Malaria Control and Elimination in Sri Lanka: Documenting Progress and Success Factors in a Conflict Setting

<div><h3>Background</h3><p>Sri Lanka has a long history of malaria control, and over the past decade has had dramatic declines in cases amid a national conflict. A case study of Sri Lanka's malaria programme was conducted to characterize the programme and explain recent progress.</p> <h3>Methods</h3><p>The case study employed qualitative and quantitative methods. Data were collected from published and grey literature, district-level and national records, and thirty-three key informant interviews. Expenditures in two districts for two years – 2004 and 2009 – were compiled.</p> <h3>Findings</h3><p>Malaria incidence in Sri Lanka has declined by 99.9% since 1999. During this time, there were increases in the proportion of malaria infections due to <em>Plasmodium vivax</em>, and the proportion of infections occurring in adult males. Indoor residual spraying and distribution of long-lasting insecticide-treated nets have likely contributed to the low transmission. Entomological surveillance was maintained. A strong passive case detection system captures infections and active case detection was introduced. When comparing conflict and non-conflict districts, vector control and surveillance measures were maintained in conflict areas, often with higher coverage reported in conflict districts. One of two districts in the study reported a 48% decline in malaria programme expenditure per person at risk from 2004 to 2009. The other district had stable malaria spending.</p> <h3>Conclusions/Significance</h3><p>Malaria is now at low levels in Sri Lanka – 124 indigenous cases were found in 2011. The majority of infections occur in adult males and are due to <em>P. vivax</em>. Evidence-driven policy and an ability to adapt to new circumstances contributed to this decline. Malaria interventions were maintained in the conflict districts despite an ongoing war. Sri Lanka has set a goal of eliminating malaria by the end of 2014. Early identification and treatment of infections, especially imported ones, together with effective surveillance and response, will be critical to achieving this goal.</p> </div

Map of Annual Parasite Incidence (API) (confirmed infections/1,000 population at risk) by district, 2000, 2005, and 2010.

<p>API per 1,000/population at risk. The costing analysis was conducted in Anuradhapura and Kurunegala districts. Key informant interviews were conducted with representatives from Ampara, Anuradhapura, and Kurunegala districts. The Malaria Atlas Project (MAP) and the Sri Lanka Ministry of Health provided the base district-level map of Sri Lanka. MAP is committed to disseminating information on malaria risk, in partnership with malaria endemic countries, to guide malaria control and elimination globally.</p

A comparison of the larvivorous habits of exotic Poecilia reticulata and native Aplocheilus parvus

Abstract Background The exotic fish Poecilia reticulata is promoted in the tropics as a biological control agent for aquatic pathogenic carriers, such as mosquitoes. Such control measures are often adopted blindly, ignoring the potential of native species and the adverse effects of introduced species. The present study was conducted to assess the diet composition of two species of fish, the native Aplocheilus parvus and exotic P. reticulata, and to assess the availability of food items in their natural environment in four types of aquatic systems. Diet composition was estimated using 24 h gut contents analysis, in a clay quarry pit and a perennial reservoir for A. parvus, and in a man-made canal and a second-order natural stream for P. reticulata. Food items in these environments were quantified by analyzing water samples collected every 2 h. Results The diet of A. parvus in the clay quarry pit and reservoir consisted of adult or larval stages of Insecta, Maxillopoda and Malacostraca. In both habitats, A. parvus selectively fed on insect parts and insect larvae. The diet of P. reticulata consisted of filamentous algae, diatoms and detritus. The diet of A. parvus showed active selection of insectivore food items against their low availability. In contrast, the diet of P. reticulata showed consumption of food items in accordance with their availability in the environment. The highest mean number of food items in the gut for A. parvus was recorded around mid-day in the clay quarry pit, but no peak feeding time was identified in the perennial reservoir. For P. reticulata, peak feeding was recorded around mid-day in both the habitats. Conclusion Irrespective of the type of environment and rate of occurrence, A. parvus preferred insect and insect larvae, whereas P. reticulata consumed the most readily available food items. The active selection of insects by A. parvus suggests they may have value as a biological control agent

Organizational diagram of the Sri Lanka Anti-Malaria Campaign.

<p>Organizational diagram of the Sri Lanka Anti-Malaria Campaign.</p

Timeline of reported cases and major events in Sri Lanka, 1911–2011.

<p>Timeline of reported cases and major events in Sri Lanka, 1911–2011.</p

Costs per person at risk in 2004 and 2009 by intervention category, in $USD, two districts.

<p>Costs per person at risk in 2004 and 2009 by intervention category, in $USD, two districts.</p

Malaria transmission factors in Sri Lanka.

<p>Malaria transmission factors in Sri Lanka.</p

Total confirmed infections from Active and Passive Case Detection, Sri Lanka, 1995 to 2011.

<p>Total confirmed infections from Active and Passive Case Detection, Sri Lanka, 1995 to 2011.</p