Sri Lanka, once among Asia’s worst affected nations for malaria, is now close to eliminating it.
The sharp drop in the number of reported cases to 196 in 2007 - with no deaths - demonstrates that the national malaria control programme has been effective even in the traditionally disease-prone northern districts, portions of which are controlled by Tamil Tiger separatists.
About four million people, a fifth of the population, dispersed over the largely rural dry zone - with rainfall of 250-500mm a month - are still vulnerable and could serve as a reservoir for the malaria parasite, said Rabindra Abeyasinghe, acting director of the government’s anti-malaria campaign.
“Elimination means we have to get rid of the pockets of the disease that we have now,” Abeyasinghe said. “Without the conflict it would have been very easy, but with the conflict it is more challenging,” he told IRIN. “But it can be done … after all, Sri Lanka has already eliminated leprosy and poliomyelitis even with an ongoing conflict.”
The Health Ministry is seeking an estimated US$40 million in donor aid and government counterpart funds to cover a five-year elimination programme in seven of the island’s nine provinces. The budget will also include strengthening a control campaign in the other two conflict-hit northern and eastern provinces.
While overseas aid, mainly from the multi-donor Global Fund to Fight AIDS, Tuberculosis and Malaria, has helped bridge the shortfall in government expenditure, the low rate of malaria incidence threatens to undermine foreign financing.
|Up to now, donors have helped us control the disease, but our success could work against us when it comes to getting much-needed funds to carry out an elimination programme. If people are not dying, donors might not see it as an urgent issue any more.|
“Up to now, donors have helped us control the disease, but our success could work against us when it comes to getting much-needed funds to carry out an elimination programme,” Abeyasinghe told IRIN. “If people are not dying, donors might not see it as an urgent issue any more.”
But the World Health Organization (WHO), which has supported the malaria control programme since the late 1940s, thinks Sri Lanka has a solid case.
“Sri Lanka is a success story in Asia, because, despite all its problems, it is one of the few that have come close to eliminating the disease,” said Supriya Warusavithana of WHO. “International donors like the Global Fund are, in fact, looking for such striking stories to draw more donor funds for themselves.”
The collaboration of the Liberation Tigers of Tamil Eelam (LTTE) had ensured virtually no reported cases in the north, considerably helping the country approach the pre-elimination phase, Abeyasinghe said. “The LTTE has cooperated with provincial health authorities in the conflict areas to reduce malaria incidence, possibly because being a jungle-based force, they suffered more.”
Abeyasinghe is confident that the monitoring and treatment provided in the embattled districts by government and international agencies eliminated any significant under-reporting of prevalence. Regular supplies of mosquito nets, insecticides and medicines were sent by the government to war-torn areas.
In addition, rapid diagnostic kits given to medical practitioners helped to identify and treat malaria patients without access to laboratory facilities. The now defunct truce signed in 2002 between the government and the Tamil Tigers also helped accelerate the control programme.
According to WHO statistics, the declining trend began after 1998, when cases peaked at about 275,000 and 117 deaths.
In subsequent years, casualties were kept down through house spraying with insecticides, treated mosquito nets, improved testing and treatment facilities in rural hospitals and mobile clinics.
Warusavithana also attributed the achievement to widespread improvements in socio-economic conditions and infrastructure and better access to basic healthcare for the poor. “Malaria has always been linked to poverty,” she said. “For instance, the rural poor used to have houses with thatched roofs, mud walls and unpaved floors, which encouraged mosquito breeding. Now, many of them have tiled roofs, brick walls and cement floors.”
Due to the conflict, eradicating the disease in the north and east is set to begin only after the programme has been implemented in the other provinces. Aiming for total elimination will also have to include screening and monitoring at entry points to the island to prevent introduction of imported parasite strains to the country.