WHO certifies Sri Lanka malaria free

[Gibbs]

Well done to the Health authorities, Polio done, TB done, Encephalitis done, Filaria done.. Now only Dengue to go

@Saradiel, @Godman

WHO certifies Sri Lanka malaria free

In the mid-20th century it was among the most malaria-affected countries, it is a remarkable achievement, said Poonam Khetrapal Singh, Regional Director of WHO

In a remarkable public health achievement, Sri Lanka has been certified as malaria-free island country by World Health Organisation (WHO) on Monday.

"Sri Lanka's achievement is truly remarkable. In the mid-20th century it was among the most malaria-affected countries, but now it is malaria-free. This is testament to the courage and vision of its leaders, and signifies the great leaps that can be made when targeted action is taken. It also demonstrates the importance of grass-roots community engagement and a whole-of-society approach when it comes to making dramatic public health gains,"WHO Regional Director, Dr Poonam Khetrapal Singh, said here.

Sri Lanka's road to eliminating the mosquitoes was tough, and demanded well-calibrated,

After malaria cases soared in the 1970s and 80s, the country's anti-malaria campaign in the 1990s adjusted its strategy to intensively target the parasite in addition to targeting the mosquito.

The change in strategy was unorthodox, but highly effective.

Mobile malaria clinics in high transmission areas meant that prompt and effective treatment could reduce the parasite reservoir and the possibility of further transmission. Effective surveillance, community engagement and health education, meanwhile, enhanced the ability of authorities to respond, and mobilized popular support for the campaign.

The adaptation and flexibility of strategies and support from key partners such as WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria fast-tracked success.

By 2006, the country recorded less than 1 000 cases of malaria per year, and since October 2012, the indigenous cases were down to zero. For the past three-and-a-half years, no locally transmitted cases have been recorded.

To maintain elimination and ensure the parasite is not reintroduced to the country, the anti-malaria campaign is working closely with local authorities and international partners to maintain surveillance and response capacity and to screen high-risk populations entering the country.

Sri Lanka is the second country in the WHO South-East Asia Region to eliminate malaria after Maldives. The announcement of Sri Lanka's victory over malaria was made at the WHO South-East Asia Region's annual Regional Committee meeting in the presence of health ministers and senior health officials from all 11 Member States.

The Regional Director said WHO will continue to support the efforts of Sri Lanka's health authorities as they relate to malaria, as well as the country's wider public health mission. This outstanding achievement should be a springboard to further public health gains in the country and the South-East Asia Region as a whole.

http://www.business-standard.com/ar...es-sri-lanka-malaria-free-116090500365_1.html

 

[Godman]

Climate change is making it hard to get rid of dengue. Sri Lanka needs to make it an opportunity and invest in Research and development against dengue.

 

[Tamilnadu]

Go SL Go......rest of the SA nations should learn from SL

 

[NGV-H]

Not one case of transmission in 3.5 years. The experience we get can be adapted to fight dengue I think.

 

[Gibbs]

Climate change is making it hard to get rid of dengue. Sri Lanka needs to make it an opportunity and invest in Research and development against dengue.

Cubans are experts in vector born tropical disease control, Should seek their expertise

 

[Bitter Melon]

Commendable job Sri Lanka. Lead on.

 

[Star Wars]

NIce...congrats

 

[Nilgiri]

Congrats. Very heartening to see.

 

[Gibbs]

Experience, rigour, determination: How Sri Lanka eradicated malaria

In 1977, Sri Lanka switched to malathion, considered less harmful to humans than DDT.

The World Health Organisation (WHO) declared Sri Lanka malaria-free last week. Victory over the disease came after more than seven decades, during which the country also went through a crippling civil war. The long years of accumulated technical experience was bolstered by a solid public health system that provided an efficient network of reporting, information-gathering and surveillance, and almost full literacy, which made it easier for health workers to educate and mobilise the 21 million population against the disease.

In the 1990s, Sri Lanka was fighting two big wars at the same time. One, the war in the North and East against the Liberation Tigers; the other, less well known, against the Anopheles culicifacies and the disease it spread. The two were not entirely unconnected.

In 1991, the number of malaria cases was nearly 400,000. In 1995, when the civil war broke out again after a 100-day ceasefire, 142,000 cases of malaria were reported which, in 1999, rose to over 260,000. The patients were mostly male. Soldiers serving in the North-east were identified as vulnerable — and because they travelled back to their homes in southern Sri Lanka, a high-risk group. In 1998, 115 people died of malaria. This is about the time the government launched itself into its second war.

The 2002-06 ceasefire helped the government’s campaign, which was backed by international funding — and by 2007, the incidence of the disease had come down dramatically to under 200. That year, when the fighting began again, saw a minor spike in the number of cases.

At the end of the war in 2009, the Sri Lankan Ministry of Health launched a malaria elimination programme, funded in part by the Global Fund to fight AIDS, Tuberculosis and Malaria. It set itself two goals: to make the country free of p. falciparum strain of malaria by 2012, and of p. vivax by 2014.

In 2010, Sri Lanka reported over 730 cases, which included both indigenous and imported cases. But in 2013, 2014, and 2015, there were only 95, 49 and 36 cases — in all cases, the infection was acquired abroad. The country had achieved three years with zero incidence of indigenously contracted malaria, making it eligible for the WHO certificate.

According to Dr Hemantha Herath, Deputy Director of the anti-malaria programme, the success owed to a multi-dimensional approach: an effective vector control programme, a three-pronged parasite surveillance programme, and “patient management”, or treatment of the disease.

Sri Lanka’s efforts at vector control go back to when it experienced its first malaria epidemic in 1934-35. DDT spraying was introduced in the 1940s, and this remained the main method of vector control. Entomological surveillance — the study of vector species, its distribution, density and susceptibility or resistance to insecticides — a labour intensive exercise, began around the same time. Reporting malaria cases was made a legal requirement.

In 1963, as a result of these efforts, only 17 malaria cases were reported. Sri Lanka dropped its guard. Spraying was discontinued. And by 1969, malaria was back. There were 500,000 cases, and the mosquitoes had developed DDT resistance.

In 1977, Sri Lanka switched to malathion, considered less harmful to humans than DDT. But it would be another two decades, until the introduction of a new insecticide group called Pyrethroid, before Sri Lanka would have better ammunition against malaria, and its fight against the disease would begin in right earnest.

“It was highly effective. Because of less smell and less residual staining of surfaces, 99% of households allowed spraying. Insecticide coverage increased,” Herath said.

Alongside, the government also distributed insecticide-treated mosquito nets. Before money poured in from the Global Fund — Sri Lanka received over $ 30 million in three tranches — the nets were made locally, and programme workers went house to house, treating the nets with insecticide, Herath said.

In 1984, a year after the ethnic question tuned into violent confrontation, chloroquine-resistant p. falciparum was discovered in the country for the first time. During 1989-91, there was a big outbreak of malaria, followed by spikes in 1995 and 1999.

Despite running a parallel state in the North for several years, the LTTE cooperated to a large extent in government health initiatives. For 3 years in the mid-1990s, the LTTE would declare a four-day unilateral ceasefire to enable an anti-polio immunisation campaign. In the same way, the Tigers did not obstruct the government’s anti-malaria efforts, implemented through local officials. The reporting was effective, if not 100%.

But there were security restrictions on sending insecticides and drugs to areas under LTTE control. There were restrictions on sending in vehicles, as the LTTE was known to confiscate anything it needed for the war. Also, health workers from the South did not want to travel to the conflict areas. Result: while local health officers continued to report cases, control and surveillance measures were not as effective.

Parasite surveillance consisted of three procedures: passive detection, in which anyone going to hospital or a health centre with symptoms of malaria had to get their blood tested; active detection, in which health workers in mobile malaria units went from house to house doing blood tests on pre-identified high-risk groups; activated passive detection, in which a blood test was done on anyone coming into a health centre for reason.

In the elimination phase from 2008, each case was reported to the anti-malaria control headquarters in Colombo within 24 hours by email. Details of confirmed cases had to be relayed back. The standard operating procedure for nearly a month-long follow-up included treatment with medicines, screening of family and places were the patient had stayed or visited, insecticide spraying in the neighbourhood, and keeping a watch on mosquito density in the area.

“Each case was investigated, treatment given, and followed up. Earlier we used to have only numbers, now we had all the details,” Herath said. He credited a technical support group of administrators, senior doctors, and professors of medicine with institutional memory of the battle against the disease, for coming up with the right strategies.

The country’s public health system, with its extensive network of free primary medical centres and health workers, was the spinal cord of the programme, which ensured no person was left out. Herath estimates that apart from the 3,000 health workers directly involved in the anti-malaria campaign, all other village-level public health workers, including midwives, too were actively engaged in educating people and mobilising opinion.

The army pitched in by not sending home soldiers who fell ill while posted in the North and East, in case it was malaria. They were treated in the camp, and given leave to go home only after they were better. This checked transmission and played a big role in eliminating the disease, Herath said.

Sri Lanka now hopes that India is able to eliminate malaria too, as there is every danger of it returning to the island through infected tourists, business travellers and Buddhist pilgrims. One suggestion from Herath, from Sri Lanka’s own experience, is that as India eliminates malaria from parts of the country, it must not reduce flow of resources to that area. “We shall be hoping and praying for India’s success, and we will be providing all support in detecting cases that may come to us from India,” he said.

http://indianexpress.com/article/ex...eradicated-malaria-health-system-who-3026438/

 

[Gibbs]

‘Big Success Story’: Sri Lanka Is Declared Free of Malaria

Global Health

By DONALD G. McNEIL Jr. SEPT. 12, 2016

After a long struggle, Sri Lanka, the large island nation southeast of India, was declared free of malaria last week by the World Health Organization. It has been more than three years since the last case.

“This is a big success story,” said Dr. Pedro L. Alonso, the director of the W.H.O.’s global malaria program. “And it’s an example for other countries.”

Sri Lanka almost succeeded in eliminating malaria 50 years ago, but its huge effort fell apart. The country became the example most frequently cited by malariologists to show how defeat could be pried from the jaws of victory.

Through the 1940s, Sri Lanka routinely had a million cases of malaria a year. Then officials began an intensive public health campaign, relying on DDT to kill mosquitoes and chloroquine to cure the disease. By 1963, the annual caseload had fallen to a mere 17.

Then the drive ran out of money and faltered, and annual cases of malaria rose above 500,000 by 1969. By then, mosquitoes had evolved resistance to DDT, and by 1992 to its successor, malathion. Malaria parasites first showed resistance to chloroquine in 1984.

But the failure also was political: The country’s ethnic fabric disintegrated.

Sri Lanka had been the British colony of Ceylon, an exporter of tea and cinnamon. After its independence in 1948, the majority Buddhist Sinhalese began discriminating against the Hindu Tamils, whom the British had favored.

Decades of civil war between the government and the Tamil Tigers ensued, with the latter aided covertly by India, until the rebellion was crushed in 2009.

In 2000, outside the rebel-controlled areas in the northeast, malaria cases began dropping as the government, with donor help, deployed a mix of indoor spraying, bed nets, rapid diagnostic kits and medicines that combined artemisinin, an effective treatment, with other drugs.

The government also screened blood samples drawn — for any reason — in public clinics and hospitals for malaria infection, and officials established a nationwide electronic case-reporting system.

In war-torn areas, the disease retreated more slowly, although the Tigers often cooperated with malaria-control teams because their villages and fighters also suffered.

Nonetheless, in a population of 20 million, it took years to get rid of the last few hundred annual cases. Most were soldiers and itinerant laborers, often from India, who worked in remote slash-and-burn farming areas and in logging and gem-mining camps.

The Sri Lankan health ministry set up mobile clinics near the camps, as well as at airports and ferry landings where migrants arrived, offering diagnosis and treatment to all. Free malaria care is still a core part of the country’s effort to prevent an imported case from leading to a new outbreak.

“They don’t ask if anyone is legal or illegal,” Dr. Alonso said of the medical staff at the clinics. “If you ask questions, people won’t go.”

http://www.nytimes.com/2016/09/13/health/sri-lanka-declared-free-of-malaria.html?_r=0

 

[nautilaceae]

Congratulation Sri Lanka! Malaria is still a problem in many rural parts of Malaysia.