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Malaria Elimination Country Case Study 3: Progress towards elimination in Sri Lanka

October 11, 2012 - 20:39 -- The Global Heal...

Many countries are nearing — or have already achieved — malaria elimination, as documented by a new series of case studies by The Global Health Group at the University of California, San Francisco and the World Health Organization (WHO) Global Malaria Programme. Having worked in collaboration with ministries of health in affected countries, the two organizations highlight new evidence about what works — and what does not — for reaching and sustaining zero malaria transmission.

The Sri Lanka report can be downloaded here: http://globalhealthsciences.ucsf.edu/sites/default/files/content/ghg/mei-eliminating-malaria-sri-lanka-lowres.pdf

Comments

William Jobin's picture
Submitted by William Jobin on

Data in this case study indicates that there have been two recent periods of malaria transmission in Sri Lanka. The first phase ended when the use of DDT and drugs in the GEP lead the malaria folks in Sri Lanka to believe that control was near, in 1960. The success was ephemeral however, and a second transmission phase occurred from 1970 to 1999. Then the annual parasite rate was brought near zero by 1999, even prior to assistance from RBM, the World Bank and the Global Fund. How was malaria controlled from 1970 to 1999? A notable part of the fight was Integrated Vector Management. I quote from this study by Feachem:

“…While larvivorous fish had been used for vector control
since the 1960s, use of this intervention began to increase
in the mid-1990s as IRS coverage declined (50). Fish were
introduced before the malaria season, with re-introduction
after each dry spell in gem pits (pits dug by gem
miners) and other small breeding areas. In response to
the increase in transmission subsequent to the Mahaweli
project which was completed in 1987, vector control
and larval source management were scaled up, with the
participation of communities and the involvement of the
irrigation and agriculture sectors through the strategy of
integrated vector management (51, 52).
Chemical larviciding was reported to be used as a
supplementary control measure from 1997 in abandoned
wells, gem pits and other areas and was considered costeffective.
Temephos continued to be used during this
time, being applied irregularly during or before
impending outbreaks, once every 10 days (46).”

In addition, Sri Lanka and especially the Mahaweli Irrigation Project have a global reputation for mosquito control through specialized irrigation and drainage techniques aimed at anopheline larvae.

Again, this raises the question of why WHO and the US PMI concentrate on bednets and indoor spraying? They should broaden their strategy to include larval control, including irrigation, drainage and agricultural techniques. They should pay more attention to their own case studies.

William Jobin Director of Blue Nile Associates