Rakotonjanabelo L A
Service de la lutte contre le paludisme, ministère de la Santé publique, Antananarivo, Madagascar.
Sante. 1995 Nov-Dec;5(6):358-62.
Malaria remains one of the major public health problems in Madagascar. For malaria, most of the eco-epidemiological facies of the African continent are found on this large island because of its geo-climatic diversity. These include the subequatorial facies on the east coast, the tropical facies on the west coast, the high-altitude tropical facies in the center and the subdesert facies in the south. In the first two facies, the stable type of malaria is encountered, where the major vectors are A. gambia and A. funestus. In the other two facies, the transmission of the disease is highly unstable yet causes deadly epidemics, principally from A. arabiensis. Malaria is even imported to a few inhabited zones situated above 1,500 m in altitude and to the centers of the large cities. The strategies of the fight against malaria consist of the following; early and correct health care of the cases throughout the country, supported by the community; drug prophylaxis for the target group of pregnant women; and eradication of adult insects in the central highlands, supported by an efficient surveillance. The utilization of mosquito bed nets impregnated with insecticide has not yet gone beyond the trial period. However, despite the efforts undertaken and the expenses run through by the national program, the fight against malaria is still far from covering the entire population. The high costs of spraying within the homes, the expanse of the country and the poor accessibility of many regions during the season of transmission, and insufficient sanitary coverage of the rural population in terms of quality and quantity, constitute the principal constraints of the fight. The current reorganization of the health service in Madagascar constitutes a favorable opportunity to establish a new approach for the fight against malaria. This is geared towards the participation of the decentralized health structures and the contribution of the community in the conception and the achievement of their respective strategies for the fight, supported by the central Service of the Fight Against Malaria. This new decentralized approach seems more appropriate to respond to the demands of the specific and selective strategies of the fight, better adapted to the different facies described above, and to render the National Program of the Fight Against Malaria more efficacious.
疟疾仍然是马达加斯加主要的公共卫生问题之一。由于其地理气候的多样性，非洲大陆的大多数生态流行病学类型在这个大岛上都能找到。这些类型包括东海岸的赤道附近类型、西海岸的热带类型、中部的高海拔热带类型以及南部的亚沙漠类型。在前两种类型中，会遇到稳定型疟疾，主要病媒是冈比亚按蚊和富氏按蚊。在另外两种类型中，疾病传播极不稳定，但会引发致命疫情，主要由阿拉伯按蚊引起。疟疾甚至还传入了一些海拔1500米以上的有人居住地区以及大城市的中心地带。疟疾防治策略包括以下几点：在全国范围内对病例进行早期且正确的医疗护理，并得到社区支持；对孕妇这一目标群体进行药物预防；在高效监测的支持下，根除中部高地的成年蚊虫。使用浸有杀虫剂的蚊帐尚未超出试验阶段。然而，尽管国家项目付出了努力并投入了资金，但疟疾防治工作仍远远未能覆盖全体人口。室内喷洒成本高昂、国家地域广阔且在传播季节许多地区交通不便，以及农村人口在卫生覆盖的质量和数量方面不足，构成了防治工作的主要制约因素。马达加斯加目前的卫生服务重组为建立新的疟疾防治方法提供了有利契机。这一方法旨在让分散的卫生机构参与进来，并让社区在制定和实施各自的防治策略中发挥作用，由中央疟疾防治服务机构提供支持。这种新的分散式方法似乎更适合应对针对性和选择性防治策略的要求，更能适应上述不同类型，从而使国家疟疾防治项目更有效。
