‘Big Success Story’: Sri Lanka Is Declared Free of Malaria
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.”
Source: The New York Times. Date: September 12 2016