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TRANSCRIPT
OONFERENCE ON MALARIA
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REPORT OF
THE EIGHTH BORNEO OONFEmNCE
Keningau, North Borneo 16 - 18 June 1959
World Health Organization Western Pacific Regional Office
Manila, Philipp ine s July 1959
WPR/MAL/3 27 July 1959
ENGLISH ONLY
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CON'lENTS
PROGRESS OF COONTRY MALARIA PROGRAMMES
Republic of Indonesia
North Borneo
Sarawak
I'IEMS OF SPECIAL INTEREST
Inter-territorial eo-operation
Migrator,y groups
Investigation
Surveillance
Insecticides
SprlVing equipnent
Personnel training and health education
The problem of spr~ing operations
Drug administration
ANNEXES
MAPS
List of participants
Programme and agenda
Area of residual spr~ing operations in Sarawak, 1958
Area of residual sprCliYing operations in Sarawak, 1 Januazy-30 June 1958
Area under active surveillame in Sarawak, 1959
Area proposed to be under active surveillance in Sarawlic in 1960
Distribution List
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Fig. 1
Fig. 2
Fig. 3
Fig. 4
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COOFEEiENCE ON MALARIA
REPORT CF THE EIGHTH BORNEO MALARIA OJNFEEiENCE
WPR/MAL/3 pagel.
The Eighth Borneo Malaria Conference was held in the Malaria Laborat£r)",
Keningau, North Borneo. The meet:ing was attendedl tv representatives of the
Governments of the Republic of Indonesia, North Borneo and Sarawale; by
observers from the BrIlnei Shell Petroleum Company Ltd., the Inte~ational
Co-operaticn Administration in the Republic of Indonesia, WHO Project Staff
from Indonesia and. the British Borneo Territories, the WHO Regional Entomol.o
g:1st and the Regional Sanitary Engineer for the Western Pacific Region.
The Conference was decl.ared open by Dr L. J. Clapham, Director of Medical
Services, North Borneo. He extended a warm welcome to all the participants,
and asked the partiCipants to discuss freelj' as this conferewe was 1nf'ormal
and pur~ technical •
Dr M. E. Santa Maria, WHO project leader in North Borneo, was elected
chairman, and Professor C. Y. Chow, Regional Entomologist, was elected rappol'
teur.
In view of the fact that Dr Cl~ham had to return to Jesselton immediatel;r
after the adoption of the agenda, 2 it was felt appropriate to respond to his
welcaning address at that moment. Dr I. D. Carter on behalf of all the parti
cipants, and Dr H. T. Soeparmo on behalf of his gOV'ernment, thanked Dr Clapham.
1 The list of participants is given in Annex: I.
2 The agenda is given in Annex II •
WPR/MAL/3 page 2
PROORESS OF COUNTRY MALARIA PROGRAMMES
Brief descriptions were given of the development and progress of malaria
programmes, and a resume is reproduced in this report.
1. REPUBLIC OF INDONESIA
The plan of operations covers a period of eleven years and envisages a
progressive expansion of tre areas under eradication until the entire popula-.' . .
tion of 15 million exposed to malaria risk is covered. In Ma,y 1959 1V a
Presidential decree a Malaria Eradication Board was established. This Board,
presided over qy the Minister of Health, is composed of representatives of the
different Ministries with the Director of the Lembaga Malaria as Secretary.
The vmo and ICA serve as advisers to this Board. A Malaria Eradication Service
under a director has also been inaugurated qy governmental decree. The Director
of the Malaria Eradication Service is responsible through the Director of the
Lembaga Malaria to the Malaria Eradic ation Board for too implementation of 1:he
programme.
In 1959, seven zones in Java and one :lOom in South Sumatra were being
covered. The trai~ of zone and sector chiefs for the eight zones has been
completed, and geographical reconnaissance is in progress. It is expected that
the spraying which has alreaqy started in two zones will be in progress in all
eight zones qy the end of 1959. Each zone has a population of about 1.4 million.
IDT at the dosage of 2 gm. technical per sq. m. is spra,ved twice a year. In the
sundaicus areas dieldrin at the dosage of 0.5 gm. technical per sq. m. is used
at an interval of eight months.
A case-finding programme by the use of voluntary workers will be cOlllllenced
chlring the attack phase and fever cases will be treated wi th s~le doses of a
4--aminoquinoline. For purposes of assessment malariometric base line data will
be collected qy mobile assessrent teams from selected index areas before sprqillr;.
Parasite surveys of trese areas will be repeated every year during the attack
phase.
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WPR/MAL/3 page 3
The programne also includes four stuc\y" teams for undertaking studies on
aspects of the work that have a direct bear~ on the eradication programme.
The training of adequate rmmbers of personnel in all categories is an
important part of the prograIQIle. All senior personnel such as malar:l.ologists,
entanologists, etc. 'Will be sent for training to international training centres
such as the Jamaica Malaria Eradication Training Centre and the Philippine
Institute of Malariology at Tala. AJ.I the junior technical persormel will be
trained in the cruntlY. For this purpose a training centre will be established
in Java. for zone and sector chiefs. The instruction will be in Indonesian
(Malay). It may be possible to extend the facilities of this train~ centre
to the neighbouring countrie s where the sare language is spoken. The lower
categor,y of personnel will be trained at provincial and zone levels.
Kalimantan
According to the plan of operations pre-eradication activities in this
area will start in 1960 and sprSiYing will be undertaken in West Kalinantan in
1961. During 19 5~ 59 malariometric surveys and studies on the bionomics of
vectors were undertaken in a few areas in Kalim3.ntan. It has been observed
that the endemicity is high in the relativel,y sparsel,y populated interior
villages. General4r speaking, along the coast the endemiciv varied from spleen
rate 15% to m. The entomological studies conducted in Kalinantan resulted in
the following findings.
Vectors I
(1) ~. leucosphyrus leucoBPhyrus - 43 specimens dissected showed 2 gland
positives and 4 gut positives.
(2) !.. venhuisi (according to Reid, this species should be. called as
~. nigerrinms) - I 'Z70 specimens dissected showed one gut positive.
The vectorial role of this mosquito needs confirmation.
(3) A. umbrosus and A. letifer have been reported as vectors by earlier
workers.
WPR/MAL/3 page 4
, . The peak of entry into houses and feeding of leucosphyrus has been found
to be between 10 p.m. to 1 a.m. Most of the specimens escape from the houses
during the last quarter of the night.
2. NORTH BORNEO
Evidence of the interruption of transmission was obtained in the area
(Keningau South) after three rounds of dieldrin residual sprayiI:f; at the
dosage of 0.6 gm. technical per sq. m. at an interval of six months concurrent
with four mass drug administrations.
On the Island of Labuan, where on1¥' dieldrin was sprayed at the dosage of
0.6 gm. technical per sq. m., annual1¥' in the first year and semi-annual1¥'
later on, no positive case was found in infants after the third round of
SPrlViI:f;. The infant parasite rate which was 0.5 percent (186 examined in
1951) had dropped to zero since the beginning of 1958. It was proposed to
carr.r rut a case finding progranme in addition to infant parasite survey.
Entomological findings
Although considerable time was spent qy the entomological staff in
helping with the supervision of spraying and drug administration, the following
findings were obtained during the period from the Sixth Conference up to date.
(1) Dissection - !::. barbirostris was found positive with sporozoites (ore
out of 20 dissected) for the first time.
(2) Insecticide-susceptibility tests:
S :ipecies Area DDT % LC 50 Die 1 drin
Bal abacensis unspr~ed 0.'51 -5 X DDT 0.55 -
Barbirostris unsprayed 1.05 0.01
1 X DI1f 1.45 0.09
4 X DLN - 0.04
5 X DDT 0.72 -Sundaicus unspr~ed 0.6 - 0.8 0.04 - 0.0,
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WPR/MAL/3 page 5
The above shows that the vectors are still susceptible to DDT and
dieldrin •
(3) Denai ty in night collections - In da;vt:ime there were usua.lJy no vector
mosquitos (balabacensis and barbirostris) found :In human dwellings even
in unspr~ed areas. Night collections had been, therefore, carried out
in the spra;ved areas. Neither balabacensis nor barbirostris had been
found inside the human dwellings sprayed with 1 roum of DDl' or dieldrin,
or 4 rounds of ·dielrlrin or 5 rounds of DDr. Night collections from out
doors where buffalo were used as bait revealed that a considerable number
of barbirostriB (1.5 - 5.8 per man-hour) cruld be caught in all the
sprayed areas under observation, but balabacensis (0.7 per man-hour) was
found o~ in the area 8pr'Ved with five rounds or DDT.
(4) Bioass8iY' - This bald been undertaken in the areas sprllYed for the fn-at
"" tilne. Up to date, three Ilonthe atter ap~1rlg, results were still ve7ll' ~
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Bati~!actor.; in both DDT and dieldrin areas.
lhildings
Excellent office and laboratory building shad recent4r been completed and
put into use. Additional staff recruitment will be completed on 1 July 1959.
3. SARAWAK
Since October 1958 there had been total coverage of all areas in which
malaria transnisaion was lmown to have occurred.
Malariometl":'.cal information had been obtaired in conjunction with the
sprSiYing operations by the taking of bloods from infants and children to the
age of 5 years and all fever cases. Very few positive infants were fOW'li
throughout the cruntry although there were a considerable number of positives
amongst the fever cases.
In general there was a reduction :in the :incidence as canpared with the
information gathered during the preceding spra;viI€ operations •
WPR/MAL/3 page 6
Surveillance operations continued in the trial area in the First Division
and wore introduced in January in the Baram District.
Positive infants detected in this work, and the few that were detected as
a result of bloods collected durjng sprlV~ operations, were investigated.
Mosquito captures were carried out in the houses in which the positive
infants lived. These captures in no case yielded significant rmmbers of
proven vectors. Insufficient rmmbers were caught to use for bio-ass~. All
mosquitos caught were dissected but none was found to be positive.
Two of the junior national staff were atten~ the crurse in malaria
eradication at the Tala Institute of Malariology on fellowships granted by the
Government of the Philippines under the Colombo Plan. Other tr~ was
conducted loc~.
Two cycles per anrmm of total coverage will be the goal, with the expan
sion of surveillance to those areas in which, from malariometric al infomation,
transmission was believed to have been interrupted.
ITEMS OF SPECIAL lNTEREST
Inter-territorial Co-operation
All the partic:ipants agreed that conferences of this nature, where
malaria workers of neighbouring countrie s could meet, discuss their conmon
problems and pool their experiences, formed one of the best means or inter
country co-operation. In addition it was suggested that the co-operation
should be extended to include the following:
(l) Periodic exchange of infomation regarding the progress of anti
malaria operations: This could be done 1:u exchanging semi-annual repcrts
thrrugh the agency or WHO. Information on a:ay items of special interest, such
as the detection of vector resistan:e or the occurrence of abnormal increases
in malaria incidence in the border areas, should be c CJllIIIWlic ated to the neigh
bouring country by the most expeditious means.
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WPR/MAL/3 page 7
(2) Trair:i...'1g of personnel: A training centre imparting instruction in
the Indonesian (Malqy) language for training chiefs of zones and sectors and
subordir.atE: staff was expe cted to open ill Java in September 1959. The possi
bility of making the tra.ini~ facilities available to candidates from countries
in Borneo was mentioned by the participant from Indonesia.
(3) Facilities for the passage of anti-malaria persomel across borders
to reach inaccessible enclaves: It was felt that this matter was beyond the
scope of the Conference and it was recommended that it should be discussed at·
the next administrative conference to be held in Indonesia with a view to
taking up the matter with the appropriate authorities.
(4) Co-ordination in tiloo and space of the development of eradicaticm
progralllIOOs: The importance of siImlltaneous development of anti-malaria
operations on both sides of the inter-country border was stressed by all
participants. In Kalimantan preliminary azTaQ5lAEmts for eraclicaticm are
planned to commence i."l 1960 for spra;ying in 1961. In Sarawak and North Borneo
the ma.laria control programmes had made considerable progress and it was
hoped that the"J wouJd be converted into eradication programmes in due course.
Migratorv groups
In Indonesia the problem of moving population falls under two groups:
(a) Land reclamm;ion and resettlement (Transmigration group) and (b) popul.a
tion engaged in shifting cultivation and nomads. As the eradicatl.on prograD1le
was planned to develop accordling to a fixed schedule erlend~ year by year
to contiguous areas, the responsibility far t~ adequate and pranpt
emergency measures for dealing with malaria in areas outside tm sphal'E! of
activity of the eradication service fell to the local public service. An
adequate S'J_pply of ant:L":lC.larial drugs would be made available to the pr0-
vincial inspec-~orG of health •
WPR/MAL/3 page 8
In North Borneo land setUenent did not form a serious problem.
Sarawak migratory groups still present a problem of sane magnitude.
In
Further
work was needed to ascertain the prevalence of malaria in tl'Eso groups. Wben
the control programme was converted into eradication, the question of
ascertaining their transit routes and establishing check posts at strategic
points for blanket treatment of these group would have to be considered.
Investigation
The eradication organization in Indoresia includes four stuqy te8lll8 for
undertaking investigation on items that have a direct bearing on the eradica
tion programne. The main activities will be directed to finding rut (a) the
optimum dosage of residual insecticides, (b) the frequency of sprSiring and
(c) the surfaces to be sprSired (whether animal shelters, caves and roofs
should be included in sprSiring). This includes stud:ies on the bionomics of
the vectors.
An important activity of these stuqy teams will be to assess tre efficacy
of different patterns of surveillance using both active and passive surveillance
technique s.
In North Borneo earlier work had shown that insecticide sprSiriIl! alone
did not completely stop transmission. However, dieldrin sprSiring combined
with drug administration had recentl;v resulted in a complete interruption of
transmission. By the end of the year it would be possible to assess the
results of DIY!' spraying combined with drug administration.
In Labuan, where d.leldrin sprSiring had been in progress since 1956 J there
was evidence that incidence of malaria had dropped to a very low level. A
case finding progranme would be started in that island as soon as the recessary
personnel became available.
In Sarawak special investigations had been carried out in sprSired areas
in which positive infants and a high incidence of malaria in children had
been found.
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WPR/MAL/3 page 9
In addition to bio-ass1V and other routine tests for determining tlle
effectiveness of insecticidal sprBiVing it was suggested that observation on
vector longevity, by using the simple method (tracheoles pattern on ovaries),
should be employed. By this method the nulliparous ani parous mosquitos
could be separated easily.
For insecticide-susceptibility tests of mosquitos, LC 100 should alB<> be
determined in addi. tion to tba:ir LC ~O.
Surveillance
The aim of rurveillance was to detect and effectively deal with all
cases of infection before they were able to produce secondary cases.
The pattern of surveillance organization required for each CCWltry
depended a great deal on the state of development of tba health service in
the country and the degree of public health awareness of the population.
Two of the D¥lst important questions to be decided in planning surveillance
were (a) the role of active and passive surveillance rEcessSlY' for the ear~
detection and treatllEnt of all parasite carriers and (b) the interval that
could safe~ be allowed between house visits (in active surveillance) withcut
running the risk of the production of secondSlY' cases.
In Indonesia an area in Central Java which had been under insecticide
sprqing for some years had been selected for .a special study. The efficacy
of the different surveillance patterns using voluntary collaborators and paid
workers would be judged by ccmpa.ring the number of parasite positive cases
detected by them against the number of parasite carriers detected £rom
repeated total mass blood surveys of selected villages in the area. The results
of similar surveillance studies that were nCM in progress in Ceylon and India
would be of great interest to Indonesia and the ofuer countries in BarrEo.
The interval between house visits would depend on the basic reproduction
rate of the parasite. This would depend on the density of the vector in
relation to man, the anthropophilic index, the sporozoite rate, the longevity
of the vector and the period of extrinsic cycle of the parasite. The
surveillance study programre in Indonesia had plans for undert~ observation
on. all those aspects.
WPR/MAL/3 page 10
In Sarawak although the programme was still a malaria control ore it had
been possible to start an active case finding programme in 3 districts - Serian,
Kuching and Baram. A total population of 81 000 had been visited at mont~
intervals over a period of six months. Blood had been taken from all cases of
fever and those with history of fever. A single dose of a 4 - aminoquinolire
had been administered to all fever cases. Those found positive were treated
also with single dose treatment during subsequent house visits at month~
intervals. In the Secian district with a population of 33 000, during the
peri~d November 1958-April 1959, 214 paraSite positive cases were detected
whereas in the Kuching district (29 000 population) onJ;y- 49 parasite positives
were found during the same period. The concurrent treatment of malaria
carriers along with the spr8i"ing would hasten too end point of malaria and
thereb,y facilitate eradication.
Insecticides
There was little to be added to what had already been mentioned in pre
vious conferences.
Spr~ equipment
The chief concerns in Spr8i"ing equipment were the qualiW, the performance
and the frequency of charges on turnover.
Most of the rCA and UNICEF supplied sprqyers were obtained from U .. S.
manufacturers. The system of purchasing them had been improved by a system
of permitting on~ those with proven good equipment, as tested by the U.S.
Public Health Services laboratory, to qualif,y in the bidding.
The qualities contributing to good performance had been consolidated into
a new d3sign which met the WHO specifications. The improved features were the
result of the experience in the Mexican programme and the new Hudson spr:ver
was a wpic al one.
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WPR/MAL/3 page 11
Size preference, choice between the 4 and 3 - U.S. gallon sprayers, had
been based on the size of the spra:ymen. In North Borneo where the sprlJ¥lOOn
spent more time in travel on foot than actual spraying in the house, this
sounded reasonable. In Taiwan, however, where the spra:ymen were not any
larger in stature, preference :L"'l size was not a cC::Ice:-n. In an eigh .. hour
work, distance from house to house did not alter the load if the spra.vmen
worked all the time. The new spra;ver, however, was a 4 - gallon equipment.
The value of constant pressure gadgets had been vE1r'Y disappointi~ in
many projects. Steaqy performance for a reasonable t:lme had never been
demonstr ated fran too type of sprayer provide d.
Erosion of nozzle tips could result in unnecessary increases in con-
. SllIlption of insecticide to about 25%, before routine changes of nozzle tips
were made. A discarded nozzle tip also meant ore U.S. dollar lost. A recent
development, an adapter, developed tu the Equipm:mt Development Laboratory at
Savannah, Georgia, might be available soon as a salut ion to the erosion and
wide variation of discharge from too spr8iY"er. The adapter was essentially a
gasket which could be inserted behind the nozzle tip; it lasted a week longer,
and it was vezy cheap too.
Personnel training and health education
This had been dealt with in general in the preceding items. In North
Borneo intensive training of laboratory technicians was urgently required.
It was suggested sane of thom could be sent to the Philippine Institnte of
Malariology at Tala, or elsewhere, for train~.
The importan::e of health education at all levels in mal aria eradication
c~aigns was streosed- lYJ an· t.he participcrlts. It was agreed that health
education should form an integral part of all r,,stional antimalaria prograzrmes.
The services of the specialized health education section of the goverrment
could be profitably employed for advising the antimalat'ia services on the
methods and techniques of health propaganda.
WPR/MAL/3 page 12
Problem of spraying operation
Timing the spraying with the idea of spraying just before the trans
mission peak in the shortest period possible was discussed. The consensus of
opinion was that this did not aPplJr in Borneo since (a) transmission was
continuous the whole year and (b) the workers had to be hired for a long period.
It was noted that the reason for increased consumption of insecticide in
North Borneo was said to be due to the inclusion of all farm huts ani the
spra;y~ of the eaves and undersides of houses.
Drug administration
In general single dose treatment using a L.-aminoquinoline was the method
in the malaria eradicati. on programre in Indone sia and plus pyrimethamine in
addition in British Borneo. In Sarawak the drug used was a combination of
L.-aminoquinoline plus pyrimethamine in tablets each containing 200 mgm. chloro
quine and 16.5 mgm. of pyrimethanine. Three such tablets were given as a
single adult dose.
Date and Place of Next Technical r-!eetiIE
The date and place of the Tenth Borneo Malaria Conference (technical) would
be discussed at the Ninth Conference to be held in Indonesia next December.
Adj ournmen t
On behalf of the GoverlllOOnt of the Republic of Indonesia, the WHO Regional
Directors for South-East Asia and the Western Pacific, the ICA in IndoneSia,
the Brunei Shell Petroleum Co., and all the partiCipants, thanks were given
to the Government of North Borneo for act~ as the host. Dr Nicholson, on
behalf of the Government of North Borneo, thanked all the participants for
attending the Conference.
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LIST <F PARTICIPANTS
GovernIlEnt of North Borneo
Dr L. J. Claphan, Director of Medical Services, Jesselton
WPR,/MAL/3 page 13
ANNEX I
Dr J. A. B. Nicholson, Deplty Director of Medical Services, Jesse11xm
Dr J. Graves, Medical Officer, Keningau
Govermu:nt of the Republic of Indonesia
Dr H. T. Soepanno, Director, Lembaga Malaria, Djakarta
Govermnent of Sarawak
Mr Joseph Yong, Laboratory Superintendent, KuclUng
Observers
Mr E. A. Smith, Acting Chief Malariolcgist, ICA (Republic of Indonesia)
Mr Loke Yee Wei, Chief Health Inspector, Brunei Shell Petroleum Co., Ltd.
World Health Organization
SEARDs Dr G. Sambasivan, Senior Malariologist, Republic of Indonesia
Mr S. N. Saxena, Assistant Malariologist, West Kalimantan, Republic of
Indonesia
VPRO:
Professor C. Y. Chow, Regional Entomologist
Mr p. S. Echavez, Regional Sanitary Engineer
Dr M. E. Santa Maria, Malariologist and Project Leader, North Borneo
Dr I. D. Carter, Malariologist and Project Leader, Sarawak
Dr F. Y. Cheng, EntomolOgist, North Barneo
Dr G. Kudicke, Malariologist, Sarawak
Mr J. W. C. Armstrong, Sanitarian, Narth Barneo
Mr Peter Grahan, EntOlIIOlogist, Sarawak
Mr George Leport, Laboratory Tecbni.cian, North Borneo
WPR/MAL/3 page 14
ANNEX II EIGHTH BORNEO MALARIA OONFEHENCE
PROGRAMME
16 June 1959 Arrival of participants
17 June
18 June
19 June
Visits to the Malaria Compound (office, laboratories and
quarters).
Demonstration of mosquito age determination and bio-ass~.
Conference (starti~ 8: 30 a.m.)
Conference
Field visits
Departure of pArticipants
AGENDA
1. Opening, election of chairman and rapporteur
2. Adoption of provisional agenda
3. Progress of country malaria programmes
3.1 Malariometrical and entomological findings
3.2 Spra;yirg operations
3.3 Mass drug administration and surveillan: e
3.4 Trai~ 3.5 Administrative matters
3.6 Plans for the future
4. Items of special interest
4.1 Inter-territorial co-operation
4.2 Migrat ory grmps
4.3 Investigation
4.4 Surveillance
5. Technical items
5.1 Insecticides
5.2 Spra~ equipnent
5.3 Personnel training and health education
5.4 Problems of spr~ operation and drug administraticn
6. Date and place of next technical meeting
7. other busine s 5
8. Adjournment
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Report of the Eighth Borneo Malaria Conference
DISTRIBUTION LIST
Dr L. J. Claphan, Director of Medical Services, Jesselton (6)
Dr J. A. B. Nicholson, Deputy Director of Medical Services, Jesselton
Dr J. Graves, Medical Officer, Keningau
Dr H. T. Soeparmo, Director, Le;::o.baga Malaria" Djakarta (6)
Dr W. Gl¥n Evans, Director of Medical Services, Kuching (6)
Mr Joseph Yong, Laboratory Superintendent, Kuching
Mr E. A. Smith, Acting Chief Malariologist, ICA, Republic of Inoonesia
Mr Loke Yee Wei, Chief Health Inspector, Brunei Shell Petroleum Co., Ltd.
Regional Representative, United Nations Teclmical Assistance Board, Bangkok
UNICEF Resident Representative, Bangkok
Dr W. W. Yung, Area Representative, Singapore
Chief Medical Officer, Kuala Belait
Divisional Medical Officer, 2nd Division, Sirnanggang
Divisional Medical Officer, 3rd Division, Sibu
Divisional Medical Officer, Hospital Miri
Dr D. H. Colless, University of Mala;ya, Singapore
Dr J. A. Reid, Institute for Medical Research, Kuala Lwnpur
Regional Director, WHO Regional Office for South-East ASia, New Delhi
Dr D. K. Viswanathan, Senior Regional Malaria Adviser, SEAm
Dr G. Sambasivan, Senior Malariologist, Republic of Indones:ia
Mr S. N. Saxena, Assistant Malariologist, Republic of Indonesia
WHO Headquarters, Division of Malaria Eradication (3)
WID Heaiquarters, Division of Public Information (2)
Regional Director, WHO Regional Office for Western Pacific, Manila
Profe sear C. Y. ChOW', Regional Entomologist, WPID
Mr P. S. Echavez, Regional Sanitazy Engineer, WPRO
Dr M. E. Santa Maria, Malariologist and Project Leader, North Borneo
Dr I. D. Carter, Malariol~ist and Project Leader, Sarawak
Dr F. Y. Cheng, Entomologist, North Borneo
Dr G. Kudicke, Malariologist, Sarawak
Mr J. W. C. Armstrong, Sanitarian, North Borneo
Mr Peter Graham, Entomologist, Sarawak
Mr George Leport, Laboratory Technician, North Borneo
WPRO (30)