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Clinical and epidemiologic surveillance of malaria cases and deaths is required to follow the progress of the reinvigorated malaria control programs nationally and internationally. Current recording, transmittal, analysis, feedback, and use of malaria surveillance information is delayed and imprecise: substantially < 10% of the malaria cases and deaths are being reported. Improvements are occurring, but more emphasis should be placed on prompt, accurate diagnosis, patient management, and recording of clinical manifestations at hospitals. Neurologic signs, severe anemia, metabolic changes, hyperparasitemia, and concurrent sepsis are medical emergencies and require proper clinical and laboratory detection; equipment, reagents, supervision, and certification of laboratorians and clinicians are necessary. Birth weight should also be a major measure of progress in malarial control and overall prenatal care. Although malaria is the most frequent diagnosis at outpatient clinics and hospitals in Africa, co-existing conditions also mandate improved diagnosis, treatment, and registration. Monthly transmittal of information from health units and collation, analysis and feedback through electronic reporting systems using modern information technologies are necessary for resource planning and staff motivation. Denominators to compute rates of illness and death require accurate censuses of communities from which patients come to health units: specialized disease and demographic household surveys designed and performed by nationals are needed to complement hospital-based numerator data. Plasmodium falciparum and P. vivax should be distinguished in the laboratory; the former causes the greatest mortality but the latter is increasingly recognized as a major peril. Because vector control is now a major component of all malaria control programs, there is an urgent need to monitor anopheline sensitivity to insecticides and entomologic inoculation rates. Where interrupting transmission is a goal, parasite rates in groups at greatest risk should be performed. Continual monitoring of plasmodial sensitivity to drugs is necessary using WHO protocols. Human, entomological, and parasitological surveillance must be performed at the same time in the same places and the information shared widely and used for improving control strategies and tactics. These surveillance priorities require training, provision of equipment, supervision, and commitment to sustainability by national authorities and international collaborators and donors.
Received October 19, 2007. Accepted for publication October 19, 2007.
Acknowledgments: The authors thank Dr. Richard Cibulskis, Dr. Colin Mathers, Dr. Ellis McKenzie, Mr. Etienne Minkoulou, Dr. Magda Robalo, and Dr. Nicholas White for useful comments. Dr. Martin Weber kindly contributed the photo of a patient with conjunctival pallor, Figure 4.
* Address correspondence to Joel G. Breman, 16 Center Drive, Fogarty International Center, Bethesda, MD 20892. E-mail: jbreman{at}nih.gov
Authors’ address: Joel G. Breman and Cherice N. Holloway, Building 16, Room 214, 16 Center Drive, MSC 6705, Bethesda, MD 20892. Tel: 301-496-0815, Fax: 301-496-8496, E-mail: jbreman{at}nih.gov.
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  J. G. Breman, M. S. Alilio, and N. J. White Defining and Defeating the Intolerable Burden of Malaria III. Progress and Perspectives Am J Trop Med Hyg, December 1, 2007; 77(6_Suppl): vi - xi. [Full Text] [PDF]
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