Learning from malaria

Sri Lanka is showing the world how to cure malaria – one day at a time. Success stories are rare in Sri Lanka, particularly in the field that was once as lethal as malaria, but time, dedication and funding has shown a way and it can only be hoped that the same can be done in time for dengue.

Despite nearly three decades of conflict, Sri Lanka has succeeded in reducing malaria cases by 99.9 per cent since 1999 and is on track to eliminate the disease entirely by 2014.

According to a paper published Thursday in the online, open-access journal PLoS ONE, researchers from Sri Lanka’s Anti-Malaria Campaign and the UCSF Global Health Group examined national malaria data and interviewed staff of the country’s malaria program to determine the factors behind Sri Lanka’s success in controlling malaria, despite a 26-year civil war that ended in 2009.

They have pointed out that typically, countries with conflict experience a weakening of their malaria control programs and an increased risk of outbreaks and epidemics, but Sri Lanka has proved to be an exception. Chief among its keys to success was the program’s ability to be flexible and adapt to changing conditions, the study found. The program was able to sustain key prevention and surveillance activities in conflict areas through support from partner organisations and support from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Otherwise, researchers found that the keys to Sri Lanka’s success were the same as those deployed in non-conflict areas: rigorously and consistently providing interventions to prevent malaria among high-risk populations; proper and prompt diagnosis and treatment of all confirmed malaria cases; and maintenance of an effective surveillance system to quickly detect and respond to spikes in cases. Still, challenges remain.

Sri Lanka has an extensive history of battling malaria, and nearly eliminated it once before. In 1963, during the era of global eradication efforts, the country achieved a low of only 17 cases, down from 92,000 cases in 1953. With funding declines and reduced spraying and surveillance, the country saw a massive resurgence to 1.5 million cases in 1967-1968.

Since 1970, Sri Lanka has worked to bring malaria back under control, with compelling success, the authors said. In 2011, the country recorded just 124 locally acquired cases – about six cases per million people. This reduction is particularly noteworthy, the researchers noted, given that much of the progress was made during the war.

Today, even with the country’s great progress, Sri Lanka continues to face hurdles in its goal of driving malaria transmission to zero. Total malaria cases have dramatically dropped, but the proportion of Plasmodium vivax malaria infections – the more difficult to diagnose and treat form of malaria most common in Sri Lanka – is on the rise. Another challenge is the shift in the population group at highest risk for malaria. The group most at risk today in Sri Lanka is adult men, particularly those exposed to malaria-carrying mosquitoes through their work, such as gem mining, military service and farming. Sri Lanka is developing new strategies to target these groups.

In contrast Sri Lanka has struggled to contain dengue with tens of thousands of cases reported annually and dozens dying. Battling dengue has become the new challenge that needs to learn from the success of malaria. Sustainable and dedicated solutions, such as what was used for malaria, need to be adapted in the case of dengue, and institutional denial such as refusal to release statistics of dengue deaths is surely the wrong path to take.