On the road to eliminate malaria in Sri Lanka: lessons from history, challenges, gaps in knowledge and research needs

Abstract

Malaria is one of the most important tropical diseases that has caused devastation throughout the history of mankind. Malaria eradication programmes in the past have had many positive effects but failed to wipe out malaria from most tropical countries, including Sri Lanka. Encouraged by the impressive levels of reduction in malaria case numbers during the past decade, Sri Lanka has launched a programme to eliminate malaria by year 2014. This article reviews the historical milestones associated with the malaria eradication programme that failed subsequently and the events that led to the launch of the ongoing malaria elimination plans at national-level and its strategies that are operational across the entire country. The existing gaps in knowledge are also discussed together with the priority areas for research to fill in these gaps that are posing as challenges to the envisaged goal of wiping out malaria from this island nation.

Figure 1

Map of Sri Lanka. Climatic zones (dry, intermediate and wet zones) of Sri Lanka, arbitrarily demarcated based on the annual rainfall.

Figure 2

Case incidence of malaria. Case numbers recorded annually from 1931 to 2002 based on stained blood film examination for malaria parasites. Source of data: Anti-malaria campaign, Ministry of Health.

Figure 3

Species distribution of malaria cases recorded in Sri Lanka from 2001 to 2012. Incidence of recorded cases of P. vivax, P. falciparum and total number of cases in Sri Lanka from year 2001 up to 2012. From year 2010 onwards figures indicate the numbers of indigenous malaria cases. Source of data: Anti-malaria campaign, Ministry of Health.

Figure 4

Distribution of malaria cases reported (2010–2013). Number of indigenous and imported cases of malaria recorded during years 2010, 2011, 2012 and 2013. Source of data: Anti-malaria campaign, Ministry of Health.