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Integration Bill Brieger | 28 May 2010 11:52 am

Tropical diseases need an integrated approach

A common critique of the Global Fund to Fight AIDS, TB and Malaria is that there are other major contributors to the burden of disease in tropical countries.  Some are infectious like pneumonia while others are non-communicable like injuries.

dscn1225sm.JPGFrom the standpoint of malaria, integration makes sense. From the start, the Roll Back Malaria Partnership made it clear that malaria control (end eventual elimination) could not succeed unless health systems were strengthened. These are the same systems that are supposed to control filariasis, helminthic diseases, diarrheal diseases, and pneumonia as well as promote maternal health, child growth and development as well as immunization programs. It was a weak health system that contributed to the failure of the first effort to eradicate malaria fifty years ago.

Two recent articles exemplify the need for integrated prevention and control services because tropical communicable diseases themselves are ‘integrated’ into the environment and the human host.

Abraham Degarege and colleagues examined Malaria and helminth co-infections in outpatients at Alaba Kulito Health Center in southern Ethiopia. Fifty-four percent of patients having malaria parasites also had at least one of three helminth infections including hookworm, A. lumbricoides and/or T. trichiura. Those with both worms and malaria (P. falciparum and/or P. vivax) had higher rates of anemia. These negative synergies require an integrated approach to patient management as well as to community prevention programs.

Marcia C. Castro and her co-researchers looked into local water sources for larval development of lymphatic filariasis and malaria vectors in Dar es Salaam, United Republic of Tanzania. Larvae of both anopheles and culex species were found in puddles, swamps, mangrove swamps, drains/ditches, human-made holes, water storage, agriculture, rivers/streams, and ponds.

Polluted urban environments are less conducive to anopheles breeding, and culex were more likely to be found in all these urban sites in Dar es Salaam, especially in drains/ditches, but again in this environment both types were found, meaning that both filariasis and malaria ‘co-existed’. Integrated control through larviciding and ITNs would help prevent both diseases.

If basic health services are well funded, staffed and supplied, no tropical disease needs to be neglected.

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