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Beware of malaria’s grim stinger

30 Dec 2021

By Dr. Charuni Kohombange Malaria is a deadly disease that can affect humans through a single mosquito bite. Although not documented, the history of malaria in Sri Lanka dates back to the Third Century BC. The initial case of malaria had been reported in the early 1900s, but had not been officially recorded since 1906, where it marked the major outbreak of malaria in Sri Lanka, then Ceylon. Malaria is caused by a single-cell parasite in the Plasmodium group. The four species of the Plasmodium parasites are named Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, and Plasmodium ovale. These parasites are transmitted between humans by anopheles mosquitoes. Anopheles culicifacies is the principal vector for Malaria in Sri Lanka. The last death due to malaria in Sri Lanka was reported in 2007 and the last case of indigenous malaria had been reported in 2012, where the country marked its malaria eradication status. Sri Lanka received the World Health Organisation (WHO) certificate for malaria-free status in the year 2016. After the eradication of the disease, all cases which were reported were related to foreign travels. However, some novel concerns are arising on a potential threat of reintroduction of malaria in the country. In a media conference conducted by the Health Promotion Bureau, Anti Malaria Campaign Director and consultant community physician Dr. Prasad Ranaweera addressed the media in this regard. Following are excerpts from his media address. Is malaria eliminated from Sri Lanka? Elimination of malaria denotes that there are no people in the country who are carrying the malaria parasites. However, the mosquito who transmits the disease still inhabits the island. Hence, if a person catches the disease from a foreign country and returns back to Sri Lanka, the mosquitoes can spread the disease if it bites that infected person. In this context, the main focus of the Anti Malaria Campaign is to identify these patients who import the disease before they get caught by a mosquito. In this situation, Sri Lanka detects about 50 cases each year even after the declaration of disease elimination. Imported cases of malaria In 2019, 53 such cases were identified, 23 out of which had been from travellers to India. In the year 2020, this number was reduced to 30 and only six were from travellers to India while the rest were from travellers to African countries. In 2021, only 25 cases had been reported up to now. Unlike in previous years, during this year, 24 out of the 25 patients are from travellers to African countries. “Unlike in other programmes, we cannot be happy with a low number of patients since this low number of reported cases could possibly signify that we have missed out some cases. The danger of missing cases is that there is a chance for the mosquitoes to catch these patients before we detect them,” Dr. Ranaweera explained. Rising concerns on spreading the disease During the past years, most of the malaria-infected patients were detected from districts such as Colombo, Kalutara, Gampaha, Galle, and Matara. However on 16 December, a patient had been reported from the Jaffna District for the first time for the last four years. Further, on 23 December another patient was detected from the city of Jaffna. While investigating further into this patient, the regional Anti Malaria Campaign officers had detected vector mosquitoes, Anopheles culicifacies inhabiting the patient’s home. This patient has travelled to an African country and been to Sri Lanka two weeks prior to this identification. In this context, there is a chance of spreading the disease as the vector mosquitoes too had been identified from the patient’s premises. Since this is a serious health concern, the provincial officers of the Anti Malaria Campaign, along with regional health authorities are taking all steps to extinguish mosquitoes. This is a crucial step at the moment to prevent the spread of the disease throughout the country. In addition, a surveillance is conducted among patients admitted in hospitals in the district of Jaffna, with the intention of detecting any possible malaria-infected patients. Further, surveillances may extend to test all individuals within the 500 m vicinity from the index case. More activities such as the distribution of mosquito-repellent-embedded bed nets and other possible mosquito elimination processes are currently underway to bring down the disease risk to the bare minimum. Do not neglect the disease Since the incidents of malaria cases are very low at the moment, public awareness on the disease is diminishing. The Anti Malaria Campaign Director urged the public and healthcare workers not to neglect the disease. In order to detect any unidentified cases, the Anti Malaria Campaign has requested all persons who have travelled to an African country within this year to get themselves tested for malaria. These testing facilities are available in all 27 regional malaria offices and the headquarters of the campaign, which is located in Colombo 5. Facilities for sample collection for malaria testing are available in all government hospitals. These persons will be subjected to three blood tests named, rapid diagnostic test (RDT), microscopy, and PCR testing for malaria. All these tests are performed free of charge by the government healthcare system. If a patient is diagnosed with malaria, they will be identified and promptly treated.   Responsibility of citizens to prevent reintroduction of malaria All of us have a responsibility in preventing reintroduction of malaria to Sri Lanka. If you have developed fever and if you have travelled to a malaria endemic country within a year, it is your responsibility to reveal your travel history to your doctor. In such a situation, malaria should be excluded. Also, if you are planning to travel to a malaria endemic country, you should take prophylactic medicines which should be started one week prior to your departure and continued throughout your stay and further six weeks after returning back to Sri Lanka. These medicines are issued free of charge from the Anti Malaria Campaign headquarters and all regional malaria centres. Malaria endemic countries Following are countries known to be endemic for malaria and the public is requested to take prophylactic medicines to protect from the disease before travelling to any of these countries: A – Afghanistan, Angola, Azerbaijan B – Bangladesh, Belize, Benin, Bhutan, Bolivia, Botswana, Brazil, Brunei, Burkina Faso, Burundi C – Cabo Verde, Cambodia, Cameron, Central African Republic, Chad, Colombia, Comoros, Congo, Côte d’Ivoire D – DPR Korea, Djibouti E – Ecuador, Egypt, El Salvador, Equatorial Guinea, Eritrea, Eswatini, Ethiopia F – French Guinea G – Gabon, Gambia, Ghana, Guatemala, Guinea, Guinea-Bissau, Guyana H – Haiti, Honduras I – India, Indonesia, Iran K – Kenya L – Lao PDR, Liberia M – Madagascar, Malawi, Malaysia, Mali, Mauritania, Mayotte, Mexico, Mozambique, Myanmar N – Namibia, Nepal, Nicaragua, Niger, Nigeria P – Pakistan, Panama, Papua New Guinea, Peru, Philippines R – Rwanda S – Sao Tome and Principe, Saudi Arabia (Yemen Border), Senegal, Sierra Leone, Solomon Islands, Somalia, South Africa, Sudan, South Sudan, Suriname, Swaziland T – Tajikistan, Thailand, Timor-Leste, Togo U – Uganda, United Republic of Tanzania V – Vanuatu, Venezuela, Vietnam Y – Yemen Z – Zambia, Zimbabwe For further information regarding malaria, you can directly contact the Anti Malaria Campaign via their hotlines 0117 626 626 and 0712 841 767.

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