Today, April 25th is World Malaria Day with the theme ‘Harness innovation to reduce the malaria disease burden and save lives’.
Sri Lanka was awarded the Malaria Elimination Certificate by the World Health Organization (WHO) in September 2016 and is now in the ‘Prevention of Re-introduction (PoR)’ phase.
Even though malaria is preventable and treatable, it is a serious and persistent threat to public health. It continues to have a devastating impact on the health and livelihood of people around the world.
WHO’s latest World Malaria Report estimates that there are 241 million malaria cases and 627,000 malaria deaths worldwide. This represents about 14 million more cases compared to the previous year and 69,000 more deaths. Around 47,000 deaths or two-thirds were linked to disruptions in malaria prevention, diagnosis and treatment during the COVID-19 pandemic.
In 2020, of the 11 countries which comprise the WHO’s South-East Asia Region, nine malaria-endemic countries contributed to about 2% of the global burden of malaria. They were Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Nepal, Myanmar, Thailand and Timor-Leste. Most cases in the region (83%), were concentrated in India.
But over the past 20 years, the region has made excellent progress in reducing its malaria burden – the total malaria cases were reduced by 78%, from 22.9 million to 5 million and the total malaria deaths were reduced by 75%, from 35,000 to 9,000. During the COVID-19 pandemic there were no major increases in the malaria burden in the region.
Over the years, as Sri Lanka battled with highs and lows of this endemic disease in harrowing lessons spanning over 100 years, WHO Sri Lanka has been extending heavy support technically and financially throughout. Near elimination was experienced in 1963, with hopes dashed on the return of the disease in epidemic proportions thereafter.
In the early 1990s, the country reported more than 600,000 cases a year but 22 years later in 2012 there was an interruption to transmission, followed four years later by elimination due to the high-performing Anti-Malaria Campaign (AMC) with effective in-country collaborations and technical leadership. Financial investments from the Global Fund and WHO supplemented an unwavering national budget for malaria over decades.
With Sri Lanka in the PoR phase currently, a high priority is to diagnose early and treat the progressively increasing incidence of ‘imported’ malaria cases reported in recent years.
Just last year (2021), a total of 26 imported cases, mostly among people who had returned from Africa and India, were reported. In a proactive measure, more than 1,000 people who were visiting malaria endemic countries and expected to return to Sri Lanka, were provided prophylaxis. More than 300,000 microscopy slides were also inspected as proactive and reactive surveillance.
With all Sri Lanka’s health programmes including malaria control activities being impacted by the COVID-19 pandemic, WHO’s support has ensured the maintenance of malaria control activities in 2020 and 2021. These activities covered capacity building of health workers including Consultants, Regional Malaria Officers, Entomologists and Entomological Assistants, on parasitological, entomological and case surveillance and management.
WHO supported the renewal of two guidelines on ‘Malaria chemotherapy and management of patients with malaria’ and ‘Scope of work to be performed when a malaria patient is reported’ last year. An external competency assessment for malaria microscopy and a national competency assessment for malaria microscopy were also conducted for laboratory technicians with the support of WHO to ensure the ability to diagnose malaria cases correctly and update their knowledge.
Another major activity supported by WHO was the mid-term review to assess the progress of malaria control under the National Strategic Plan 2018-2022 in achieving the objectives and targets along with readiness to sustain the PoR phase.
Several recommendations and guidance on achieving targets and objectives in the next two years were provided under this comprehensive review performed by international and local consultants.
WHO Sri Lanka was directly involved in the procurement of anti-malaria drugs and commodities, with adequate stocks enabling the AMC to treat patients with minimal delay and minimal treatment failure.
As World Malaria Day is commemorated, Sri Lanka is an example of how elimination of malaria can be achieved even against heavy odds such as a 30-year civil war till 2009. There is, however, a clear signal that to keep the gains achieved intact and prevent re-introduction, continued investment and sustained political commitment for malaria prevention and control are essential.