03 May 1996
ADMINISTRATIVE ORDER
No. 12 series 1996
IMPLEMENTING GUIDELINES ON SUSTAINABLE PREVENTIVE AND
VECTOR CONTROL MEASURES OF THE MALARIA CONTROL PROGRAM
The Philippines was among
the 96 member countries of the World Health Organization (WHO) which indorsed
the New Global Malaria Control Strategy. This was adopted during the
Ministerial Conference on Malaria in Amsterdam, Netherlands last October 1992.
The essential elements of the Strategy include Sustainable Preventive and
Vector Control Measures.
In response to this
commitment, the Department of Health, through the Malaria Control Service
(MCS), conducted a series of Consultative Meetings to come up with the
implementing guidelines. The participants were the MCS staff, the Malaria
Coordinators, the Assistant Provincial Health Officers and the WHO Consultants.
I. DEFINITION
Sustainable
Preventive and Vector Control Measures refer to the adoption of measures for
the prevention and control against the malaria parasite and the mosquito
vector, which are affordable, applicable and appropriate under our local
conditions so that these measures can be sustained throughout the duration of
malaria control operations.
These
control measures are applied in the appropriate endemic areas in accordance
with the following stratification criteria:
A. Type “A”
area
Has
a Parasite Rate in children 10 years old and below of ≥2%; is mountainous and
forested; and with temporary/makeshift houses, cultural minorities, seasonal
population movement and agriculturally – less developed
B. Type “B”
area
Has
a Parasite Rate in children 10 years old and below of ≥2%; is in the forest
fringes, plains or coastal areas; and with more or less permanent houses and
agriculturally developed.
C. MEPA
(Malaria Epidemic Prone Area) is any
area with a Parasite Rate in children 10 years old and below of ≥2%.
II. OBJECTIVES
A. To reduce the source of infection in the human
population
B. To reduce the man – vector contact
C. To reduce the density of the mosquito vector
population
III. GUIDELINES
A. On
Chemoprophylaxis
1. Drugs are given as a preventive measure to residents (from
non–endemic areas) who are visiting malaria endemic areas; otherwise, this is
not recommended.
2. Only Chloroquine drugs should be given, to be taken at
weekly intervals, starting from 1–2 weeks before entering the endemic area and
continued unto 4–6 weeks after leaving the area. In pregnant women, it is given
starting on the 4th month of pregnancy.
3. The following table if the Chemoprophylaxis Treatment
Schedule Guide
Age in years Chloroquine
(150 mg base / tablet)
0 – 4 ½
tablet
5 – 8 1
tablet
9 – 12 1
½ tablet
Over 12 2
tablets
4. This can be performed by the Field Assistance Worker
(FAW), the Rural Health Midwife (RHM) or the Municipal Malaria Coordinator
(MMC) in their respective areas of coverage – at the Main Health Center (MHC),
at the Barangay Health Station (BHS) or in the field.
B. On
Insecticide – Treatment of Mosquito Net
1. Mosquito nets are soaked in an insecticide solution
and allowed to dry, and used as a protective measure against the vector
mosquito while asleep at night.
2. The coverage includes all malaria–endemic areas with
priority implementation give to type “A” and type “B” areas, based on
stratification guidelines.
3. The insecticide shall be provided by the Malaria
Control Service (MCS).
4. The MMC or the FAW shall inform the barangay leaders
who, in turn, shall inform their respective communities, on the schedule of
this activity.
5. This shall be undertaken by the MMC, FAW or any MCP
personnel every 6 months at the BHS, barangay hall or any selected place.
6. The mosquito net shall be secured by the respective
household owners. Those who are unable to do so can make a request from the
barangay leaders how to obtain them. Regarding this, the MCS has allocated and
provided guidelines to the RFOs for the distribution of mosquito nets as seed
investment for the different malaria–endemic provinces. The LGUs, in their
respective areas of jurisdiction, shall collaborate with the MCP personnel
concerned regarding the distribution process. It is suggested that they develop
financial schemes or income–generating activities to enable the community to
provide mosquito nets for all households.
7. The household owners within the catchment malaria–endemic
areas shall bring their respective mosquito nets to the designated place at the
scheduled dated for the mosquito net treatment.
C. On House
Spraying
1. Insecticide is applied to the indoor surfaces of the
house through spraying.
2. Based on the Stratification, this is undertaken in
type “B” areas only; while Focal Spraying is done in MEPA areas where epidemics
have occurred and upon discretion of the provincial MCP Unit. This can also be
done in other areas during epidemics upon the discretion of the provincial
Epidemic Team.
3. The insecticide and spray equipment shall be provided
by the MCS, through the provincial MCP unit.
4. The MMC or the FAW shall inform the barangay leaders
who, in turn, shall inform their respective communities on the schedule of this
activity, including the target areas & houses.
5. This shall be undertaken by the FAW or any MCP
personnel who will visit all targeted houses within the barangay on at least 1–cycle
basis each year and should be completed before the peak of transmission in the
area concerned.
6. The household owners shall be encouraged by the
barangay leaders to submit their houses for spraying; they shall be instructed
by the sprayman on the precautionary measures before and after spraying the
house.
7. The LGU shall provide assistance to the spray teams
within their respective areas of jurisdiction: this could be in the form of
temporary quarters, location guide or even security against social unrest,
particularly in rebel – infested areas.
8. The Spraying Operations should be undertaken on the 4th
quarter of the present year or on the 1st quarter of the following
year.
D.
On Stream
Seeding
1. This is the propagation of fish to eat the larvae of
the vector mosquito. This larvivorous fish, then, are sowed in breeding streams
after a month.
2. This is implemented in all malaria–endemic areas based
on the stratification; but only the foothill streams are targeted, the number
of which shall be determined by the MMC.
3. The construction of bio–ponds for fish propagation
shall be the responsibility of the LGUs and their corresponding communities.
The number of bio–ponds to be constructed, as sources of larvivorous fish, for
each malaria–endemic municipality will depend on the number of streams to be
seeded with the propagated larvivorous fish.
4. The MMC or any MCP personnel shall provide guidelines
for the fish to be seeded, the construction of the bio–ponds, the fish
propagation, the streams to be seeded and the stream seeding procedure.
5. The community shall obtain for the fish fingerlings to
be propagated or the larvivorous fish to be seeded and shall undertake the
propagation and stream seeding activities.
6. Seeding shall be done once a year during the vector’s
peak density months.
7. The MMC shall provide information on the peak density
months.
8. Approximately 2 – 4 fishes per square meters are
needed to produce an immediate impact; on the other hand 200 – 400 fishes per
hectares are needed for a delayed effect.
E. On Stream
Clearing
1. Vegetation overhanging along stream banks is cut to
expose breeding streams to sunlight, rendering it unsuitable for mosquito
habituation.
2. Implemented in all malaria–endemic areas based on the
Stratification, but the MMC shall determine the target streams to be cleared in
the respective barangays.
3. The MMC or any MCP personnel shall provide guidelines
for the streams to be cleared and the stream clearing procedure.
4. The community shall obtain the clearing instruments
and shall undertake this activity every 3 months.
F. Other
Preventive Measures
1. Clothes which cover arms and legs should be worn in
the evening.
2. Outdoor night activities, particularly during the
vector’s peak biting hours from 9pm to 3am, should be avoided.
3. Mosquito repellants such as mosquito coils, soap,
lotion or other personal protection measures advocated by the DOH/MCS.
4. Neem trees and other herbal plants which are
(potential) mosquito repellants as advocated by the MCS should be cultivated.
5. Zoophrophylaxis which makes use of domestic animals
like the carabao, cows, etc. and placed near human dwellings to deviate
mosquito bites from man to these animals.
Please be guided
accordingly.
CARMENCITA NORIEGA –
REODICA, M.D., M.P.H.
Secretary of Health
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