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Malaria and lymphatic filariasis: the case for integrated vector management

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Summary

The global programmes to eliminate both malaria and lymphatic filariasis are facing operational and technical challenges. Available data show that the use of treated or untreated bednets and indoor residual spraying for malaria control concomitantly reduced filarial rates. In turn, mass drug administration campaigns against lymphatic filariasis can be combined with the distribution of insecticide-treated bednets. Combining these disease control efforts could lead to more efficient use of resources, more accurate attribution of effects, and more effective control of both diseases. Systematic integration requires coordination at all levels, mapping of coendemic areas, and comprehensive monitoring and evaluation.

Introduction

Several groups have advocated combining control efforts for malaria with those for neglected tropical diseases, lymphatic filariasis in particular.1, 2, 3, 4, 5 Malaria, caused by protozoa of the genus Plasmodium, and lymphatic filariasis, caused by the nematodes Wuchereria bancrofti, Brugia malayi, and Brugia timori, overlap in their distribution in most of Africa, south and southeast Asia, and some parts of Latin America.6, 7 Similarities exist between malaria and lymphatic filariasis in relation to their transmission: both diseases may be transmitted by the same or related vector species, both are potentially controlled by the same vector-control interventions, both have no or almost no hosts other than human beings, and both prevail under conditions of poverty and poor environmental sanitation.

Malaria and lymphatic filariasis cause the highest global burdens of all vector-borne diseases, particularly in Africa and southeast Asia (table 1).7, 8, 9, 10, 11 Malaria is transmitted by Anopheles species in all regions, whereas regional differences exist in the mosquito genera that transmit filarial parasites. In much of Africa and parts of the western Pacific (eg, Papua New Guinea), the anopheline vectors of malaria are also the principal vectors of lymphatic filariasis.12 Culex quinquefasciatus is an important vector in urban areas of east Africa, but in west Africa this species is considered refractory to infection with W bancrofti.13 Elsewhere, members of the Culex pipiens complex (predominantly C quinquefasciatus) and Aedes species are the principal vectors of lymphatic filariasis.7, 11

Integrated vector management is promoted by WHO as the best approach to improve the efficacy, cost-effectiveness, ecological soundness, and sustainability of vector control.14 To achieve integration, vector control should be based on local evidence, adopt a multidisease approach, and combine interventions wherever appropriate and feasible. In its implementation, integrated vector management depends on collaboration between health-sector programmes, other sectors, and communities.15, 16 Here we aim to substantiate a recent statement by WHO on integrated vector management to control malaria and lymphatic filariasis17 by summarising available evidence and suggesting the way forward.

Section snippets

Two global programmes and their challenges

The history of global programmes for the control of malaria and filariasis shows that the emphasis on vector control or drugs changes over time. Vector control, primarily through indoor residual spraying with DDT (dichlorodiphenyltrichloroethane) and dieldrin, was central in the first malaria eradication campaign (1955–69), but lost its significance as financial and technical constraints put eradication out of reach; eradication of malaria was never attempted in sub-Saharan Africa.18, 19, 20

Programme interactions

Vector control to prevent transmission of malaria parasites and mass drug administration to prevent transmission of microfilariae are two strategies that can affect several diseases. Vector control can reduce vector–human contact for more than one disease, particularly where malaria and lymphatic filariasis have the same principal vectors. Mass drug administration campaigns can facilitate the improvement of vector control if linked with the distribution of LLINs.1 In central Nigeria, this

Evidence of combined effects

Several studies have documented the outcome of integrated control of malaria and lymphatic filariasis (table 2).45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55 In some studies, the integration was deliberate; in others, vector control interventions intended for malaria control inadvertently affected lymphatic filariasis. In most reported instances, both diseases had the same anopheline vectors.

In the Solomon Islands, where both diseases had anopheline vectors, indoor residual spraying with DDT

Towards integration

Malaria and lymphatic filariasis have much in common in terms of their geographical distribution, transmission biology, and mutual interactions. Moreover, the global programmes to contain them have matching goals, strategies, and challenges.8, 25 Integration would be required at the level of communities, districts, ministries, and donors.16 The prospects for integration are contingent on the local context of disease epidemiology, vector ecology, and a country's operational capacity. Therefore,

Search strategy and selection criteria

We searched PubMed and Scopus for articles published from 1960 to May, 2012. Studies were identified using search terms “malaria” and “Wuchereria” or “Brugia”. References from the retrieved articles were used to identify other relevant publications that were not identified from the database searches. Each article written in English was assessed for its methodological quality and the relevance of its results.

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