 1955 Ш1СЕР has provided a part of the insecticides used, while WHO provides technical advice. In 1957 a pilot project of mass treat- ment of 4600 persons with chloroquine was carried out; from 1958 onwards th$ whole population protected by residual spraying is to receive chloroquine and pyrimethamine treatment, UNICEF is to supply the necessary drugs. pagSVJ4/2e 1

174=" Year of Region and Total population No. conmence- Residual spraying Chemotherapy Progress Remarks project under protection raent Drug Adult Preq» 195T 1958 Insecticide Dose Preq. тшшттштшттт 2 _ ш dose

AER 1 Zanzibar-杯 July 1957 0 2в) ОООDieldri n 0.6 1 Chlor.)0.6 Monthly This includes the pearly Pyr. )0.05for 6m. island of Pemba. 120 000 Immigrant labour (approx 20 000) # receive antimalarial drugs on arrival and during stay.

2 East Jan. 195斗 50 500 Dieldrin 0.5-0.6 1 cycle Pilot control project Africa-1 every (xoltamate eradication) (Tanganyika) 8 monttis 3 S.Rhodesia 1957 (1 200 ООО) (BHC) Objects: Assessment ERN-8 not WHO project present status (Entomol^ & Epidem.) for aim eradication. 1959 pilot sur- 5麵 veillance operations. 4 Sema311and- 3 Jan. 1958 25 ООО (lOÎNÇOCOjl:rregula r Chlor. 0.6 1958/59： Study of BHC, dieldrin +Pyr, 0.05 endemic malaria, ШГ to nomads single ifethods of inter- dose> once a year rupticMi of trans- mission. Prevention of epidemics in nomads. Eventually: eradica- tion in co-ordination nei^ibouririg countries • Year of Total population Chemotherapy Progress Remarks Region and commence- Residual spraying Но. under protection project ment )rug Adult Preq» 1957 1958 Insecticide Dose Preq. dose g

AER щтчштттт Dieldrin resistance 502 000 (WHO) In sprayed areas 5 Liberia-16 April 1953 established 167 000 (ICA Руг. O.O5 Monthly etc.) Prom 1958s 20 000 forя 6 m. Chlor.+)0.6 469 000 DDT 2.0 2 per year Pyr. )0.05 50 000 Non-sprayed areas Special study pyr. • O.O5 Monthly (LTM) effect pyrim, 20 000 for iBm. and prim, on ， Chlor.+)0.6 ， transmission Prim. )0.015 20 000 Chlor.+)0.6 Monthly Mass chemotherapy 6 Ghana-1 1958 60 000 No residual spraying Pyr. jo.05. 6 m. project 10 000 Chlor. 0.6 Monthly 10 000 6 m. Medic. Endemic goitre salt (combined Chlor, Chlor. + 40 000 iodine) Prom 1957» Dieldrin + BHC 555 эоо 500 000 ШГ 2.0 2 per Chlor. 600 mg Once 7 Nigeria-2 195^ resistance dis- 0okoto) year Pyr. 25 every 3000 6 m. covered in 1955» people Switch, over to DDT in 195?. paoqeНУ5

Year of Region and Total population No. eonanence- project under protection Hesidual spraying Chemotherapy Progress Remarks ment 1957 1958 Insecticide Dose Freq. Drug Adult Preq. m2 dose .g AERO Senegal Jan. 1953 8 492 000 DDO? 2.29 1 year- In non-sprayed areas Mass chemotherapy ly Chlor. 0.6 twice 1957/58 124 000 per year Pyr. 0.05 twice ¡ 118 000 m. б ш Руг. 0.025 weekly Isle of Mar 1 200 3 m. In sprayed areas Руг. 0.05 twice a U8 000 m. 6 ra Pyr. 0.025 weekly 50 000 3 m. 9 Upper Volta April 1953 50 000 ШГ 2.0 1 year Sprayed areas Failure In 1957 epidemio- Dieldrin 0.5 ly Pyr. 0.05 fort- to tntaHlogica l studies. 5 000 nightly rupt Dieldrin resistance 3 ш. trans- established mission in 4 years 10 Dahomey Mar. 1953 604 000 Dieldrin 1.2 1 year- Chlor. )0 • 6 monthly) ly +Pyr. )0.05 6 m.) sprayed areas ) Disap- Inter-country 000 ) pointing programme. Propos ее ) results strengthening ento- Togo (French) фгИ 1955 308 ООО Dieldrin 1.2 1 year- Chlor.)0.6 monthly) of res- mological research ly +Pyr. )0.05 4 m.) idual for pre-eradication 50 000 ) spraying pag|<2e1

Year of 178 Region and Total population сопниепсе- Residual spraying Chemotherapy Progress >• project under protection Remarks ment 1957 1958 Insecticide Dose Ereq. Drug Adult Preq. dose

EMR

1956 54 000 129 000 ШГ 2.0 оюве Pilot project for a year eradication и Ethiepia-14 Dieldrin 0.5 (small part of area) J 1957 250 000 ^53 4CKJ (7$ 000) Dieldrin 0.5 once Pilot project for Sudan-6 a year eradication

In a study area with 75 000 population perfect total coverage is arrived at by con- tinuous visits and spraying of new structures^, etc. SEAR _ Ш • i, _

э Nepal -1 1955 37 000 DOT 2.0 once Pilot control pro- (Raptl yeariy ject, conversion Valley ) ШГ 1.0 twice to eradication yearly foreseen (332 000： (Dieldrin ICA) ICA)

1 T Year of Remarks ^ j Region and Total population Residua], spraying Chemotherapy Progress л commence- under protection project ment ！958 ! Insecticide Dose Freq.Dru g Adult Freq, 1957 ‘‘ m?- dose _g

I958 WPR 17 2o2 twice Chlor) 0.6 У\- times Transrras- Pilot control. North 1955 57 000 57 000 I DOT yearly -b Pyr-) 0,05)yearly sion not Envisaged Borneo-5 (•Д5 000 totally eradication envisaged) (f^om 19^) during spray- ing and two interrup- weeks later ted in 5 yrs spaying During 1958 Dieldxdn 0 = 68 twice (57 000) yearly only6C^ of population (Dieldrin useá only in under resid- A. sundaious areas ual spraying received in fact drug treatment

260 ОООjDDT 2 • 0)twdce Amodla- 0.4 Single Up to 1957： j Full survefll 18 Sarawak-5 ¡ 1952 128 ООО anee started :Dieldrin 0 • 6)yearly quine dose at areas vlth time of S.R. 20知 in Serian (Since 1958 dieldrin is used spray- sprayed district only in A• sundaicus areas) ings Pitxn]958s (10 000 all malar" pop.)* Still ious areas • under spray- ing paghbh.Ve /

l80 pb Year of Region and Total population commence- Residual spraying Chemotherapy Progress Remarks NOe under protection project ment 1957 I958 Insecticide Dose Freq. Drug Adult Freq> IÏT dose g

WPRO Pilot control。 West New 1955 120 0C0 120 000 DDT 2.0 twice 1957 Pilot operationj Interrup- 19 Eventual eradica- Guinea 2 yearly Chlorweekly tion of Dieldrin CK75 once& 8 weeks transmis- tion envisaged sion after twice 4600 1 yearly pop» 2-1/2 yrs spraying not satis- factory- Addendum: Plan of operation 1958: Chlor. 0»6 ) Twice a +Pyr, 0,05 ) year +120 000 (all popular tion under residual spraying) VT. SPECIAL RESEARCH PROJECTS

The Organization has for several years past stimulated and sponsored several research projects and co-operated with a large number of institutes. This activity during the past three years can be reported as followsj

Table A shows the actual grants given to 1J> specific research projects. Table В includes a list of institutes or other research organizations with which the Organization is in close liaison and co-operation.

New research projects are presented in Table C,

Future research activities can only be forecast on a global basis, because the subjects cannot be foreseen until they appear as results of the development of activities.

A. Grants for Research Projects during the Period 1956-1938

Date of Recipient Amount Description of project No, of grant signature 8Ж8 5I00 一-S 1 58 9.I2.I955 Serological identification of Lister 5 Institute 8 blood-meals of mosquitos 1 2 1 1 1 956 2 9• 1 1 1 9 5 7 叨 submitted by the national and of • Preventive international research workers. Medicine, During the period 1955-57, about London 20 000 tests were carried out.

National 29.6,1956 20 ООО Investigations of the efficacy Institute of chloroquine and pyrimethamine of Health, as suppressants of malaria when ÜSFHS administered in common salt. USA

Federal 5.9.I956 2 800 (1) Establishing of an Malaria Insectioide Resistance Reference Service, Laboratory. Lagos, (2) Investigation on the Nigeria development of insectioide resistance under selection pressure. Recipient No, Date of of grant signature Amount Description of project $ 4 London School of 28.12.1956 1 000 Help to investigations of test Hygiene and methods for assessment of Tropical Medicine susoeptibility of mosquitos. (Entomology Dept.)

5 Colonial 9.1.1957 1 400 Chemical examination of Pesticides insecticide deposits from Laboratory^ London samples collected in the field.

6 Institute of 20.9.1957 2 000 Study of sporontooidal action Microbiology, of pyrimethamine and Parasitology & primaquine in malaria due to Entomology P. falciparum and P. vivax. "J, Cantacuzino", Bucarest

7 Istituto di 5.9.1957 2 000 Study of sporontooidal action Malariologia of primaquine in E. Marchiafava, P. falciparum and P. vivax. Rome, Italy

8 Bernhard Nocht 19.11,1957 3 000 (1) Experimental study of Inst, für resistance to DDT of Schiffs- und A, atroparvus. Tro penkrankheiten, (2) Experimental study of Hamburg, Germany resistance to dieldrin of A. stephensi. O) Variation in susceptibility to insecticides due to seasonal or physiologioal faotors.

9 Liberian Institute I8.ll.i957 2 500 Effect of pyrimethamine on of Tropical ê^omgg崎鄉á achizógciny of Medicine, Pi Íáleí-péruffi. �Ч ‘ “ i Harbel, Liberia

10 Istituto Lazzaro 21.3.1958 2 800 (1) Study of phytogenetic Spallanzani, relationship between palearctic Centro di and neoarctic representatives Genetica^ of maculipennis, Pavia, Italy (2) Cytogenetic study of resistant anophelines such as A. sundaicus and A. stephensi. ！ Recipient Date of No. Amount Description of project of grant signature $ 11 Istitutç Investigatirei of 2000 DDT or dieldrin Superlore di 15ЛД958 2 000 deposit samples frrvn WHO-assisted Sanità, Rome, malaria control prpjects in West Africa Italy

12 1stituto (1) Study of dynamics of induced DDT Super!ore di 1.7Л958 2 800 resistance in A. atrnparvus, Sanità, Rome, (2) Study on the presence of DDT Italy dehydrochlorinaee, (3) Investigation of vectorial capacity of A. atroparvus.

13 Teheran (1) Research on resistance to insecticides University, 12.7.1958 2 500 of A. stephensi. Malaria Inst. (2) Co-operation with the WHO Dieldrin Teheran, Iran Assessment Team in Iran

Б. Other Research Activities Including Grants to Individual Workers

1. A. ^ambiae investigation team .in West Africa

The study of A. gambiae is being carried put by a special Ш0 research and advisory team composed of an entomologist team leader and three specially trained technicians. The team was first established in Bukavu (Belgian Congo) and transferred in November 1957 to Accra (Ghana). Although some difficulties interfered with the work of this team several problems were investigated. The polymorphism of chromosomes of resistant strains of A. gambiae was confirmed.

2 . Study of the biochemical mechanisms in susceptible and resistant malaria vëctgrs (1958

This study is being carried out in the field by a short-term consultant, a staff member of the Communicable Disease Center, Savannah (Georgia, United States of America) seconded by the United States Public Health Service to WHO. He has carried out a considerable amount of work in Greece, Turkey, and Italy, and ccnfirmed in brief interim reports the presence of DDT resistance in A. sacharovi in Greece and in Turkey. He is working at the present time on A. atroparvus in Italy. A complete report on this assignment is expected in December 1958. 3. Study of population genetics of resistant strains of mosquitos (1957-1958)

This study is being carried out by a short-term ccnsultant to the Malaria Institute of India. The purpose of this study is to assess the level of selection pressure of an insecticide which should be applied under natural conditions so that the development of a resistant strain may be postponed as long as possible, provided that the mortality rate of the vector is sufficient for interruption of transmission of malaria. , This work is now being pursued. The first progress report indicates a satisfactory commencement of these studies.

4 . Investigati^r^^ega^el^^orrelatecL compounds in resistant insects

This work has been carried out at the Istituto Super!ore di Sanità in Rome under a grant from WHO. The grant amounted to $5000 for 1958. This work was carried out using the following substances (a) inorganic bromides,(b) bromo-acetic acid and aklyl and aryl bromoacetates, (c) cetyl-bromoacetate. This work was done on houseflies and on mosquitos (Д. at reparus), The results obtained showed that of the alkyl esters of bromoacetie acid and chloro'acetic acid the lauryl esters were the most insecticidal to resistant and susceptible strains of flies. Cetyl cyanide is another agent (cetyl-bromoacetate being the first) to which, insecticide resistance is negatively correlated. Preliminary work on the lipoid content of susceptible and DDT-resistant A. atroparvus indicate that the resistant strain has higher values. Additional work on chromosome arrangements of resistant and susceptible strains of A. atroparvus showed that after 28 generations of larval selection when the LC- of larvae and 0 adults was increased threefold the strain contained 7¥ inversion heterozygotes (21多 in the normal strains); on the other hand, the percentage of inversion homozygotes was 5% in both the selected and normal strain.

5. Investigation on toxicity_of

This work was carried out by a short-term consultant en secondment from the Cemmunicable Disease Center, Savannah (United States of America) during the period May-August 1958. This investigation assessed the dangers of exposure to dieldrin in field workers in some areas and recommended a series of practical protective measures in the field. 6» Field study on the ecology of ¿ alblmanu^ in Panama |fii

This project was carried out with the collaboration ñf the Gorgas Laboratory, The investigation confirmed the presence of protective behaviour in A. albimanus as a result of the use of residual insecticides.

C. New Research Projects Proposed fpr 1959-1960

Research project Description

Research and development of insecticide Development of improved equipment for the application equipment application of insecticides

Research and development of protective Development of improved protective equipment against toxic insecticides equipment and preventive measures for spraymen working under tropical field conditions

Field trials of the Pinotti method The addition of any antimalarial drug to common salt offers a possibility of malaria eradication in areas v&iere the application of residual insecticides is incapable of completely interrupting transmission

Studies on malaria chemotherapy- 1. Study of the minimal suppressive dose of chloroquine 2. Study on the repository formulation of drugs to produce long-lasting effect Studies on the gametecytocidal effect of primaquine on P. falciparum and P, vlvax

Studies on the ecology of A. gambiae Studies on the general biology and behaviour of A» gambiae in Africa will be pursued with a special emphasis on the investigation of the relationship between the vectorial capacity ef the mosquito and its resistance to insecticide (dieldrin)

Study of the sporontocidal effect of Investigation of the action nf primaquine primaquine on the development of the malaria parasites in the mosquito after the administration of the drug to African gametocyte carriers Research project Description тшл-^ж •丨• • i, _ м————ш Experimental study of surveillance Epidemiological and logistic investigation of the value of different types of surveillance methods in areas of disappearing malaria in India and Ceylon

In addition to these subjects the following have been proposed for future studies:

1. Research on general epidemiology of malaria in areas where the disease has not been eradicated,

2. Research on dynamics of disappearing malaria in eradication campaigns.

J. Research on the development of antimalarial drugs with a long sporontooidal and shizontocidal action.

4. Field testing of new antimalarial drugs,

5# Research on the biochemistry and genetics of resistance of anophelines to insecticides.

6. Research on the development of new insecticides with a high toxicity tñ mosquitos, low toxicity to man and long residual action, Research on compounds negatively correlated with present insecticides against which resistance has developed. PRESENT STATUS OP INSBCTICCSl； RSSISTANCE IN MALARIA VECTORS . » ‘ . The introduction of DDT and related insecticides for the control of malaria was not followed by the rapid development of resistance which had been observed in other insects such as the domestic fly. For several years DDT was used without any- noticeable decrease in its effectiveness against anopheline mosquitos. It was only in 1951 that the first observation on the development of DDT resistance in A. sacharovi was made in Greece. Since then resistance has been found in an increasing number of malaria vectors in various parts of the world. Resistance to insecticides has been i defined as "the development of an ability in a strain of Insecte to tolerate doses of toxicants which would prove lethal to the majority of individuals in a normal popula- tion of the same species". A species which has developed resistance has always had a certain number of individuals capable to withstand doses of insecticide normally lethal to the species, but the number of these individuals was so small before the use of the insecticide that the existence of a factor for resistance was in most cases •unsuspected. It is only through the selective effect produced by the repeated use of insecticides that the susceptible individuals are eliminated and that the resistant jones progressively occupy their place. When this happens the insecticide falls to produce in the field the cmtrol it effected before and insecticide resistance is suspected. Control failure is usually the first indication of the development of resistance in anopheline mosquitos, but definite proof can only be provided by a reliable testing method.

The World Health Organlzatic« has been promoting the establishment of a standard method for the assessment of susceptibility or resistance in mosquitos, and also has been co-ordinating the investigative leading to the establishment of standard methods for assessing the susceptibility of larvae and. adult mosquitos. A simple test kit ("Busvine and Nash" kit) was reeomnended by WHO in 195、 In 1957 a new test kit known as the WHO adult resistance testing kit was developed and has now superseded

Expert Committee on Insecticides* Seventh report, WId Hlth Org, teohn. Rep. Ser. SB2)/21 page 188

the Busvine and Nash test kit. Both have been supplied freely by WHO to malaria workers all over the world. Two hundred and one Bus vine and Nash test kits and 195 WHO adult test kits have, been distributed^ Рог the assessment of the suscepti- bility of larvae special test kits were developed and 50 have been distributed.

Information obtained with these two methods and received by WHO Headquarters indicates that insecticide resistance can be considered as proved in the species and in the countries given below. The adjoining шар shows graphically the distribu- tion of insecticide resistance in malaria vectors.

Resistant vector Insecticide to which Country in which species they are resistant resistance was detected

A, alblmanus Dieldrin El Salvador Guatemala Nicaragua « A. aquasalis Dieldrin Trinidad « A. gambiae Dieldrin French West Africa Liberia Nigeria A^ pseudo punctipennis Dieldrin Mexico A. Quadrimaoulatus Dieldrin* United States of America A. sacharovi Dieldrin* and DDT Greece DDT Turkey A> stephensl DDT Iran India Iraq Saudi Arabia A> subpiotus subpictus Dieldrin Indonesia A sundaicus f DDT Burma Indonesia

* Dieldrin resistance characteristically extends to BHC and to aldriri, ohlordane # and other cyclodiene derivatives.

And possibly to DDT in Bl Salvador PRESENT STATUS OF INSECTICIDE RESISTANCE IN MALARIA VECTORS (NOVEMBER 1958)

OÚ

stephensi

：：錄警 I ^^Pl.Shush 个 a A. sacharovi

N_,、喊― � Zen^- 、.„•„

N- utf^L^zirirî^SîKaserun

Known ( i of resistance (base map) H ” “ (inset maps)

SAUDI ARABIA • In addition to these proved cases of resistance, mention should be made of a preliminary report indicating the development of dieldrin resistance in A, subpiotus malaylensis, k. vagus and A» barbirostris In Eastern Java. The number of species involved is therefore nine, or, considering the last mentioned pnes, twelve. This will indicate to what extent insecticide resistance is today a definite reality in the field of malaria work.

But the problem of insecticide resistance in malaria vectors can only be viewed in its proper perspective if the human population affected by the development of resistance is considered. The total population living in malarious areas where resistant anophelines have been found is approximately 25 million people. When this is compared with the total population of 515 million living in malarious areas and protected by residual insecticides, it will be realized that at present the population "at risk" in areas of resistance is only about 5 per cent, of the population protected. To this it should be added that the cases in which the development of DDT and dieldrin resistance in a vector in a given area has left the malariologist with no weapons against the adult mosquito are indeed very few. There are probably only two cases in which this has happened; in Greece where A# sacharovi has developed resistance to both the DDT and dieldrin groups, and El Salvador where A, albimanus has also developed resistance to the two types of insecticide. But even in these two exceptional cases the latest information available indicates that the malariologist may still find a weapon against the adult mosquito in the group of organo-phosphorus insecticides. VI. GLOBAL MALARIA ERADICATION: APPRAISAL OP TOTAL COST

In a malaria eradication programme where success or failure is measured against zero transmission, the required financial resources must be provided in full; anything less means failure.

From the financial viewpoint there are two critical phases, the period of total coverage spraying and the period of surveillance. During the total coverage spraying very considerable effort is required by both governments and assisting organizations for interrupting transmission; no less a critical phase, however, is the period of surveillance when malaria ceases to be an obvious public health problem. Determined and persistent effort is required to find out and to stamp out all the residual foci of the disease. ,

Total Funds Required

Table 1 shows the estimated total requirements for the world-wide programme for malaria eradication as from 1959 at $ 1687 millions.

Tables 2 to 7 give the costs of the country progranimes by region.

Basis of Estimation

The total requirements have been based on the latest figures available of population at risk in malarious areas (column J>) - in the majority of cases 1956 and 1957 statistics. The natural increase (births less deaths) has been calculated throughout the anticipated length of the projects at the following percentages (based on information taken from the 1957 United Nations Demographic Yearbook).

Americas 2.5多 p.a. Eastern Mediterranean countries (including Algeria, Morocco and Turkey) 2.5多 p.a. Elsewhere 1.8^ p.a.

Note No : account has been taken of emigration from non-malarious areas to malarious areas where malaria is disappearing. It is not possible at present to determine this percentage of immigration. The length of the project (column 4) in the majority of cases is eight years (one year preparatory, four years of spraying - attack phase, followed by three years of surveillance). The number of years has been estimated from 1959 onwards. Where known the starting date of projects not yet in operation has been quoted (column 5). The starting dates of the rest of the programmes after I960 have still to be determined

It will be noted that certain projects have less than eight years to run. These are projects where operations are already in progress. Щ Brazil (nine years), Indonesia (11 years) and Nepal (nine years) the programme in each case is a staggered one, for which a plan has been made. It is anticipated staggering will be necessary elsewhere but plans are not yet determined.

The basis of estimation during the attack phase (column 7) has been calculated at United States cents per capita per annum. In the majority of cases (except Africa) the estimates are based on the latest costings available in the various Regions. In Africa an average of 40 cents per capita has been taken, based on the best information available.

The calculated cost of an eradicaticm programme over the eight-year period has been determined for the first year - the preparatory year, and for the three final years of surveillance at 75 per cent, of the cost during the attack phase.

In the Americas the three years of surveillance has been calculated at 40 per cent. of the cost of the attack phase due to more extensive use in this region of "passive surveillance".

C-overnmont Budgets

Government budgets, v&iere known, are projected (column 8) through the whole length of the programme, at the latest information available (either 1959 or i960) cn the assumption that such governments will contribute at least no less in the future, than thoy have in the past, towards eradication.

With regard to ROTiania, however, It is pointed out that the rural health services oí the Government deal with activities other than malaria. The amount of the Gwverraient contribution as notified has therefore been restricted to cover the cost cf the programme. The information from governments is meagre. Every endeavour is being made in the ensuing months to obtain more complete information on the various governments' participation.

Bilateral and Multilateral Support

The support from the International Co-operation Administration through bilateral agreements has been taken at the anticipated dollar contribution for the year ending JO June i960, together with the counterpart contribution as known for the year ending 30 June 1959； the counterpart contribution for I960 is not known.

This participation has been calculated, in spite of the knowledge that the ICA 《 contribution is granted only on a yearly basis, on the assumption that support from ICA will continue in those projects which have already been started with ICA assistance.

This support has been projected through the length of the project with the exception of Libya and Viet Nam (south) which have been projected only to i960 and 1963 respectively, otherwise a surplus of contributions over estimated requirements would have resulted.

The UNICEF contribution has been projected on the same understanding but only to the end of the attack phase, assuming that UNICEF would have already contributed to the equipment and transport for either the evaluation operation from the very beginning (as in the American projects) or for the surveillance operation starting at least before the last year of the completion of the attack phase. |

There are exceptions in the forward projection so far as UNICEF funds are concerned for the programme in Libya and Sonalia. Support has been restricted in Libya up to I960 and in Somalia up to 1963, otherwise a surplus contribution over estimated requirements would have resulted.

Similarly the budgets of WHO (Regular) WHO (MESA), and WHO/ГА have been projected throughout the length of the project again on the assumption that those Organizations will contribute no less in the future, than they have in the past, towards eradication.

The total of all anticipated bilateral and multilateral support during the whole length of the various projects is shown under column 9. Shortfall

Column 10 shows that the total operational cost requirements of projects and the anticipated support at the present forthcoming indicates a gap of $ 1092 million. This financial gap is made up of two broad elements: (i) the lack of information on the extent to which many of the governments are able to finance their own eradication activities; and (ii) the real shortfall between the resources that the governments and the international agencies at present anticipate to have. It must also be noted that the governments of many countries appearing on the table show no amounts (column 8) for the sums allocated by these governments in their national budgets for malaria activities.

Certainly many governments are spending considerable sums on malaria activities and it is regretted that such information is not forthcoming. As has already be^n mentioned every endeavour is being made to obtain realistic figures of the participation of governments.

Meantime, however, the total of column 8 can be considered to represent only a fraction of the real government participation and consequently the shortfall (column 10) will have to be reduced when these figures are ^novm.

WHO Technical Advisory Services in the Field

The amount of WHO technical advisory services at present given to the existing projects and to be given in the future projected at existing r^tes over the length of the project (column 11} aincunts to $ 57-5 millions.

Global Pilot and Research Projects

Table 8 shows the estimated total budget requirements both WHO and government participation at $ 12.4 millions (column 5) for Pilot and Research Projects and other Co-ordination Activities•

Co-ordination

It is proposed to hold an inter-regional malaria conference every year, in a different region during 10 years at a global cost of $ 3斗2 000.

Activities concerning the Development of Technical Policies

It is proposed that a meeting of the Expert Committee on Malaria be convened every two years and one study group every year during a ten-year period at a total cost of $ 220 000. Training Activities

These include training centres (support for six in addition to those already supported in the Americas), seminars (two every year) and training of auxiliary personnel, making a total of $ 5 300 000.

Research

It is estimated that an amount of at least $ 1 000 000 will be required to undertake research programmes in the future as and vdien the necessity arises.

Administration Costs

The total budget requirements projected over the vAiole period of the programme for V/H0 Headquarters, Geneva, operational and administration costs is $ 6.0 million

Summary of the Total Requirements

Costs of Country Programmes $ 1 60^ 9^9 000

WHO Technical Advisory Services 57 500 000

Pilot and Research Projects and 19 302 000 Co-ordination Activities

WHO Headquarters Operating and б 050 000 Administration Costs

$ 1 686 781 000 EB2^/21 page I95/I96

TABLE 1

SUMMARY: GLOBAL MALARIA ERADICATION Currency United States Dollars A»j?raisal of total cost Expressed In thousands

！ ！ Present Estimated Anticipated Shortfall to Estimated Total funds Basis of government cost of Population Starting support • for be covered, by duration required estimation budgets technical Total in date operational governmental, Country of for whole for projected advisory population ,malarious where costs from bilateral and Remarks eradication programme attack phase through services areas known WHO, WHO/TA multilateral programme from 1959 (cents) wh»le required UNICEF, ICA assistance programme from WHO

1 Notes 2 3 4 5 6 7 8 10 11 12 k—— 9 $ $ $ $ $ HEADQUARTERS

Operating costs 4 681 Administration costs 1 3斗9 6 0)0

COUNTRY PROGRAMMES

Africa 149 342 1)2 963 41斗 700 4 690 3 175 406 835 . 8 612 America 177 800 85 619 190 200 105 704 39 56b 44 934 14 201 South-East Asia 5斗9 352 503 218 337 879 152 195 113 729 71 955 7 586 Europe 286 642 68 918 47 222 13 902 4 015 29 305 909 Eastern Mediterranean 191 449 144 507 258 216 32 397 15 803 210 016 3 912 Western Pacific 188 016 43 067 91 732 16 205 10 614 64 91З 7 280 Western Pacific Notes (a) and (b) 624 ООО 110 000 264 ООО 264 ООО 15 ООО 2 166 601 1 088 292 1 603 9^9 З25 093 186 900 1 091 958 57 500

i 丨 _ sa= PILOT AND RESEARCH PROJECTS AND CO-ORDINATION ACTIVITIES 19 302

GRAND TOTAL REQUIREMENTS (in US dollars) Country Programmes 1 603 949 000 WHO Technical Advisory Services 57 500 000 Pilot and Research Projects and Co-ordination Activities 19 302 000 WHO Headquarters Operating and Administration Costs 6 030 000 $ 1 686 781 000 EB23/21 page 197/198

TABLE 1 BIS

Global Malaria Eradication

Operational and Administration Cogts - УШО Headquarters, Geneva

US dollars

Division of Malaria Eradication 2 475 700 Contractual Technical Services and 873 000 other Research Technical Publications 30 000 Translation Services 75 500 Supply Services 257 700 Ccxnmon staff costs 645 100 Common Services 324 000

4 681 000

Administration Costs

Division of Administrative Management and 506 500 Personnel Division of Budget and Finance 218 200 Internal Audit 123 700 Common staff costs 312 000 Common Services 188 600

1 )49 000

Total Headquarters б 030 ООО 5 Л1951815521 9503538563^>096976569*557269150587895922姒 5404040 1 4 认13 950諾18072645950358789592112 3 317178105327#53*188171148067882437028576317111105200811oool1883 _ m 3 • 鐘 L960 脚 • 3 5 3 264 3 10)

1 3 40姒姒4040 540 5

3 • 5- 1 1 M 3 3 3 _ 5815哭1 3 i 1 3 3 2 1 • 2 1 69 31 :• 2 2

16 吣 g

1. 1957 from the 1957 Iftilted Nations Deoogrmphlo 195* Census 2. 1957 Seocxid Meeting Antlmalarla Co-ordination : 6. 1949 EetiBate 1956 7. 1957 from estimate ia Eradioation Division) from the 1957 united N象tiene Denographlo (Vloe Minister of PubUo Health 21 October 1958) 1956 Сепяив 8. exoludlng Byelonus * Estlaat-ее by WHO

^il TABLE 2 (continued)

Present government Antiolpated budgets support for projeoted throu^i WHO, WHO/EA idiole UNICEF, ICA

Notes 10 U 12

AFRICA (ooDtlcued) 2 520252250905588520§250905588*35шт100100»209го»250§088諾310二100НЗ250778088593167288888488 0 819乓15102^^Ê^ÊS3941360959011 5 8 6 ^ss^ê^s 19 14 姒 姒姒11040 奂 ^ 1 .960 ¡28 4 2 ^ 225 13 1 388888848 1

M 625KN16C

-8 2 б25316 540404055 2

154 TanganyJL 8 8 姒4040吣 Togo (Autonomous Refubllo

of) 1 8 Uganda 5 1280 - Union of South Afrloa 1 Zanzibar and Pemba

Estimated cost of technical advisory services not by countries required from WHO H095905 789 Regional Office operating costs 128

149 342 132 96) 414 700 690 175 406 8)5 8 612 У1 ра«е 201

Í^495g725R • №

謅268^2270354103698890550遝384770^33196061928251765185雄 46.98 5 5 19361^16 11^ 26 荔680278160§250726147618 018704605061670512§15889517098115*9776111«29^ 1227 51392500020010019*1588009а57с53385001бо800а50омооо897570170203829298101 I 7 г 09628г2965880719105700878126 #1忑111U7152H259g196l ri |173 787451|^955385?35|\ ^479 — 如 埘s oí 5 «1 9 1959 只 oí 5 8 2 败 14799358194 奶热 L i 73- ?8 4 2 1 111 11 2 2 IH^°8794ao?0552613a5 76-64-54-7 二 6 32 332 11 ^ 1959 2 331 1 2 1411X51 38322532 2 2 1^1 2201 31 6 1 5 2 18 9 2 76 1 lw 6 m490a68x® 56 1 170 120 4 76-6 4 12 69 49 4 5 24 291

8 916

177 800 85 963 190 200 105 704 39 564 44 954 14 201 page 202 JI

Population Starting date Сошггу populAtlœ 959

g S §§05*16500000082700 5 210120902 059162069848430750113030 Й 1 荔盅諡309091 M 2 510 , 15810•20 抝 4 213 8 939284 100» 12 12 500 253 5 427 3 390 000 2 576 75 000 1959 518

6

a 70» 巧 500 1959 裘 971

9 15 ooo 6 28；

164

091

5*9 352 503 218 3J7 879 71 955 586 TABLE 5

Present Estimated Basis of Anticipated Shortfall to government Population duration Starting support for cost of budgets Total in of date required for operational governmental. technical projected advisory Remains Country population malarious eradication 油ere for »diole attack phase through WHO, WHO services (cents) vdiole /ТА required from 1959 UNICEF, ICA programme from WHO

1 Notes 2 4 5 6 7 8 9 10 11 12

$ 本 $ $ $ EUROPE С У 0 0 Albania 3 1 421 1 500 5 1 422 С У 1 422 0 1 Bulgaria 4 7 629 2 000 5 1 289 K N 8 1 281 6

Prance (Algeria) 8 198 0 8 198 3 9 800 3 OCX) 8 H

Greece 3 4 4 3 512 m 3 122 1^0 8 031 500 C M 590

Morocco 9 6i»8 3 1959 7 w 1 552 5 56O 158 500 8 112 H

Portugal 3 8 909 1 860 4 968 0 144 824 20 H 4 17 W 6 000 1 953 1 7钌 170 4 Rural Health Services of

activities other than malaria* Government support restricted to $ 1 763 Spain 1 29 杯31 8 000 5 - I 265 m 792 15 Turicey 24 797 8 577» 6 II 800 8 519 840 2 641 51 USSR 8 151 600 25 000 2 5 250 5 250 Yugoslavia 5 17 886 5 l8l 4 4 i»95 3 820 438 235 30

Estimated cost of technical advisory services not distributed by countries required from WHO 195

Regional Office Operating Costs 290

286 642 68 918 47 222 13 902 4 015 29 305 909 TABIE 6

Anticipated Shortfall t support for Ъ« covered by Country populAtion governnental, bilateral and 1959 multilateral

10 11 12 $127260103ê175841li219^^9127^§

315413333 6600004538813*71450118gm036300s02006050888655740 129348 的刃如4237抖扔刃27刃坫抝40253027513050 1 ж1861111846 66o 1 127 I960 400 25 620 103 17 600 588 14 482 2 7 000 149 1 024 1 83^ 4 837 1 185 1950 9 196^2152431 754 1 672 300 7 X5 430 5 8 1959 219 ICA and UNICEF support : 8 projected beyond i960 13 550 1 409 8 7斗 ООО 1960 146 91 995 8 Saudi Arabia 3 5 ООО I960 16 660 Som&lla (Italian) 3 w 255 8 624 226 UNICEF support not projected 1960 5 8 196З 43244 10 263 1 ^675$ 8 830 20 082 1961 77 136 2 76 069 4 666 I960 8 6 773 215 16 449 1959 370 2 726 10 657

distributed by countries required from WHD

Beglon&l Office Operating Costs

191 H9 144 507 258 216 32 397 15 803 210 016 3 912 VI TABIE '

Present Estimated Total funds Basis of Anticipated Shortfall to government duration Starting required estimation support for be covered by- Total budgets of date for whole for operational governmental, Country population projected eradication where programme attaok phase costs from bilateral and through known from I959 (cents) WHO, WHO/TA multilateral whole assistance programme UNICEF, ICA

Notes 8 10 11 12

WESTERN PACIFIC

1 Australia 3141112313355133152 Northern Territory 丨 9 ，§§583§800§203277700J17396904788076261034 § 45改?52356317B0620姒3016^30403010446054540刃40545403戈Г63政2459362唤打钩渐0 17明幻为 45130687817806932763162SI Queensland 592^^3 50 6 Brunei 1 30 6 3 1419421 988 4 1 380 572 ООО 3 519421 China (Republic of)⑷ ООО 3 444 725 Hong Kong 582 58 & Japan 850 9 Korea (Republlo Of) ООО» 8 I960 Laos 7 6 ООО 8 Macau 8 1 6 抓70050200500500200»8075001005C)o Malaya 18 8 9^1氺86<&5 Guinea 8 2 412 4 New Hebrides 58 North Borneo 2 1221 骂 Papua and New Guinea 4 2 517 4 I 8R Philippines 8 7 826 4 584 Portuguese Timor 74 Ryuku Islands 1959 8 Sarawak 9 500 450 178 Solomon Islands , ч 7 抝 Viet Nam (Republlo of)… 1959 5 б 055 4 283 184 ICA support not projected 3 beyond I963 of technical advisory services not distributed by oonntries required from WHO 5 1)2 Regional Office operating 1 378

188 016 067 91 752 16 205 10 614 64 913 7 280 (a) Concerning Mainland Chinai the latest information iriiloh might be out of date shows that out of a population of 600 millions, 100 millions s, whloh would represent an estimated oost of $ 240 millions for eradioation and $ 14 millions for teohnloal advisory services.

(b) Conoernlng Viet Nam (north)j the latest information, whloh might be out of date shows that out of a population of 14 millions, 10 millions live in malarious areas, whloh would represent an estimated oost of $ 24 millions for eradication and $1 million for teohnloal advisory servloes* 啦3/21 TABIE 8 page 206 GLOBAL PILOT AND PROJECTS AND CO-ORDINATION ACTIVITIES

Currency US dollars expressed In thousan

Anticipated support Present Government Estimated duration from WHO, WHOAA, Total cost of budgets projected Country of UNICEF and ICA for through whole period idiole programme whole period of 1959 of progranne from 1959

AFRICA 229645179忑^ British East Africa 83 312^171561954^1671412 Cameroons 306 French West Africa 567 521178 467 68 1165 138 125 Zanzibar 244 Inter-Country Programmes 412

998

Inter-Country Programmes 5 017 5 017

SOUTH-EAST ASIA

Inter-Country Progranmes 371 371

EUROPE

Prance (Algeria) 70 70 Inter-Country Prograone8

113 113 EB23/21 TAB££ 8 раде 207/208

壽104100558 1308100800 238

204

？ 862 5 862 OthT Activities

1 ООО 1 ООО

Total 丨585 15 717 19 302

Inter-regional Expert Coranltte Stu^ Groups Training centre Seminars VII. EPITOME OF ¥Ю EFFORT

A programme as extensive, ambitious, and dynamic as that of malaria eradication, based on techniques that are well known, but whose application must be planned in detail and carried out with chronological precision, requires an executive adminis- tration and a technical advisory support capable of responding to such a requirement.

Although every project has but one objective, namely malaria eradication, its operation, on a national scale, necessitates not only a large and devoted personnel, but, as a consequence of the logical diversification of activities, the advice, in every case, of well qualified experts. In the past it was possible for malariologists and entomologists to run a control or pilot project, in which the technical.orientation was the fundamental outlook, without help; modern malaria eradication projects need above all people with administrative gifts, able to direct, co-ordinate, supervise and assess extensive operations, involving a large body of man-power supplies, д transportation technical and administrative records• Por an operation in which # millions of houses must be sprayed regularly every year and millions of people must # be checked for epidemiological evaluation, it is easily understandable that the national services must be adequately staffed and the international advisory assistance -thoroughly organized.

Part II of the report gives the information by regions of this concentrated effort. Item 1.7 shows in a sketch map and a summary table the progress which has so far been made.

Until July 1957 all the malaria activities of the Organization were entrusted to a Malaria Section of the Division of Communicable Diseases in Headquarters, while the regional offices had, except in Europe, a regional malaria adviser; it was only in the Region of the Americas that the regional adviser was also the head of a malaria eradication office with a number of suitable co-workers•

a On 1 July 1957 Director of Malaria Eradication was appointed in Headquarters, and on 1 December of the same year a Division of Malaria Eradication was established under his direction; a second post of regional malaria adviser, together with posts of entomologist, and sometimes of sanitary engineer, were created for the regions cf Africa, Eastern Mediterranean, South-East Asia and Western Pacific. In the European Regional Office a malaria adviser was also appointed. In each region the adminis- trative and clerical help has been increased. In the Region of the Americas an even greater development of staffing was found necessary. ,,..

Technical Advisory Services

The vas trie s s of a global attack requires an organization of different levels, each one with its own peculiar functions.

At the country level, the day-to-day operational assistance provided requires nine different categories of professional staff: (1) malariologists, for the preparation of plans, for the general technical aspects, and particularly for epidemiological operations; (2) sanitary engineers, for spraying operations and related activities, transportation and supplies;⑶ entomologists, for allied operations, especially susceptibility tests; (4) parasitologists, for the organization of laboratories responsible for parasitological verifications and related techniques; (5) statisticians, for all matters related to statistical information, particularly case reporting and registration； (6) consultants in administrative methods, for the organization of the central and peripheral administrative offices and for advising on the most efficient and expeditious administrative methods within the framework of legislation and standards in force in each country; (7) specialists in transport management and vehicle maintenance, for all matters related to the proper operation of the transport system; (8) health educators, for the specific phases of education and information on the eradication programme； and (9) sanitary inspectors, responsible for co-operating in the peripheral organization of spraying and evaluation operations, and for advising on techniques for supervision of these operations. . The above personnel are also responsible for local training at the corresponding level and for the development and application of techniques for supervision and appraisal of the work, particularly of that still to be done. This scheme has reached its full development in the Americas and is being implemented in the other regions.

Particular mention should be made of the need for consultants in administrative methods. The most harmful influence on an eradication programme can be caused by wrong or inadequate administrative procedures. Many of the more malarious countries are still under-developed, and have under-developed administrations which cannot afford the necessary support to be given to a nation-wide and time-limited programme. Administrative assistance> therefore, is as essential as technical assistance.

At the regional levels, as has been stated above, malaria eradication units have been established and are now being strongly implemented; these units are responsible for the plaiming of projects, the supervision of country advisory teams, the regional co-ordination, and all the operational arrangements needed for country and inter-country programmes.

In the Region of the Americasj which is divided into zones, malaria eradication units have been established in some of the zones, with more or less similar duties.

At Headquarters the Division of Malaria Eradication is responsible for the co- ordination of the global attack, for supplying (through its own staff or special consultants) the highly technical assistance needed by the regions^ and for the promotion of technical standards, in addition to its other duties which are referred to below.

Training

Global malaria eradication calls for a wide and strong effort in training workers to reach a high standard of operational efficiency» Three new malaria training centres have been created in the Americas (Mexico, Jamaica and Sao Paulo, Brazil) in addition to the existing one in Venezuela. New training activities are in prooese of in^plexnentation in Cairo and Manila; facilities for training exist already in New Delhi and Teheran; the formation of four other centres is under study.

Special courses for national and international senior officers have been held in Amsterdam, Basle, Guatemala^ Port-au-Prince, London and Rome, followed by in- training service in eradication campaigns in various countries of Latin America, in Iran, Iraq, Tanganyika and Turkey. This has enabled the Organization and the Pan American Sanitary Board to complete, or nearly to complete, the staffing of the 3杯5 posts of international professional personnel now budgeted for all over the world. Most of the couses> though intended for international personnel, have been attended also by fellows sent by governments for their own malaria eradication services. Pilot and Research Projects

Information on these projects has been given in Parts III and IV. The status of vector resistance is quoted in Part V； these studies of paramount importance have been pursued with the collaboration of the Division of Environmental Sanitation and the Division of Communicable Diseases.

Promotion of Inter-regional Co-ordination

Expert committees and study groups have been convened at various times. The sixth ieport of the Expert Committee (Technical Report Serles No. 12^) has been considered as a "master guide" for malaria eradication programmes, and the seventh report (Vffl0/1VIal/210) which is bringing up to date sorae new technical key points, will be submitted for the consideration and approval of the Executive Board. With the same object of co-ordination, seminars have been organized on health education (May 1957 in Lima, Peru in collaboration with ICA), on laboratory techniques applicable to malaria eradication (July 1957 in Cali, Colombia), and on susceptibility and resistance of vectors to insecticides (New Delhi, February 1958, and Panama, June 1958).

Obviously malaria eradication in a country involves protection of its bordersí efforts must therefore be made to ensure that neighbouring countries will adopt eradication programmes in order not to endanger the success of eradication measures taken in countries adjacant to them. It is also Important that the experience of any one country in the technical or administrative aspects of eradication scheme should be made known to other countries. Since the historical resolution WHA8.50 of the Eighth World Health Assembly, the following inter-regional malaria conferences have been convened:

Second African Malaria Conference held in Lagos, 1955

Inter-regional Malaria Conference for Eastern Mediterranean and European Regions, 1956 (Athens)

Malaria Conference for Eastern and South Eastern Europe, 1957 (Yugoslavia)

Malaria Symposium in Bangkok, 1957

Inter-country meeting on malaria control and antimalaria co-ordination conferences, Indo-Burmese Border, December 1958. Many technical meetings have also taken place in the Region of the Americas between the Directors of the National Malaria Eradication Services; sessions of the Antimalaria Co-ordination Board for Viet Nam, Laos, Cambodia, Burma, Malaya and Thailand, as well as a session of the Borneo Xnter-territorial Conference, have been devoted to the co-ordination of antimalaria work.

Finally, mention should be made of the numerous and fruitful inter-agency staff meetings, held with the purpose of co-ordinating the efforts of bilateral and multilateral assistance in this gigantic project.

MESA Participation In WHO Effort

It was undoubtedly due to the Malaria Eradication Special Account that most of the increasing activities of WHO in the field of malaria could be realized; it is also thanks to MESA that the position of malaria eradication as "priority No, l" is being maintained. Obviously, therefore, the full implementation of this extensive programme depends upon the adequate support to MESA and the necessary assistance to country projects by WHO and other agencies.

If such financing is not adequate, some programmes already started must be interrupted; the funds already invested in them would be wasted and the whole scope of this ambitious project might collapse. Furthermore, the danger of the develop- ment of resistance to insecticides in the vector would increase the drawbacks of such interruptions, making harder, longer and much more expensive the struggle against this scourge of mankind.