Malaria in Nepal: Challenges towards elimination
Malaria is still a major health problem in Nepal where more than 80% people are at risk, with 4% of them being at high risk. According to the Epidemiology and Disease Control Division (EDCD) of Health Ministry of Nepal, 1 million people (out of Nepal’s current population of 29,000,000) live in malaria high-risk areas with a reported incidence of more than 1 case per 1000 population per year.
Dr. Dirgha Singh Bam, Senior Physician and former health secretary of Nepal government says, “Pregnant women and children under five years of age are especially at high risk and special preventive measures should be taken for them.” Nepal has made remarkable progress towards controlling malaria spread, and malaria cases declined by 84% over the past decade. But, it has been a challenge for the National Malaria Control Programme to provide sufficient anti-malaria services such as early diagnosis and treatment, indoor residual spraying, distribution of insecticide treated nets, among others. According to Bam, Nepal has adopted a long term malaria eradication strategy with the ambitious vision of a malaria-free Nepal by 2026. But 75% of Nepal’s population lives in malaria risk zone, and both—the mosquitoes and the parasite— are gaining resistance to existing drugs. Dr. Santosh Poudel, a physician at Teaching Hospital, Kathmandu, Nepal says, “There has been an increasing proportion of Plasmodium falciparum and imported malaria cases in the last decade.”
While 31 malaria-risk districts of Nepal showed a significant decrease in the incidence of verified malaria and of plasmodium vivax between 2004 and 2012, but incidence of plasmodium falciparum and clinically suspected malaria remains high. Also, the scale of preventive measures appears to have been limited in Nepal. There are 13 high-risk districts on the basis of the annual parasite incidence (API), and according to ECDC, these 13 districts account for 90% of the malaria burden in Nepal.
The Global Fund to fight AIDS, tuberculosis and malaria (The Global Fund) has been supporting a malaria control programme in malaria-risk districts in Nepal since 2004. This includes rapid diagnostic test (RDT) kits, artemisinin combination therapy (ACT) and long-lasting insecticidal nets (LLINS). “The majority of funds under the malaria grant were spent for purchase of LLINS. The rest of the fund was utilized for the preventive and supportive programmes against malaria in Nepal,” Bam says. According to Dr. Poudel, the people of malaria-risk districts live in foot-hills and nearby forest areas with poor socio-economic status. “Support to National Malaria Programme is essential to increase capacity on technical and management aspects to control and eradicate malaria. It further requires to develop effective monitoring mechanisms to study disease trends and effectiveness of medicines and insecticides,” Dr. Poudel opined.
The Asia Pacific regional burden of malaria has been halved in the last 15 years. But, It still creates a huge drain on health resources. Dr Tim France, Team Leader for External Communications, Asia Pacific Leader’s Malaria Alliance (APLMA) and Managing Director of Inis Communication says in a recent webinar, “The burden of malaria decreases the productivity; undermines household income; and keeps children out of school.” About 50,000 people die from malaria annually in the Asia Pacific region and 2 billion people remain at risk across the region. Malaria investment in this region has grown over the past decade and is around USD 350 million annually. According to Dr France, a malaria free Asia Pacific region by 2030 can only be achieved if the problem of multi-drug resistance is vigorously addressed.
According to Anna Nakanwagi-Mukwaya, Country Director (Uganda), International Union Against Tuberculosis and Lung Disease (The Union), much attention and funding is focused on individual diseases programmes and not on health systems strengthening. She said, “The health systems in many countries are very poor and can not support meaningful reduction of TB, malaria, HIV or antimicrobial resistance. The current decline is very slow to meet the Sustainable Development Goals (SDGs) by 2030.”