MALARIA: A Disease Close to Eradication Grows, Aided by Political Tumult in Sri Lanka

Lynsey Addario for The New York Times

By DONALD G. McNEIL Jr.: Published: December 27, 2010
 Malaria cases jumped 25 percent in Sri Lanka from 2009 to 2010, the country’s ministry of health is reporting. And while this year’s total is still small, at 580, the trend is unsettling to experts.
Sri Lanka is a bellwether for the dream of malaria eradication — and Exhibit A for the argument that politics affects the disease more than climate or public health measures do.
The country — the former British colony of Ceylon, famous for tea and cinnamon — is an island, so eradication is possible.
That almost happened once. After independence arrived in 1948, Sri Lanka had an estimated one million annual cases. With DDT and chloroquine, it drove that down to 18 cases by 1963. But spraying was cut back as DDT fell into disfavor, and by 1969, there were more than 500,000 cases.
Simultaneously, the country’s ethnic fabric fell apart. The majority Buddhist Sinhalese passed laws discriminating against the Hindu Tamils, who were favored under the British, leading to 30 years of civil war. The majority was also split for decades between pro-Soviet and pro-Western factions.
Malaria persisted, with cases highest in the north and east, where the Tamil Tiger insurgency was strongest. Nonetheless, by 2005, the country was below 2,000 cases, though experts said they were undercounted in rebel areas.
Last year, the rebellion was crushed, and malariologists hoped the new national reconciliation policy would lead to eradication. As cases ticked up, a ministry official blamed global warming — a weak argument in a wet tropical country. But he also said more clinics would be opened in former rebel areas.
http://www.nytimes.com/2010/12/28/health/28global.html?ref=health

MALARIA: Sri Lanka

An oft-cited story describes how Sri Lanka reduced its incidence of malaria from 2·8 million cases in 1946 to a mere 17 in 1963, only to see the rate resurge in subsequent years. Yet, in the past decade, Sri Lanka has brought its annual caseload down from more than 200 000 confi rmed cases in 2000 to just 670 cases in 2008, with no deaths due to malaria in more than 2 years.
Similarly, in the Philippines, the past decade has seen nine provinces become malaria free, bringing the total to 22 of 81.
Eight of 20 malaria-endemic countries in WHO’s Western Pacifi c and Southeast Asia regions achieved declines in annual cases of more than 50% from 2000 to 2008.
Success stories such as these reverberate throughout Asia–Pacific in this era of renewed commitment to elimination.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60350-9/fulltext

Sri Lanka: malaria in armed forces

Out of the 500 malaria patients detected last year, the majority were Armed Forces personnel in North and East, a Healthcare and Nutrition Ministry spokesman said. The spokesman said Sri Lanka will totally eradicate malaria by 2014 citing that in 2009 only around 500 malaria patients were found here while this number was half a million in 1994.
According to the spokesman, within 15 years, Sri Lanka has brought down the number of malaria patients by 98 percent. However, he said, malaria patients are still reported from Anuradhapura, Trincomalee, Vavuniya, Hambantota and Kilinochchi.
Mullaitivu and Kilinochchi are the most affected areas. This is because the malaria eradication program did not reach those areas during the last 30 years. Swift action was taken by the Healthcare and Nutrition Ministry and the National Malaria Control Program to control malaria among IDPs. Global Fund to fight AIDS, Tuberculosis and Malaria provide funds for Sri Lanka’s malaria eradication program.
http://www.dailynews.lk/2010/04/26/news02.asp