Hewitt Sean, Delacollette Charles, Poirot Eugenie
VBDC Consulting Ltd, Llandysul, United Kingdom.
Southeast Asian J Trop Med Public Health. 2013;44 Suppl 1:249-305; discussion 306-7.
The malaria burden in the Greater Mekong Subregion has been dramatically reduced over the last 20 years but the disease remains an important public health issue in all six countries. This chapter introduces the standard tools for malaria control (long lasting insecticidal nets; indoor residual spraying; early diagnosis and appropriate treatment; epidemic surveillance and response; and, communication) and presents the evidence base supporting the use of each of these tools in the Subregion. Targeting approaches and delivery mechanisms for these tools are presented and discussed country by country. The technical limitations of these standard tools and delivery mechanisms are then discussed in the context of local variations in the epidemiology of the disease. The challenges presented by the feeding and resting habits of local vectors, by the characteristics and behavior of different human population groups, and by particular species and drug resistant strains of malaria parasites are considered. A range of innovative tools and delivery mechanism that have been developed to address these problems are presented and moves to bring these various innovations together to provide a comprehensive package of malaria control services for each risk group are discussed. Implementation arrangements are introduced and an overview of the stakeholder landscape at regional and country level is provided. Finally, remaining programmatic gaps (which include limited coverage, declining funds, drug resistance, weak surveillance and weak health systems) are highlighted and areas in need of further action (including the need for continued innovation) are discussed.
在过去20年里，大湄公河次区域的疟疾负担已大幅减轻，但在该区域所有六个国家中，疟疾仍是一个重要的公共卫生问题。本章介绍了疟疾控制的标准工具（长效驱虫蚊帐、室内滞留喷洒、早期诊断和适当治疗、疫情监测与应对以及宣传），并阐述了支持在该次区域使用这些工具的证据基础。逐国介绍并讨论了这些工具的靶向方法和交付机制。然后，结合该疾病流行病学的局部差异，讨论了这些标准工具和交付机制的技术局限性。考虑了当地病媒的摄食和栖息习性、不同人群的特征和行为以及疟原虫的特定种类和耐药菌株所带来的挑战。介绍了为应对这些问题而开发的一系列创新工具和交付机制，并讨论了如何将这些不同的创新整合起来，为每个风险群体提供全面的疟疾控制服务包。介绍了实施安排，并概述了区域和国家层面的利益相关方情况。最后，强调了剩余的规划差距（包括覆盖范围有限、资金减少、耐药性、监测薄弱和卫生系统薄弱），并讨论了需要进一步采取行动的领域（包括持续创新的必要性）。
