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[COLOMBO] Malaria incidence in Sri Lanka has declined sharply since 1999, with zero indigenous deaths reported since 2008, say researchers.

In a paper published last month (29 August) in the online, open-access journal, Public Library of Science One (PLoS One), researchers said malaria eradication drives have succeeded in making Sri Lanka a ‘low endemic country’ for the mosquito-borne disease.

According to the paper, during 1999–2011, Sri Lanka achieved 99.9 per cent reduction in infections, and attributed the success to such measures as indoor residual spraying and the distribution of insecticide-treated nets.

The paper, however, highlighted a substantial increase in the proportion of malaria cases in adult males, a trend linked to the higher level of exposure to infected vectors by those working in gem mines and remote jungle areas with no access to medical treatment or preventive measures.

Sri Lanka’s anti-malaria campaign director, S. L. Deniyage, said that the country is poised to achieve malaria eradication by late 2014.

Deniyage told SciDev.Net that the main threat of infections to Sri Lanka is from persons travelling abroad to places like Tamil Nadu state in India, Haiti, Liberia, Nigeria, Pakistan, Rwanda, South Africa, Sudan and Uganda.  Sudan.

Sri Lanka's success, Deniyage said, was due to a "strong passive case detection system with enough focus on malaria diagnosis and treatment. In addition, there is sound vector control and well-maintained surveillance measures." 

Sri Lanka moved from high endemicity in 2004 to controlled, low endemic transmission in 2009, with one of the worst affected districts, Anuradhapura, recording a reduction of 48 per cent in expenditure on malaria control.

From 1995–1999, there had been an increase in confirmed infections of the neglected disease from 142,294 to 264,549 cases. In early 2000, it began to decline steadily, so that in 2011 there were only 175 confirmed cases, of which 124 were indigenous.

Similarly, malaria-related mortality has declined. In 2009 and 2011, there was one death in each year, both imported cases from Nigeria, the researchers claim.

Firdosi Rustom Mehta, country representative of the World Health Organisation, told SciDev.Net that Sri Lanka's success was "due to a combination of many factors, primarily the sustained work done in malaria control."

Sri Lanka’s director-general of health services,  U. A. Mendis, said better access to public health facilities and sustained anti-malaria interventions led to achieving malaria control, though pockets of high transmission are being recorded at intervals. 

Link to paper in PLoS One: