2019 Jan 10
Following a successful feat in 2016, Sri Lanka managed to free the island from the Malaria epidemic.
Unfortunately, this victorious eradication of Malaria appears to be impermanent.
A short-lived victory
After two years of being Malaria-free, the disease has made an appearance, causing islandwide shock once again.
Two cases of malaria were reported from Siyambalanduwa recently. One of the victims was reported to be an Indian national employed at a construction site of a private sugar factory in Athimale, Siyambalanduwa.
The second victim is a 45-year-old local resident of Meegoda employed at the same sugar factory. Physicians now suspect that the local patient had contracted the disease from the first patient, the Indian national. Residents of the area have also alleged the disease has been spread by Indian labourers.
Efforts are currently underway at the National Research Agency, Singapore to ascertain from where the patients had contracted the disease.
Here is what you need to know about the long–time running, once defeated Malaria epidemic that seems to be gradually on the rise once again.
The species
In Sri Lanka, Plasmodium vivax and Plasmodium falciparum accounted for most infections while there were a few cases due to Plasmodium malariae and Plasmodium ovale. The principal vector is Anopheles culicifacies species E. This Anopheles species has a wide range of habitats that include shallow water pools in rivers, shallow wells, swamps, even rain water depressions. The mosquito is both an indoor and outdoor biter and prefers the dusk time for blood meals.
Local Efforts on Eradication and Progress
The local Anti-Malaria Campaign (AMC), Sri Lanka’s National Malaria Control Programme, was established as a field office in 1911. This specialized programme formulates policies, monitors trends, provides technical guidance to the regional malaria offices, coordinates training and research, and oversees surveillance.
1921 – 1969
Control measures were implemented. However, the island faced a devastating epidemic in 1934-1935 which resulted in 1.5 million out of a population of approximately 6 million being affected. This period saw over 80,000 inconceivably devastating deaths within just a mere 07 months.
1970 – 1999
Irrigation schemes began expanding throughout the island, particularly in malaria endemic regions. Simultaneously, mass population movements took place as people pursued better prospects. The 1980s heralded many events that invariably disrupted mundane life and complicated the administration of public health interventions, particularly for malaria control.
2000 – 2012
Malaria was finally on the decline. Health authorities concentrated on building staff capacity, fine-tuning malaria treatment, consistent surveillance, and active and passive case detection. Since 2012, Sri Lanka had not recorded any indigenous cases. All cases came from outside the island.
2013 – 2016
Peacetime brought prosperity and improvement in trade and travel. Tourists, migrant workers, and refugees, especially from malaria endemic India, arrived. Fortunately, malaria did not make a reappearance. Health-care workers persevered to identify malaria patients and asymptomatic carriers. Following 03 consecutive years of zero local transmission, Sri Lanka was certified by WHO as a malaria-free country in 2016.
Commemoration of Success
Following decades of a plethora of valiant efforts ranging from insecticide spraying to testing travelers and educating health professionals, Sri Lanka finally managed to bid adieu to the Malaria epidemic.
Dr. Poonam Khetrapal Singh, Regional Director of WHO South-East Asia Region in the 2016 report issued notes, “Sri Lanka’s success began with an ambitious vision,” which was sustained by very concrete ingredients. These ingredients included consistent surveillance and case detection; comprising of both parasitological and entomological surveillance, using mobile malaria clinics, case management and health education, vector control with widespread use of mosquito nets and integrated vector management, and strong policy actions and advocacy. Political commitment, the private health sector, advocacy among medical professionals, decentralized control, an excellent cadre of field staff, and coordination at every level were all vital in maintaining zero transmission.
The return of Malaria is grim news indeed for us Sri Lankans. Yet, let us hope that the spread will be contained and managed effectively with the involvement of the relevant organizations.
