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World Malaria Day – April 25, 2024 “Accelerating the fight against malaria for a more equitable world”

World Malaria Day, observed on April 25 annually aims to raise awareness on the global efforts to control and ultimately eradicate malaria. It was instituted by WHO Member States during the World Health Assembly of 2007 and the World Malaria Day was first held in 2008. The development of Anti-Malaria day as a worldwide event has roots to the Africa Malaria Day, an event that had been observed since 2001 by African countries. The African countries initiated celebrating this day one year after the historic Abuja Declaration in 2001 which was signed by 44 malaria-endemic countries at the African Summit on Malaria.

Globally in 2022, there were an estimated 249 million malaria cases and 608 000 malaria deaths in 85 countries. The WHO African Region carries a disproportionately high share of the global malaria burden and in 2022, the Region was home to 94% of malaria cases (233 million) and 95% (580 000) of malaria deaths. The WHO South-East Asia Region accounted for about 2% of malaria cases globally: malaria cases declined by 76%, from 23 million in 2000 to about 5 million in 2022.

For centuries, malaria plagued the island nation of Sri Lanka, causing significant suffering and death among its population. However, the country’s commitment to combating the disease has led to a remarkable success story in malaria elimination. Formal malaria control efforts were first established in 1911, with the establishment of the Anti-Malaria Campaign in Kurunegala.

Over the years, additional units were set up in different regions of the country where the populations were at high risk of malaria. Despite efforts, major outbreaks continued to occur throughout the 20th century, with devastating consequences, especially in 1934-35 when 1.5 million individuals in the country were infected and nearly 80 000 died.

A pivotal moment in 1946 was the introduction of dichlorodiphenyltrichloroethane (DDT), which led to a dramatic reduction in malaria incidence. Followed by this success, the government launched a malaria elimination program in 1958, aligning with WHO recommendations.

The initial “Attack Phase” of the malaria program saw significant gains, and by 1963, near-elimination status was achieved, with only 17 reported cases, mostly imported. However, the subsequent “Consolidation Phase” faced setbacks, culminating in a massive epidemic during 1967–1969. Factors such as undetected transmission foci, population movements, and complacency among public health personnel contributed to this setback.

Undeterred, the program shifted its focus, blending elimination principles with control measures. Operationally, the Anti-Malaria Campaign (AMC) evolved from a centralized structure to a decentralized approach in 1989, with provincial health authorities taking greater responsibility under the guidance of the National Anti-Malaria Campaign Directorate.

The concerted efforts bore fruit, with the last case of indigenous malaria reported in October 2012, well ahead of the targeted date of end 2014. The success of the elimination program can be attributed to sustained action and an evidence-based approach, facilitated by the structured framework of the AMC.

Today, Sri Lanka stands as a beacon of hope in the fight against malaria, showcasing what can be achieved through dedication, adaptability, and collaborative efforts. The journey from endemicity to elimination serves as an inspiration for other malaria-affected countries, demonstrating that with perseverance, malaria can be conquered.

This demonstrated success led to the country being awarded with the WHO certification of Malaria Elimination in 2016.

The WHO Global Malaria Program (GMP) is responsible for coordinating WHO’s global efforts to control and eliminate malaria. Its work is guided by the Global Technical Strategy for Malaria (GST) 2016–2030 adopted by the World Health Assembly in May 2015 and updated in 2021. The GTS calls for a reduction in malaria case incidence and mortality rate of at least 75% by 2025 and 90% by 2030 from a 2015 baseline. Despite the considerable progress made since 2000, if the current trends continue, it is likely that the GTS 2025 targets will not be achieved globally.

In the recent past AMC was able to successfully overcome several challenges including a new mosquito vector, Anopheles stephensi. The characteristics of this vector make its control challenging; An. stephensi quickly adapts to the local environment, surviving extremely high temperatures during the dry season, when malaria transmission usually reaches a seasonal low. Insecticide resistance data reported to WHO by different countries show that An. stephensi has demonstrated resistance to pyrethroids, organophosphates, carbamates and organochlorines. WHO encourages countries in which An. stephensi invasion is suspected or has been confirmed to take immediate action, by increasing vector surveillance to delineate the geographical spread of this vector, and by using data to implement interventions aimed at preventing its further spread, especially into urban and peri-urban areas.

Sri Lanka takes steps to prevent the re-establishment of malaria. These include conducting regular entomological and parasitological surveillance, improving case detection and following up of imported malaria cases, providing preventive medication to individuals traveling to endemic areas to reduce the risk of malaria infection etc.

The World Health Organization Sri Lanka is playing a crucial role in supporting the country’s efforts to sustain the Prevention of Re-establishment (PoR) phase against malaria. Through timely technical and financial assistance, WHO has significantly contributed to maintaining key aspects of malaria elimination.

One of the primary contributions of WHO has been ensuring an uninterrupted supply of essential anti-malarial commodities, including medicines, Long-Lasting Insecticidal Nets (LLINs), Rapid Diagnostic Tests (RDTs), and insecticides. The continuous provision of these vital tools has been instrumental in effectively managing and controlling malaria transmission in Sri Lanka. Additionally, WHO has provided ongoing support for clinician training programs, ensuring that healthcare professionals receive the necessary knowledge and skills to diagnose and treat malaria cases promptly and accurately. By enhancing the capacity of healthcare workers, WHO has strengthened the country’s healthcare system’s ability to effectively respond to malaria cases. WHO has facilitated the end-term review of the Malaria Strategic Plan. This review process helped to identify areas for improvement and inform future planning and decision-making to ensure the continued success of malaria elimination efforts in the country. Furthermore, WHO has offered technical assistance in the development of the Strategic Plan for Prevention of Re-establishment of Malaria (2023-2027). This strategic plan serves as a roadmap for guiding malaria elimination efforts over the coming years, outlining key objectives, interventions, and strategies to prevent the re-establishment of malaria transmission in Sri Lanka.

In 2024, WHO plans to support the country to conduct an integrated vector-borne diseases review which includes Malaria. The review will provide valuable insights into the strengths, weaknesses, and gaps in vector-borne disease control efforts, helping inform policy decisions, resource allocation, and programmatic interventions aimed at reducing the burden of these diseases.

Continued investment is necessary in sustaining Sri Lanka ‘malaria free’ status and WHO will continue providing its technical assistance to the AMC to mobilize resources to prevent the re-establishment of malaria in Sri Lanka.

References:

Anti Malaria Campaign

https://www.who.int/campaigns/world-malaria-day/2023

https://www.who.int/publications/i/item/9789240086173

Gayan Dharmasiri, A.G., Perera, A.Y., Harishchandra, J. et al. First record of Anopheles stephensi in Sri Lanka: a potential challenge for prevention of malaria reintroduction. Malar J 16, 326 (2017). https://doi.org/10.1186/s12936-017-1977-7