Should chemoprophylaxis be a main strategy for preventing re-introduction of malaria in highly receptive areas? Sri Lanka a case in point

Malaria Journal

Research

Hemantha D. B. Herath¹  Renu Wickremasinghe²  S. Deepika Fernando³  A. Rajitha Wickremasinghe⁴ 

[1] Anti Malaria Campaign, 555/5 Elvitigala Mawatha, Public Health Complex, Narahenpita, 00500, Colombo, Sri Lanka;Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka;Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka;Department of Public Health, Faculty of Medicine, University of Kelaniya, 11010, Ragama, Sri Lanka;

关键词: Malaria;    Chemoprophylaxis;    Cost;    Prevention of re-introduction;    Sri Lanka;   

DOI  :  10.1186/s12936-017-1763-6

 received in 2017-01-10, accepted in 2017-02-28,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundImported malaria cases continue to be reported in Sri Lanka, which was declared ‘malaria-free’ by the World Health Organization in September 2016. Chemoprophylaxis, a recommended strategy for malaria prevention for visitors travelling to malaria-endemic countries from Sri Lanka is available free of charge. The strategy of providing chemoprophylaxis to visitors to a neighbouring malaria-endemic country within the perspective of a country that has successfully eliminated malaria but is highly receptive was assessed, taking Sri Lanka as a case in point.MethodsThe risk of a Sri Lankan national acquiring malaria during a visit to India, a malaria-endemic country, was calculated for the period 2008–2013. The cost of providing prophylaxis for Sri Lankan nationals travelling to India for 1, 2 and 4 weeks was estimated for that same period.ResultsThe risk of a Sri Lankan traveller to India acquiring malaria ranged from 5.25 per 100,000 travellers in 2012 to 13.45 per 100,000 travellers in 2010. If 50% of cases were missed by the Sri Lankan healthcare system, then the risk of acquiring malaria in India among returning Sri Lankans would double. The 95% confidence intervals for both risks are small. As chloroquine is the chemoprophylactic drug recommended for travellers to India by the Anti Malaria Campaign of Sri Lanka, the costs of chemoprophylaxis for travellers for a 1-, 2- and 4-weeks stay in India on average are US$ 41,604, 48,538 and 62,407, respectively. If all Sri Lankan travellers to India are provided with chemoprophylaxis for four weeks, it will comprise 0.65% of the national malaria control programme budget.ConclusionsBased on the low risk of acquiring malaria among Sri Lankan travellers returning from India and the high receptivity in previously malarious areas of the country, chemoprophylaxis should not be considered a major strategy in the prevention of re-introduction. In areas with high receptivity, universal access to quality-assured diagnosis and treatment cannot be compromised at whatever cost.

【 授权许可】

CC BY   
© The Author(s) 2017