Larval Source Management: A Supplementary Measure for Malaria Control
Malaria, a parasitic disease transmitted by female Anopheles mosquitoes, has for millennia been a major cause of human illness and death. The disease remains a significant global public health problem, with over 3.4 billion people at risk and 627,000 estimated deaths in 2012. Renewed international attention has led to great progress in controlling malaria in the last decade, with an increase in foreign disbursements from less than $100 million in 2000 to $1.97 billion in 2013. This has precipitated huge campaigns to distribute long-lasting insecticidal nets (LLINs) and to conduct indoor residual spraying (IRS) of homes; both highly effective methods of control that target the adult malaria mosquito vector. These interventions have helped reduce global malaria mortality by a quarter since 2000, and malaria is now declining in many endemic countries in sub-Saharan Africa and elsewhere. However, maintaining these gains is challenging given the shortfall in funding for malaria control, together with resistance to drugs and insecticides in the malaria parasite and mosquito vectors, which could render LLINs, IRS and artemisinin combination therapies, our first line antimalarial drugs, less effective. Firstly, funding for malaria control has consistently fallen short of the $5–6 billion required annually, reaching only $2.5 billion in 2012, and international disbursements have now levelled. This is worrying since budget shortfalls have caused malaria control programmes to fail in the past. Secondly, the emergence of mosquitoes resistant to pyrethroids (the only insecticide currently available for impregnating bednets) and all three additional classes of insecticide available for IRS is concerning since replacement chemicals have not yet been approved. Thirdly, parasite resistance to artemisinin has emerged in South-East Asia and is likely to spread globally. Additional methods for controlling malaria are increasingly needed in light of these challenges. An effective supplement could be to target mosquito larvae, an intervention known as larval source management (LSM). This article will assess the potential of LSM to contribute to malaria control today and in the future. Specifically, it will examine (1) how LSM is undertaken, (2) its effectiveness and (3) its potential role in malaria control.
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Document Type: Regular Paper
Publication date: February 1, 2014
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