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마라리아根絶을 爲한 Case Detection 活動의 諸問題點 關한 考察

Evaluation on the Results of the Malaria Case Detection Activities in Korea

공중보건잡지 1967년 4권 1호 p.1 ~ 8
함기선,
소속 상세정보
함기선 (  ) - 서울대학교 보건대학원

Abstract


When anti-malaria programs changed from control method to eradication by total insecticide coverage, it was found that with rapid reduction of the volume of malaria cases the parasite rates furnished by malariometric method of sample surveys were no more sensitive enough to measure further progress. It then became necessary to measure malaria in a continous manner, and no longer in a sample but in the whole population. The method used for this purpose has been given the general name of case detection.
In korea, the results of the malariometric surveys, which were conducted throughout the contry in 1960 and 1962, indicated that routine prevalence surveys were not sensitive enough for an overall assessment of the malaria situation. It was felt necessary to establish case detection procedures as a better method to obtain an approximation of the true malaria incidence in the contry. In the period from 1960 through 1965, the national malaria eradication service trained medical and voluntary groups all over the country with the passive case detection (PCD) procedures. As active case detection (ACD) is very costly a small number of ACD workers were employed each year in some selected areas of the country.
The author, in an attempt to evaluate the efficacy of two case detection measures-passive and active-and of the usefullness of various category of PCD units, made analysis of the data obtained by the national malaria service as follows:
1. Since the collaboration of the PCD workers are voluntary basis and no reporting fee is paid at the moment, there is a general trend that the PCD units are liable to loose gradually their interest in malaria notification after they received the PCD training. The main reason for the decrease in the number of fever case reports after the PCD training campaigns is the lack of proper supervision and follow-up of the PCD units due to the limited size of the malaria project.
2. In view of almost no difference of the slide positive rates (SPR) which obtained by the professional health-medical group (SPR 51%) and by laymen group (SPR 54%), it can be said that the ability of the laymen group in the indentificaion of fever cases are definitely not inferior to that of the professional group. Moreover, the school teachers and the village chiefs reported about 71% of total fever cases in 1966 (up to the end of August). Thus, the importance of the role played by the laymen group in malaria detection is clearly demonstrated.
3. In comparison with the experience with PCD in other countries, the high SPR found in Korea are remarkable. For explanation of this the author has considered two or three factors that may have a bearing on this phenomenon. As malaria symptoms with a distinct fever periodicity which are characteristics of Korean strain of plasmodium vivax, are well known to the rural population, the farmer suffering from a disease will not go to a PCD unit for help if he is not suspecting himself to have malaria as a rule. Therefore, in the majority of fever case reports which are the primary screening based on the clinical symptoms is already made by the side of patients.
4. As the author mentioned above, the high SPR obtained though passive case detection indicate that in korea the "fever case" reporting is of exeptional value for the detection of malaria cases. It is, however, very difficult to obtain the collaboration of PCD workers contantly in area where almost no malaria transmission occurs as well as in those area where the malaria transmission has decreased for one reason or another. To obtain an approximation of the true malaria incidence in a locality additional evidence which will be obtained through ACD procedures will be important.

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