ISSN: 1391 - 0531
Sunday April 20, 2008
Vol. 42 - No 47

It’s the end of the road for Malaria

By Kumudini Hettiarachchi

The final phase of a battle is on, not just on one front but on many, and the war trophy is elimination of a tiny but persistent foe and relief for the people. The foe, of course, is the malaria-carrying mosquito and the final battle envisages the use of latest technology such as the popular mobile phone and computers.

“Hard work” and “dedication” have brought Sri Lanka to the threshold of the pre-elimination phase of malaria, the bane of many a developing country, The Sunday Times understands from the Director of the Anti-Malaria Campaign (AMC), Dr. Rabindra Abeyasinghe.

Multi-pronged battle: Mobile clinics.

“Malaria is under control and we have reached that stage gradually. We can now consider elimination,” he stressed supporting his claim with facts and figures…….from 200,000 cases of malaria in Sri Lanka 10 years ago, there has been a drastic drop to 196 cases in 2007.

As people across the globe celebrate World Malaria Day on April 25, Sri Lanka in its long battle with this vector-borne disease has not been doing anything new but concentrating on time-tested measures, it is understood.

The measures include an integrated vector control strategy not dependent on one method for the control of mosquitoes but multi-pronged such as house-spraying of insecticides and control of mosquito-breeding areas with larval fish and also insecticides; promotion of the use of mosquito nets, both through free distribution of nets to the needy in vulnerable areas and encouragement of purchases by people; not only treatment of patients with malaria by encouraging doctors to detect the disease early, but also thorough follow-up to ensure complete cure and monitoring for a month through blood tests; and mobile clinics to reach the poorest of the poor, with blood tests being done then and there and treatment begun immediately.

“Through mobile clinics, we go to the people in remote areas without waiting for them to come to us,” says Dr. Abeyasinghe, explaining however that following successes in the control programme, re-orientation is needed to get into the pre-elimination phase which generally lasts about 3-4 years. “In a control programme the focus is on problematic areas vulnerable to malaria while elimination would mean everywhere equally well to ensure that malarial cases do not occur anywhere in the country.”

The programme needs to go into higher gear from “control” to “elimination” drive, with strengthened surveillance to prevent occurrence of malaria cases and intensified vector control in vulnerable areas which have all been mapped out, The Sunday Times learns.

Multi-pronged battle: providing nets.

And in the final battle the health authorities have enlisted the support of international public health expert Dr. Panduka Wijeyaratne who has an innate interest in malaria, with his last responsibility in Nepal as USAID’s Resident Director being this very subject.

With Dr. Wijeyaratne engaged in community service in the east of Sri Lanka, he has been called upon to bring that perspective when dealing with malaria elimination in the north-east which may be a weak link in the overall strategy.

Explaining that the mindset of the Anti-Malaria Campaign should get into creative mode, he says the strategy should be to track all general practitioners in the country who may have come across fever cases who could be malarial reservoirs of infection. “Surveillance is of utmost importance,” he says echoing Dr. Abeyasinghe’s thoughts, while adding that surveillance should be carried out taking advantage of modern tools such as mobile phones, Geographic Information Systems mapping approaches and also new diagnostic methods.

“Give mobiles to peripheral staff, under a rigorously planned system so that they can not only provide quick reports on patients with malaria but also on mosquito breeding grounds through SMSs,” urges Dr. Wijeyaratne explaining that even a small hole dug in a construction site could turn into a breeding ground.

Larval breeding surveillance should be extremely strong and support case surveillance.“Then the system must be geared to complete the cycle of surveillance–detection– report–response,” he says adding that rapid response by the campaign’s headquarters or from the district level is of paramount importance.

Another challenge that needs to be overcome is intense surveillance to prevent multi-drug resistant forms of malaria coming through Sri Lanka’s entry points. “We should have a strategy, where people coming in are asked where they have been, whether they have had a fever especially because some of the Southeast Asian countries are hotspots,” he said.

Dr. Wijeyaratne has been mandated by WHO and some countries in the SAARC region to develop a proposal to control cross-border malaria. Chasing after the last few cases is more expensive and more difficult – that’s the challenge to put in more money, he says.

Explaining that this is an exciting point in the country for malaria, Dr. Wijeyaratne urges that we take it head-on without relaxing.

The hope is that soon Sri Lanka can be declared malaria-free.

The lethal and the benign

There are two types of malaria – benign and lethal (can die if not treated) in Sri Lanka. Ten years ago 25-30% of the cases fell into the lethal category but in 2007 a major decline was recorded bringing the figure to 3.5%. Of 196 cases, only 7 were classified lethal and half of these were imported.

The two species of malaria are Plasmodium vivax and Plasmodium falciparum while the main vector is Anopheles culicifacies, which breeds mainly in pools in stagnant rivers, abandoned gem mining pits in the dry zone and agricultural wells. Vectors of less importance are Anopheles annularis and Anopheles subpictus.

“Malaria is a disease which can be transmitted to people of all ages and is caused by parasites of the species Plasmodium that are spread from person to person through the bites of infected mosquitoes. The common first symptoms – fever, headache, chills and vomiting – appear 10 to 15 days after a person is infected. If not treated promptly with effective medicines, malaria can cause severe illness that is often fatal,” according to the World Health Organization.

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