Malaria control in Nepal 1963–2012: challenges on the path towards elimination

Malaria Journal

Research

Bodo Ahrens¹  Ulrich Kuch²  Meghnath Dhimal³ 

[1] Biodiversity and Climate Research Centre (BiK-F), Senckenberg Gesellschaft für Naturforschung, Frankfurt am Main, Germany;Institute for Atmospheric and Environmental Sciences, Goethe University, Frankfurt am Main, Germany;Biodiversity and Climate Research Centre (BiK-F), Senckenberg Gesellschaft für Naturforschung, Frankfurt am Main, Germany;Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany;Nepal Health Research Council (NHRC), Ministry of Health and Population Complex, Ramshah Path, Kathmandu, Nepal;Biodiversity and Climate Research Centre (BiK-F), Senckenberg Gesellschaft für Naturforschung, Frankfurt am Main, Germany;Institute for Atmospheric and Environmental Sciences, Goethe University, Frankfurt am Main, Germany;

关键词: Anopheles;    Climate change;    Cross-border;    Environment;    Insecticide;    Imported malaria;    Malaria elimination;    Plasmodium;    Resistance;    Vector;   

DOI  :  10.1186/1475-2875-13-241

 received in 2014-02-19, accepted in 2014-06-19,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundMalaria is still a priority public health problem of Nepal where about 84% of the population are at risk. The aim of this paper is to highlight the past and present malaria situation in this country and its challenges for long-term malaria elimination strategies.MethodsMalariometric indicator data of Nepal recorded through routine surveillance of health facilities for the years between 1963 and 2012 were compiled. Trends and differences in malaria indicator data were analysed.ResultsThe trend of confirmed malaria cases in Nepal between 1963 and 2012 shows fluctuation, with a peak in 1985 when the number exceeded 42,321, representing the highest malaria case-load ever recorded in Nepal. This was followed by a steep declining trend of malaria with some major outbreaks. Nepal has made significant progress in controlling malaria transmission over the past decade: total confirmed malaria cases declined by 84% (12,750 in 2002 vs 2,092 in 2012), and there was only one reported death in 2012. Based on the evaluation of the National Malaria Control Programme in 2010, Nepal recently adopted a long-term malaria elimination strategy for the years 2011–2026 with the ambitious vision of a malaria-free Nepal by 2026. However, there has been an increasing trend of Plasmodium falciparum and imported malaria proportions in the last decade. Furthermore, the analysis of malariometric indicators of 31 malaria-risk districts between 2004 and 2012 shows a statistically significant reduction in the incidence of confirmed malaria and of Plasmodium vivax, but not in the incidence of P. falciparum and clinically suspected malaria.ConclusionsBased on the achievements the country has made over the last decade, Nepal is preparing to move towards malaria elimination by 2026. However, considerable challenges lie ahead. These include especially, the need to improve access to diagnostic facilities to confirm clinically suspected cases and their treatment, the development of resistance in parasites and vectors, climate change, and increasing numbers of imported cases from a porous border with India. Therefore, caution is needed before the country embarks towards malaria elimination.

【 授权许可】

CC BY   
© Dhimal et al.; licensee BioMed Central Ltd. 2014