On the road to eliminate malaria in Sri Lanka: lessons from history, challenges, gaps in knowledge and research needs

Abstract

Malaria is one of the most important tropical diseases that has caused devastation throughout the history of mankind. Malaria eradication programmes in the past have had many positive effects but failed to wipe out malaria from most tropical countries, including Sri Lanka. Encouraged by the impressive levels of reduction in malaria case numbers during the past decade, Sri Lanka has launched a programme to eliminate malaria by year 2014. This article reviews the historical milestones associated with the malaria eradication programme that failed subsequently and the events that led to the launch of the ongoing malaria elimination plans at national-level and its strategies that are operational across the entire country. The existing gaps in knowledge are also discussed together with the priority areas for research to fill in these gaps that are posing as challenges to the envisaged goal of wiping out malaria from this island nation.

Towards the implementation of malaria elimination policy in South Africa: the stakeholders’ perspectives

“…The modelling study conducted by Caminade et al has previously implicated climate in malaria, but was unable to establish direct causality between the climate and malaria distribution trends [1]. One informant in this study explained that water bodies lasting long enough for mosquitoes to develop into full adults is crucial and this is supported by the literature [6]. The suggestion by some respondents that the reduction in malaria transmission in South Africa is mainly due to the changes in climate, rather than to the recent interventions, requires further investigation to better understand how the climate has affected the epidemiology of malaria, so that interventions can be better adapted to the context.…”

“…Five key informants were females and seven were males. Half [6] were either Ph.D graduates or Professors, one was an M.Sc graduate, two had B.Sc Honours, two had National Diplomas and one had a B.Tech qualification. Six themes and seven subthemes were developed from the analysis.…”

A Cost-Effectiveness Analysis of Plasmodium falciparum Malaria Elimination in Hainan Province, 2002–2012

“…First, it is obvious that the maintenance of the adopted strategies to achieve malaria elimination (and sustain thereafter) would require substantial funding, and such monetary allocations in the midst of conflicting priorities for the government certainly is a challenge and will be more so in the future. 37 Second, although cases imported from other countries have not led to secondary cases in the past years, careful surveillance and further research to prevent the reintroduction of malaria by imported cases from other countries are necessary and required. 27 Third, health education and health promotion intervention contributed to the early diagnosis of malaria, especially to the population that visited falciparum malaria-endemic countries recently.…”

Hypothesis: Dynamics of Classical Malaria Epidemics Show Plasmodium falciparum's Survival Strategy

“…18,21 The subsequent history of malaria in Sri Lanka has been driven by a memory of the severe epidemic of 1934-1935. 22 A nearly complete program of dichlorodiphenyltrichloroethane (DDT) malaria eradication lead to a nadir of only six locally transmitted cases in 1963. When the malaria eradication program was pre-maturely ended, however, malaria resurged to again become a major public health problem, with 0.5 million malaria cases reported in 1969.…”