Today is World Malaria Day. Sri Lanka was declared malaria-free by the World Health Organisation (WHO) in 2016. But, the country’s journey towards achieving this target had been long and arduous.
Organised malaria control activities commenced in Sri Lanka over a century ago in 1911, with the establishment of the Anti-Malaria Campaign, when Sri Lanka was still a British colony. A major achievement of the Campaign was the dramatic reduction in the countrywide malaria incidence after the introduction of DDT in 1946. In 1958, the Government of the newly independent Ceylon launched a malaria eradication programme, in keeping with the WHO recommendations at that time.
Remarkable gains were achieved during the eradication programme, and near eradication status was reached in 1963, with the number of reported cases dropping to as low as 17, out of which 11 were imported cases. However, soon after, a major setback was experienced which gave rise to a massive malaria epidemic in1967-1969.
Several factors were thought to contribute to the failure and adequate financial support was not forthcoming from the Government at the time when the incidence was extremely low. The programme continued on eradication principles for several years and subsequently re-oriented as a control programme which included many elements of the earlier eradication programme.
In 2009, Sri Lanka embarked on a phased malaria pre-elimination programme after the end of the separatist war in the Northern and Eastern Provinces of the country and, in 2011, launched the malaria elimination programme. The last case of indigenous malaria was reported in October 2012, well ahead of the targeted date of end 2014. The success of the elimination programme is largely due to the sustained action that was possible due to the existing structure of the AMC and the evidence based approach adopted.
However, giving rise to alarms, a few malaria cases were identified in the country in the recent past, particularly among Indian migrant workers in northern areas, and those who had recently returned from the African continent.
Following this, medical experts urged people with fever symptoms to inform the medical practitioner if he or she has a travel history to a malaria endemic country.
Addressing the Media at the Health Promotion Bureau (HPB) recently, Consultant Physician, National Hospital, Colombo, Dr. Upul Dissanayake said, with the increasing number of imported malaria cases, hospital and Anti Malaria Campaign authorities observed a degree of reluctance, particularly among patients who had visited West Africa, to reveal even the fact that they had visited a malaria endemic country. Because fever is a symptom of dengue, chikungunya, and malaria, the patient should inform the doctor that he or she has travelled to Africa, he urged.
Also, the medical practitioner too should question whether the patient with fever had travelled to a country where malaria was still a problem.
Deputy Director General Public Health-I Dr. M. Arnold said, although Sri Lanka had been able to eradicate the malaria parasite the malaria mosquito was still present in Sri Lanka, Therefore, although all the detected cases were imported ones, the possibility for a local spread of the mosquito-borne disease was very high.
Director of the AMC, Dr. Prasad Ranaweera noted there had been 26 imported cases of malaria in 2021 while from the beginning of this year till the end of the second week of April the country has seen 16 cases. He lamented that by December this year the number of malaria cases may top 70.
He warned therefore that the AMC’s main challenge was to ensure that not even one imported case was missed out. The presence of the Anopheles Malaria mosquito in the country would only help the disease to spread locally, the Director cautioned.
According to WHO, in the last year, about 95 per cent of the estimated 228 million cases occurred in the African region, along with 602,020 reported deaths. Six of the countries that are worst-impacted by malaria in the region, are reported to have accounted for up to 55 per cent of cases globally, and for 50 per cent of these deaths.
They also said the past year has seen significant breakthroughs in malaria prevention and control, in spite of the Covid-19 pandemic. Landmark recommendations on the use of the first vaccine against malaria – RTS,S – were released by the WHO late last year. This vaccine will be used to prevent malaria among children aged six months to five years, who live in moderate- to high-transmission settings.
While this is a groundbreaking advance in the development of new tools to fight this disease, with the potential to save millions of lives, supplies are currently limited. As such, it is important to ensure that the doses that are available are utilised for maximum impact, while ensuring continued availability of other preventive measures to those most at risk.