Down to Earth

Sri Lanka conquers malaria

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


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.


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

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