Namibia’s path toward malaria elimination: a case study of malaria strategies and costs along the northern border

BMC Public Health

Jenny Liu¹  Petrina Uusiku²  Chris Lourenco⁴  Gretchen Newby¹  Michelle Gerigk¹  Cara Smith Gueye³ 

[1] UCSF Global Health Group, San Francisco, CA, USA;Namibia National Vector-borne Diseases Control Programme, Windhoek, Namibia;UCSF Global Health Sciences, 550 16th Street, 3rd Floor, UCSF Mail Stop 1224, San Francisco, CA, 94158USA;Clinton Health Access Initiative, Boston, MA, USA

关键词: Costs;    Program operations;    Namibia;    Malaria elimination;    Malaria;   

Others  :  1122930
DOI  :  10.1186/1471-2458-14-1190

 received in 2014-03-24, accepted in 2014-11-10,  发布年份 2014

【 摘 要 】

Background

Low malaria transmission in Namibia suggests that elimination is possible, but the risk of imported malaria from Angola remains a challenge. This case study reviews the early transition of a program shift from malaria control to elimination in three northern regions of Namibia that comprise the Trans-Kunene Malaria Initiative (TKMI): Kunene, Omusati, and Ohangwena.

Methods

Thirty-four key informant interviews were conducted and epidemiological and intervention data were assembled for 1995 to 2013. Malaria expenditure records were collected for each region for 2009, 2010, and 2011, representing the start of the transition from control to elimination. Interviews and expenditure data were analyzed across activity and expenditure type.

Results

Incidence has declined in all regions since 2004; cases are concentrated in the border zone. Expenditures in the three study regions have declined, from an average of $6.10 per person at risk per year in 2009 to an average of $3.61 in 2011. The proportion of spending allocated for diagnosis and treatment declined while that for vector control increased. Indoor residual spraying is the main intervention, but coverage varies, related to acceptability, mobility, accessibility, insecticide stockouts and staff shortages. Bed net distribution was scaled up beginning in 2005, assisted by NGO partners in later years, but coverage was highly variable. Distribution of rapid diagnostic tests in 2005 resulted in more accurate diagnosis and can help explain the large decline in cases beginning in 2006; however, challenges in personnel training and supervision remained during the expenditure study period of 2009 to 2011.

Conclusions

In addition to allocating sufficient human resources to vector control activities, developing a greater emphasis on surveillance will be central to the ongoing program shift from control to elimination, particularly in light of the malaria importation challenges experienced in the northern border regions. While overall program resources may continue on a downward trajectory, the program will be well positioned to actively eliminate the remaining foci of malaria if greater resources are allocated toward surveillance efforts.

【 授权许可】

   
2014 Smith Gueye et al.; licensee BioMed Central Ltd.

【 图 表 】

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