New Delhi: In WHO’s South-East Asia Region, national malaria control programmes have achieved significant progress in the last ten years. But this achievement could be unravelled by the growing threat of resistance to artemisinin, the most effective anti-malarial drugs. On World Malaria Day, WHO advocates rational use of anti-malarial drugs and acknowledges the crucial role of community health workers in reducing malaria in the Region.
In the South-East Asia Region, 70% of the population is at risk of malaria. In 2009, there were an estimated 28 – 41 million cases and 49000 deaths, a big economic as well as human burden as most of those affected are above 15 years of age. Around 94% of reported malaria cases and deaths are from India, Indonesia and Myanmar. “Malaria most affects those whose living conditions are already in a precarious state, and exacerbates poverty, especially in rural areas, “said Dr Samlee Plianbangchang, Regional Director, WHO Regional Office for South-East Asia. He added, “Community participation is essential, especially the involvement of community health volunteers. “
Since the 1990s, a combination of improved health systems, strategic planning, implementation of evidence-based interventions, effective partnerships with various stakeholders including NGOs, strong political will, increasing financial support and community participation have resulted in a declining trend in malaria. In Bangladesh and Thailand, malaria transmission is now limited to only a few districts. In, Bhutan, DPR Korea, Nepal, Sri Lanka and parts of India and Indonesia, the malaria incidence had been reduced to such low levels that the concerned health authorities and partner agencies are now steering the malaria control programme towards pre-elimination. The Maldives has an effective system for malaria disease surveillance and response that has enabled the health authorities to detect and treat imported cases and prevent re-establishment of malaria transmission since 1984. Although the malaria burden in India, Indonesia, Myanmar and Timor-Leste is high, the coverage of malaria control services is increasing and the malaria situation is much better now than ten years ago.
Rapid diagnostic tests are now widely used even at the most peripheral health facilities and villages, and coverage and quality of microscopy have improved. The number of artemisinin-based combination treatment courses provided increased from 260 000 in 2005 to 1.768 million in 2009. The cumulative availability of effective insecticide treated mosquito nets (ITNs) and long lasting insecticidal nets (LLINs) increased from 4.263 million in 2005 to 17.387 million in 2009. There are markedly fewer malaria outbreaks today than ten years ago. These outbreaks are responded to immediately, thus preventing further spread and deaths.
But population migration, environmental degradation and climate change could result in the re-emergence of malaria. Sustained and greater investments are needed to scale up key interventions, strengthen human resources and improve monitoring and evaluation. Research is needed to develop new tools and to test innovative delivery mechanisms to reach high-risk groups such as ethnic communities, forest workers and settlers, subsistence farmers, and migrant labourers.
The emergence of malaria parasite resistance to artemisinin-based drugs on the Thai-Cambodia border and possibly the Thai-Myanmar border seriously threatens malaria control in those countries as well as globally. A well-coordinated response by key partners is on-going to contain and prevent further spread of resistance to artemisinin-based drugs.