During pre eradication era,
nearly 40% of the population was subject to malaria annually and malaria
deaths accounting for 6% of total deaths from all causes. In 1945, the
estimated malaria cases and deaths were around 2.5 million and 8,500
respectively. Sri Lanka had
started large scale spray operation in 1947 and achieved tremendous success
too. The spectacular successes of the
early years of the malaria eradication programme
were nullified by the country-wide epidemic in 1967/1968, when over half a
million cases were detected. The
epidemic pressure relented in subsequent years, and by 1972, the incidence
was brought down to 132 605 detected cases.
The situation thereafter reversed once- again and the number of cases
detected increased progressively to 400 777 in 1975 with a Slide Positivity
Rate of 26.7%. The most alarming fact in the malaria situation was the
increase in the proportion of P. falciparum
infections which, from less than 0.5% in 1968, reached 8.3% in 1974, and
almost doubled to 15.9% in 1975. The
number of deaths due to P.falciparum has also
increased. With widespread resistance
of A. culicifacies to DDT, malathion
spraying was introduced in 1975 in areas of P.falciparum
transmission affording protection to nearly one million people. Towards the end of 1976 DDT spraying was
completely discontinued and during 1977 exclusively malathion
was used as an adulticide.
After 1975, the situation
continued to improve till 1982. The
number of cases came down to 38,5667, API 2.5 per
thousand and SPR touched 3.4% respectively and Pf% remained under check i.e.,
below 5%. The situation deteriorated there after again and
became worst during 1986 and 1987 when number of reported cases rose to
412,521 and 676,569 respectively due to epidemic. The API, SPR during the said period were
25.5 per thousand, 28.1% and 41.5 per thousand, 34.6 % respectively. In 1991, reported number of cases again
rose to 400263 with API 29.1 per thousand and SPR 28.6%. The situation improved slowly there after and in 1995, the
reported number of cases touched at 142,294 ,an decrease of 64.5%, API came
down to 14 per thousand SPR at
13.0%. But again this success again
did not last long and situation deteriorated there after In 1997, the
reported cases again rose to 218, 550 an increase of 53.6%, API reached up to
18.9 per thousand and SPR
rose to 16.4%. During 2001
- 2007, country has shown tremendous improvement in malaria situation. Reported malaria cases came down from
66,522 cases to 150 cases only in 2007, showing a reduction of 98.5%. After
1984, though Pf% remained fluctuating between 20% to 25% but steadily gone up
and touched it highest mark at 27% in 1987 and finally to 7% in 2008. No
death has been reported in 2008. After
Maldives, Sri Lanka has
reached to the stage to eradicate the malaria from the country. The country
has achieved RBM as well as MDG’s Targets well
before time.
In Sri Lanka transmission occurs in
most parts of the country. P.vivax is the predominant parasite, and A.culicifaces the most important vector. Chloroquine
resistance in P. falciparum is increasing. There has been an increase of vector
populations in areas where water development projects have been implemented
with a subsequent increase in malaria transmission. Indoor residual spraying (IRS) has been the
main vector control measure used in the country. In view of the resistance to DDT and malathion, the rotational use of fenitrothion
and a pyrethroids is now
being practiced with the aim of reducing the load of transmission of malaria.
|
Malaria Situation in Sri lanka,
2008 :
At a Glance
|
Total
population
|
: 21.0
million
|
Population
in malarious areas
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: 6.74
million
|
Number
of Lab confirmed malaria cases
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: 670
|
Number
of probable malaria cases
|
:
0
|
Number
of deaths due to malaria
|
: 0
(Reported)
|
No. of Severe Malaria
Cases
|
N.A.
|
Cases treated with ACTs
|
: 32
|
No
of LLINs Distributed
|
: 253,000
|
No.
of effective LLINs+ITNs (cumulative) availability
|
|
Population protected with ITNs
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: 1.5
million
|
Population protected
with IRS
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: 650,742
|
Vectors: An. Culicifacies and resistant to DDT and Malathion
Supported by Global Fund
Reached to pre-elimination stage of malaria
|
|
Goals and Targets:
To reduce malaria morbidity and mortality until the
disease is no longer a public health problem in the country.
Targets
|
Baseline data in
2005
|
2010
|
To reduce the API among at risk population
in the country
|
0.4
|
> 0.1
|
To sustain zero mortality from malaria in Sri Lanka
|
00
|
00
|
To reduce the proportion of
P. falciparum
infection
|
5.7%
|
>3
|
To eliminate the occurrence of malaria
infections in pregnant women.
|
NA
|
00
|
To reduce the proportion of malaria
infections in children below 5 yrs
|
10%
|
>5%
|
Control strategy:
Early detection and prompt treatment is the mainstay
of parasite control with support from health
infrastructure.
Usage
of Rapid diagnostic kits for the early detection of
malaria in the population living in areas of conflict and the border
villages.
Strengthen
the entomological units in the regional offices and establish computer-based
surveillance.
IRS with Malathion
used as the major vector control measures on selective basis.
Other control methods used are
insecticide-treated nets for personal protection and community awareness
through health education
Issues and Challenges:
Present epidemiological and
entomological surveillance system has failed to warn the malaria outbreaks
early enough for timely intervention
Lapses in the existing
epidemiological surveillance system e.g. not reporting clinically treated
patients and patients treated from private institutions
Lapses in the existing quality
control systems have failed to deliver the expected results
Lack of research based
information has created problems in planning malaria control activities.
Inadequate training
opportunities has slowed down incorporation of recent advances in the field
of malariology
Lack of laboratory facilities
at central and district level
Lack of management skills at
all levels
WHO
The Global Fund
Sarvodaya
Lions International
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