Ministry of Public Health History of Malaria Treatment History of Malaria Treatment in Madagascar in Madagascar Milijaona RANDRIANARIVELOJOSIA Milijaona RANDRIANARIVELOJOSIA, PhD, HDR , PhD, HDR ARTEMISININ CONFERENCE 2010 Joint WHO/RBM/MMV meeting Joint WHO/RBM/MMV meeting Supported by DFID, UK Artemisinin – The Future 12 th – 14th October 2010 in Antananarivo, Madagascar
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History of Malaria Treatment in Madagascar · History of Malaria Treatment in Madagascar ... Evolution de la population à Madagascar. Travaux et Documents, n°5, ... Vector Malaria
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Ministry of Public Health
History of Malaria TreatmentHistory of Malaria Treatment
12th – 14th October 2010 in Antananarivo, Madagascar
Origin of malaria in Madagascar:Origin of malaria in Madagascar:linked to the human population settlementlinked to the human population settlementlinked to the human population settlementlinked to the human population settlement
Origin of the human population Origin of the human population in the southin the south--western part of the western part of the
I di OI di OIndian OceanIndian Ocean
On the basis ofOn the basis of-- laguagelaguage-- agricultural practiceagricultural practice-- archeological dataarcheological data-- archeological dataarcheological data-- genetic studygenetic study-- traditional habittraditional habit
Source : Biodiversité Source : Biodiversité du paludisme dans le mondedu paludisme dans le monde
“Malaria” known by Malagasy“Malaria” known by Malagasy
(page 73)(page 73)
Tazo Tazo (fever, chill, headache, fatigue …) (fever, chill, headache, fatigue …) is not only malariais not only malaria
Malaria history in Madagascar: Malaria history in Madagascar: myth, legend and realitymyth, legend and reality
InIn thethe pastpast
OralOral traditiontradition priorprior toto thethe EuropeanEuropean arrivalarrival
AA powerfulpowerful QueenQueen saidsaid :: ““HazoHazo (trees)(trees) andand tazotazo (fever)(fever) areare thethe protectionprotectionff thth ki dki d DD tt thth d”d”ofof thethe kingdomkingdom.. DoDo notnot openopen thethe road”road”
Madagascar,Madagascar, cemeterycemetery forfor EuropeansEuropeans inin thethe pastpastFeverFever asas killerkiller inin thethe costalcostal areasareas asas inin XVIXVI centurycenturyFeverFever asas killerkiller inin thethe costalcostal areasareas asas inin XVIXVI centurycenturyFeverFever asas killerkiller duringduring thethe FrenchFrench militarymilitary campaigncampaign inin 18951895
Si h h d lSince the XX century: much more modern tools tocombat malaria in Madagascar
People naturally live with malaria in MadagascarPeople naturally live with malaria in MadagascarPeople naturally live with malaria in MadagascarPeople naturally live with malaria in Madagascar
TreatmentTreatmentTraditionalTraditional medicinemedicine:: plants,plants, exorcism,exorcism, prayersprayersTraditionalTraditional medicinemedicine:: plants,plants, exorcism,exorcism, prayersprayersModernModern drugdrug inin:: selfself medicationmedication atat home,home, recommendedrecommendedinin--homehome managementmanagement ofof fever,fever, massmass treatment,treatment, healthhealthf ili if ili i i ii i iifacilities,facilities, intermittentintermittent preventivepreventive treatments,treatments, ……
Madagascar Madagascar priorprior to the XX to the XX centurycentury : far : far awayawaygg pp yy yy
World Malaria Report 2008, WHO/HTM/GMP/2008.1World Malaria Report 2008, WHO/HTM/GMP/2008.1
Evolution of history of malaria treatment in Evolution of history of malaria treatment in Madagascar: linked to natural and political history ofMadagascar: linked to natural and political history ofMadagascar: linked to natural and political history of Madagascar: linked to natural and political history of
Evolution of the malaria treatment in MadagascarEvolution of the malaria treatment in Madagascar
Traditional medicine (plants)
Q i i d Ci h l t tiQuinine and Cinchona plantation
CQ followed by synthetic drugs
Remedies and drugs
Selective Cure and
1 1980 200519451900 2011
Treat empirically Selective cure
Cure and prevent
Time line1 1980 200519451900 2011
Evolution of Malagasy population Evolution of Malagasy population between 1900 and 2005 between 1900 and 2005 (X1000)(X1000)( )( )
ddDDT and DDT and ChloroquineChloroquinemassive usemassive use
Gastineau B., Rakotoson L. (2005). Evolution de la population à Madagascar. Travaux etDocuments, n°5, Programme 4D, Institut Catholique de Madagascar et IRD, 14p., Antananarivo.
1980s : last malaria outbreak in Madagascar1980s : last malaria outbreak in MadagascarWhy did it happen ?Why did it happen ?Why did it happen ?Why did it happen ?
SinceSince 19451945 ::CQCQ toto treattreat andand toto preventprevent malariamalaria
ll ll DDTDDT i di d ii ((19491949))++ largelarge scalescale DDTDDT indoorindoor sprayingspraying ((19491949))
19521952 –– 19711971 ::CQCQ forfor chemoprophylaxischemoprophylaxis inin childrenchildrenQQ p p yp p y
19801980ss ::malariamalaria outbreaksoutbreaks (increasing(increasing malariamalariath h tth h t thth tt ithith f t lf t lcasescases throughoutthroughout thethe country,country, withwith moremore fatalfatal
casescases inin thethe highland)highland)
Evolution of the malaria treatment in MadagascarEvolution of the malaria treatment in Madagascar
Traditional medicine (plants)
Q i i d Ci h l t tiQuinine and Cinchona plantation
CQ followed by synthetic drugs
Generic CQ
Remedies and drugs
Selective Cure and Epidemy
1 1980 200519451900 2011
Treat empirically Selective cure
Cure and prevent
Epidemycontrol
Time line1 1980 200519451900 2011
1980s : last malaria outbreak in Madagascar1980s : last malaria outbreak in MadagascarHow was organized the repost against it ?How was organized the repost against it ?How was organized the repost against it ?How was organized the repost against it ?
Chloroquinisation campaignChloroquinisation campaign (intensive in 1988/89)(intensive in 1988/89) and DDTand DDT
Sign attached to announce the sale ofchloroquine during the chloroquinisationcampaign to respond to the last malaria epidemicin Madagascar. (Milijaona & Donatien, 2005)
Recent use of Recent use of chloroquinechloroquine in Madagascarin Madagascar
Massive distribution of Massive distribution of chloroquinechloroquine for infor in--home management of home management of feverfever in children since 2003in children since 2003feverfever in children since 2003in children since 2003
ComorosComoros (>70%)(>70%)Low prevalence of Low prevalence of pfcrtpfcrtmutantmutant P falciparumP falciparum
History of Malaria Treatment in Madagascar:History of Malaria Treatment in Madagascar:
What is next ?What is next ?What is next ?What is next ?
Key for malariaKey for malaria eliminationelimination in Madagascarin MadagascarKey for malaria Key for malaria eliminationelimination in Madagascarin Madagascar
VectorVectorAutochthonous or importedAutochthonous or imported
ACTsACTsNets (LLIN)Nets (LLIN)
Indoor sprayingIndoor spraying
HumanHuman
DiagnosisDiagnosisp y gp y g
«« It It isis time for time for artemisininartemisinin »»
BionexxBionexx banner banner promotingpromoting Artemisia annuaArtemisia annua cultivationcultivationwithwith a a specialspecial focus on focus on outgrowersoutgrowers
I I dedicatededicate thisthis talk totalk to
Mrs Marcelline Mrs Marcelline RazanamparanyRazanamparany(former(former presidentpresident of theof the RedRed Cross)Cross)(former (former presidentpresident of the of the RedRed Cross)Cross)
for the for the successfulsuccessful chloroquine chloroquine campaigncampaignqq p gp gsheshe ledled in rural areas (1950 in rural areas (1950 –– 1971) 1971)
sheshe savedsaved life for millions of life for millions of childrenchildren
93 yrs in 2005
Ministry of Public Health
History of Malaria TreatmentHistory of Malaria Treatment