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ACTIVITY REPORT No. 60 Malaria in the Peruvian Amazon: A Review of the Epidemiology, Entomology, and Insecticide Resistance of Vectors March 1999 by Andrew A. Arata; Trenton K. Ruebush II, Charles H. Porter, John D. Stein; L Philip Lounibos; and Darjaniva Molina de Fernández Prepared for the USAID Mission to Peru under EHP Activity No. 353-CC Environmental Health Project Contract No. HRN-5994-C-00-3036-00, Project No. 936-5994 is sponsored by the Bureau for Global Programs, Field Support and Research Office of Health and Nutrition U.S. Agency for International Development Washington, DC 20523 TABLE OF CONTENTS ABOUT THE AUTHORS................................................................................................................................................v ACRONYMS .....................................................................................................................................................................vii FOREWORD ........................................................................................................................................xi Andrew A. Arata Background xi Objectives ...........................................................................................................................................................................xii Tasks....................................................................................................................................................................................xii Task 1: Epidemiology: Diagnosis and Treatment of Malaria............................................................................xiii Task 2: Entomological Aspects of Malaria Transmission..................................................................................xiii Task 3: Vector Susceptibility or Resistance to Insecticides Used for Malaria Control .................................xiv Tables 1 Malarious Areas in Peru at High Risk of Transmission and Control Priorities, 1997..............................xii 2 Preliminary Summary Results of Insecticide Susceptibility Trials in Northern Peru ..............................xiv Map: Peru and Neighboring Countries ......................................................................................................................ix PART 1: EPIDEMIOLOGY: DIAGNOSIS AND TREATMENT OF MALARIA Trenton K. Ruebush Charles H. Porter John D. Stein EXECUTIVE SUMMARY ........................................................................................................................................... 1-3 1 BACKGROUND .................................................................................................................................................... 1-5 2 ACTIVITIES............................................................................................................................................................ 1-7 3 OBSERVATIONS/FINDINGS.......................................................................................................................... 1-9 3.1 Current Malaria Situation in Loreto Region ................................................................................................. 1-9 3.2 Organization of Malaria Control Activities ................................................................................................ 1-10 3.3 Diagnosis.......................................................................................................................................................... 1-11 3.4 Treatment......................................................................................................................................................... 1-13 3.5 Epidemiologic Surveillance........................................................................................................................... 1-14 3.5.1 Passive case detection (PCD) ........................................................................................................ 1-14 3.5.2 Active case detection (ACD) ......................................................................................................... 1-15 3.6 Health Information System for Malaria ...................................................................................................... 1-15 3.7 Influence of Residents= Behavior on Malaria Transmission..................................................................... 1-16 3.8 Entomologic Observations ........................................................................................................................... 1-17 3.8.1 Adult mosquitoes............................................................................................................................. 1-17 3.8.2 Larval stages ..................................................................................................................................... 1-17 3.9 Vector Control Activities .............................................................................................................................. 1-18 i 4 CONCLUSIONS AND RECOMMENDATIONS........................................................................................ 1-21 4.1 General Comments ........................................................................................................................................ 1-21 4.2 Case Management/Epidemiology................................................................................................................ 1-21 4.3 Entomology/Vector Control........................................................................................................................ 1-23 5 PRINCIPAL CONTACTS .................................................................................................................................. 1-25 APPENDICES A Weekly Register of Immediately Notifiable Diseases....................................................................................... 1-27 B Monthly Operational Record for Malaria........................................................................................................... 1-31 C Malaria Patients Receiving Different Treatments by Drug and P.f./P.v. ....................................................... 1-35 D Weekly Malaria Summary...................................................................................................................................... 1-43 FIGURES 1 Malaria Cases and Blood Smears - Peru 1960-96................................................................................................ 1-5 2 Population and Malaria Cases - Peru and Loreto Region 1960-96................................................................... 1-6 3 Cases of P. falciparum and P. vivax - Loreto Region, Peru 1990-96 ................................................................... 1-6 4 P. falciparum Cases by Week - Loreto Region, Peru 1995-97 ........................................................................... 1-10 5 Organogram, Ministry of Health, Peru............................................................................................................... 1-12 MAP: Rural Localities along the Rio Nanáy ............................................................................................................ 1-8 PART 2: ENTOMOLOGICAL ASPECTS OF MALARIA TRANSMISSION L. Philip Lounibos 1 PURPOSE OF THIS CONSULTANCY............................................................................................................ 2-3 2 ACTIVITIES............................................................................................................................................................ 2-5 3 OBSERVATIONS, PERSPECTIVES, AND RECOMMENDATIONS .................................................... 2-7 3.1 Vector Biology .................................................................................................................................................. 2-7 3.1.1 Taxonomy in relation to malaria transmission .............................................................................. 2-7 3.1.2 Ecology................................................................................................................................................ 2-8 3.1.3 Behavior .............................................................................................................................................. 2-9 3.1.4 Incrimination and competence...................................................................................................... 2-10 3.2 Vector Control ................................................................................................................................................ 2-10 3.2.1 Control versus eradication.............................................................................................................. 2-10 3.2.2 Impregnated bednets....................................................................................................................... 2-11 3.2.3 Larval control ................................................................................................................................... 2-11 3.2.4 Adult spraying .................................................................................................................................. 2-11 3.2.5 Interventions, designs, and experiments...................................................................................... 2-11 3.3 Manpower and Resources 3.3.1 Personnel..........................................................................................................................................