Malaria

Progress made in the SEA Region, 2005 - 2010

      As compared to 2000, in 5 countries of the Region namely Bhutan, DPRK, Sri Lanka, Nepal and Thailand, malaria incidence (of confirmed cases) has reduced more than 50% where as in India the reduction is more than 25%.

      The reported Malaria Mortality in the SEA Region has reduced by 58% as compared to 2000. Bangladesh, Bhutan, Myanmar, Sri Lanka and Thailand shown more than 65% reduction in malaria mortality.

      The overall cumulative availability of effective bednets (LLINs/ ITNs amongst population at risk (API>1) has increased from 4.3 millions in 2005 to 17.1 millions in 2010 showing an increase of 298% (Fig 1). Apart from Sri Lanka where population at high risk(API> 1) is nil and Nepal where the said population is very low, the coverage of LLIN / ITN amongst eligible population (API> 1) is highest in Bhutan followed by Bangladesh. In Nepal, the entire eligible population covered under LLINs besides many people in low risk of malaria (API<1) are covered under LLINs. In Sri Lanka, as the entire population is at low risk only, therefore, LLIN /ITN coverage is shown accordingly (Fig. 2 ).

      The coverage under IRS for eligible population (at high risk of malaria) has reached 56.6 million (Fig. 3).

      The availability of RDT has increased from 1.2 million in 2005 to 10.1 million (relates to 2008; figures for 2009 & 2010 are not available) showing an increase of 841% .

      The availability of ACT has increased from 78900 in 2005 to 3913913 in 2010 showing an increase of around 49 times.

Policy

All countries in the region are implementing the 2 main vector control measures (LLINs and IRS) depending on the epidemiological setting. Since the adhesion to countries in SEA to the WHO Global Malaria Control Strategy in 1992, IRS has been the main tool used for vector control, especially in high-transmission settings and for the control of epidemics. However in the past years tremendous efforts have been made to scale-up the use of insecticide-treated nets one of the priorities of the Revised Malaria Control Strategy 2006-2010 of the region.

Drug policy changed in the countries and ACT has been introduced in all the countries. P. vivax cases are treated with CQ and PQ in all places where resistance is not developed yet.. Since the burden on pregnant women in the region is relatively low, countries in the region are not using IPTp (although recommending the use of personal protection with LLINs for pregnant women).

Interventions coverage

Over the past years, significant progress has been witnessed among countries in the Region in increasing access levels to key malaria control interventions: in particular, Bangladesh and Bhutan have shown strong capabilities to increase access to LLINs and India, Sri Lanka and Thailand have conducted successful large scale IRS programs. The summary of malaria prevention status in the SEA Region has been placed under Tab. 1.

Access to LLINs has been very low until recently. The overall bednet coverage (LLINs / ITNs) in the Region has increased slowly but steadily from 1.3% in 2005 to 9.0% in 2010 (Fig. 1 ) among the population at high and moderate risk (API> 1) of malaria in the Region. Bhutan, Bangladesh, and Thailand and Timor-Leste have made a significant contribution in this regard. The access to ITNs/LLINs varies wildly across countries, from a 76% in Indonesia ( in some project areas) to over 95% in Bhutan. In Bangladesh, in 13 high endemic districts, the bednet coverage amongst the HHs ranges from 40%-55% where as in Indonesia, in the seven highest malaria burden provinces, 92%-99% of households were covered under LLINs with support from the Global Fund.

IRS is used in high transmission settings and in case of major outbreaks. India, Nepal, Sri Lanka and Thailand are using IRS as a primary vector control measure. In other countries, the same is applied mostly to control epidemics. In Bangladesh, although there is a policy to apply IRS but they have stopped using it since 1991 where as DPRK has started using the same since 2008. In 2010, Timor Leste used IRS first time for malaria control programme. The criteria for applying IRS differ from country to country. In a big country like India IRS is practiced in areas with API>2. Sri Lanka, Thailand and Nepal are applying IRS to the areas with API< 1 as per their intervention policy. During 2000 -2010, the population covered under IRS were between 41–81 million where as total population at risk with API> 10 were around 106-203 million covering 22.8% - 64.3% of the population at high risk (API>10) under IRS. In 2010, 57.9 million population was covered under IRS in the Region. India alone sprayed 53.4 million population followed by DPRK (2.0 million),

Significant progress has been made recently because of availability of resources through donors specially Global Funds in this direction. Around 101.1 million blood examination (ABER = 8.3%) were performed during 2009 in the public sector in the Region. In Bangladesh and Myanmar intensive case finding was reported and hard to reach population were also covered through RDTs during 2008. The usage of RDT’s grown from 1.2 million in 2005 to 10.1 million in 2008 (around ten fold) where as the number of ACT treatment doses have been increased from 78,900 to 1,726,158 showing approximate 21 fold increase over the same period (Tab. 2).

Tab. 2 : Intervention Coverage in SEA Region 2005-2010

Source: Country Report, 2010; * Cumulative effective ITNs/LLINs

During 2001-2010, the overall malaria incidence in the SEA Region has not declined much. This was mainly due to intensive case finding with increased funding using RDT at community level as well as in hard to reach areas. On the other hand, due to usage of ACTs by malaria programmes in the Region, the malaria mortality has significantly declined in the Region as a whole. The confirmed malaria cases and deaths declined by 5.4% and 51.4% respectively during the above mentioned period. Bhutan, DPR Korea, India, Sri Lanka and Thailand were the key achievers in this regard (Fig. 4).

Of the 10 malaria-endemic countries in the Region, Sri Lanka and DPR Korea have reached at the malaria pre-elimination stage whereas two other countries, Bhutan, Nepal and Thailand, have made good progress in this direction.

Other Related Information

Figures

      Fig1- Cumulative Availability of Effective Long Lasting Inscticide Treated Nets (LLINs) / Insecticide Treated Nets (ITNS) & Population at Risk (API >1) Covered in SEA Region, 2005-2010 [PDF 25 KB]

      Fig2- Percentage Population at Risk (API>1) Covered under LLINs/ ITNs in SEA Region, 2010 [PDF 31 KB]

      Fig3- Population at High Risk of Malaria Covered under IRS in SEA Region, 1996-2010 [PDF 79 KB]

      Fig4- Malaria incidence (confirmed cases) per 1000 population at risk of malaria in selected countries of the SEA Region) 2001-2010 [PDF 16 KB]

Tables

      Tab1- Population Covered under Bednets & IRS in SEA Region, 2010 [PDF 16 KB]