Sri Lanka con­quers malaria

The last case of malaria was re­ported in the coun­try in Oc­to­ber 2012

Down to Earth - - HEALTH - DILRUKSHI HANDUNNETTI, COLOMBO

Health Or­ga­ni­za­tion (WHO) de­clared Sri Lanka malaria-free on Septem­ber 6, 2016. Sri Lanka's achieve­ment is truly re­mark­able. In the mid-20th cen­tury, it was among the most malaria-af­fected coun­tries, but now it is malaria-free, says Poonam Khetra­pal Singh, WHO re­gional di­rec­tor. Health of­fi­cials in Colombo claim that pol­icy and pro­gram­matic shifts led to the suc­cess. This is a com­bi­na­tion that worked, says He­man­tha Herath, deputy di­rec­tor, Anti-Malaria Cam­paign.

Sri Lanka signed up early for WHO's Global Malaria Erad­i­ca­tion Programme (GMEP) in 1958 which re­sulted in an im­me­di­ate de­cline in re­ported malaria cases spread by Anophe­les mos­quito. But malaria cases con­tin­ued to spike in­ter­mit­tently in the 1960s, 1980s and 1990s. Malaria reached epi­demic lev­els in 1999 with con­firmed cases reach­ing 265,000. This served as a wake-up call for the govern­ment.

The coun­try first shifted from the sin­gle-vec­tor con­trol to an in­te­grated vec­tor-con­trol programme that was ap­plied across the is­land. A decade later, Sri Lanka added web-based sur­veil­lance meth­ods and be­gan work­ing closely with the com­mu­nity to erad­i­cate malaria.

By Novem­ber 2012, there was re­mark­able progress. The lo­cally re­ported cases by then stood at zero with the last lo­cal case being re­ported in Oc­to­ber 2012. It is about vig­i­lance and fol­low up, says Herath. In the three years that fol­lowed, 95, 49 and 36 cases of malaria were re­ported, all of them hav­ing con­tracted malaria over­seas. Due to a strong web-based sur­veil­lance, the cam­paign was able to track cit­i­zens trav­el­ling from coun­tries with a his­tory of malaria trans­mis­sion and im­me­di­ately re­fer them for treat­ment. Spe­cial at­ten­tion was paid to se­cu­rity forces per­son­nel, im­mi­grants and tourists. A 24x7 hot­line was added next for im­proved track­ing and the method of treat­ment was also changed. Iso­la­tion treat­ment was pro­vided to pa­tients to con­tain the spread­ing of in­fec­tion. The coun­try's strong pub­lic health sys­tem is re­spon­si­ble for the suc­cess, says Anura Jayaw­ick­rama, Sri Lanka's health sec­re­tary. Early de­tec­tion and con­tin­u­ous treat­ment were the key to suc­cess. For years, mo­bile clin­ics have been used to reach com­mu­ni­ties, par­tic­u­larly those liv­ing in the malaria-af­fected re­gions such as the is­land's north-west and north-cen­tral, he says. Mo­bile malaria clin­ics in high trans­mis­sion ar­eas meant that prompt and ef­fec­tive treat­ment could re­duce the par­a­site reser­voir and the pos­si­bil­ity of fur­ther trans­mis­sion, WHO stated in its state­ment is­sued af­ter an­nounc­ing the coun­try malaria-free.

Sri Lanka is the sec­ond coun­try in South­east Asia to erad­i­cate malaria. Last year, WHO had de­clared the Mal­dives malaria-free. The coun­try has not re­ported malaria cases since 1982. The coun­try main­tained strong epi­demi­o­log­i­cal and en­to­mo­log­i­cal sur­veil­lance to sus­tain its malaria-free sta­tus for the past three decades. The same strat­egy is adopted in In­dia but ac­cord­ing to K Gu­naksekaran, sci­en­tist, Vec­tor Con­trol Re­search Cen­tre, Puducherry, the rea­son for Sri Lanka's suc­cess is that they were con­sis­tent with the ef­fort. Un­like us, Sri Lanka con­tin­ued its ef­forts even af­ter it had brought down the num­ber of malaria cases. We don't even have reg­u­lar sur­veil­lance for dengue and chikun­gunya.

THE WORLD

COURTESY: GOVERN­MENT OF SRI LANKA A pub­lic health of­fi­cer treats pa­tients at a mo­bile malaria clinic in Sri Lanka

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