By Gift Briton
The successful journey to eliminate and prevent relapse of malaria cases in Sri Lanka offers valuable lessons for countries striving to attain malaria-free status, notes the World Health Organization (WHO).
Sri Lanka got malaria-free certification from WHO in 2016 after maintaining zero indigenous malaria since the last reported case in 2012.
In an e-newsletter dubbed Global Malaria Programme, the global health body gives detailed steps Sri Lanka took to eliminate malaria and subsequent strategies and policies implemented to prevent the re-establishment of the disease.
Sri Lanka joined the WHO’s Global Malaria Eradication Programme in the 1950s when malaria had been endemic in the country for centuries. By 1963, it had reduced malaria cases to near-elimination levels but a resurgence of the disease that persisted for nearly five decades occurred.
Sri Lanka renewed its efforts to defeat the disease in the 1990s and by implementing intensified case detection and treatment strategies, supplemented with active case detection using mobile malaria clinics, and targeted vector control using indoor residual spraying and integrated vector management, cases began to fall.
According to the e-newsletter, the country scaled up intervention coverage and deployed newer tools, including long-lasting insecticidal nets for vector control and rapid diagnostic tests for diagnosis and artemisinin-based combination therapies for the treatment of Plasmodium falciparum malaria. This happened after receiving funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria.
The steady reduction of malaria incidences inspired the anti-malaria campaign (AMC) to start working on a stalled plan to eliminate malaria. AMC is a directorate body tasked to lead Sri Lanka’s malaria elimination programme.
With the support of various nongovernmental, private sector and international organisations, AMC maintained uninterrupted malaria control efforts. Some of these organisations supported AMC in malaria diagnosis and treatment, collection and analysis of vector data, and mobilizing and engaging the community in malaria elimination activities.
At the time, several factors challenged elimination efforts, including malaria in armed personnel who moved between villages during the civil war in the north and east of the country. An outbreak of P. vivax in army camps also happened in the south of the country which could easily undermine the elimination goal but these were averted by effective collaboration.
The collection and analysis of vector data and response systems and case surveillance using case detection, case notification and reactive response, drove cases to zero by 2012.
As Sri Lanka neared elimination, the focus of the malaria programme moved to detecting and responding to imported malaria to prevent the resumption of transmission. The prevention of malaria relapse programme in Sri Lanka has been reported for more than 11 years. The country continues to profile and identify high-risk populations for imported malaria and focuses the surveillance through proactive and reactive case detection.
The malaria eradication programme regularly communicates to clinicians through various channels, including social media, reminding them to elicit an overseas travel history and to test for malaria in febrile patients. Maintaining functional collaborations with key stakeholders such as the armed forces has been a critical and major component of the prevention of re-establishment programme.
A robust prevention of re-establishment programme has maintained zero indigenous malaria for 11 years post-elimination. Sustaining such a programme in the long term may require transitioning from an endemic disease approach to a health security risk approach by gradually integrating some functions into other vector-borne disease control programmes.
Given the high risk of malaria re-establishment, it is important to maintain a central, dedicated programme to retain technical expertise, provide guidance and undertake monitoring and evaluation functions to prevent re-establishment, reads the e-newsletter.
