Health Ministry gears up to declare Nepal malaria-free country by 2022Imported malaria cases, lack of trained human resource at the local level and climate change pose a challenge in meeting the target.
The Epidemiology and Disease Control Division has been working to declare the country malaria-free from next year. To that effect and for the country to earn malaria-free status, indigenous cases or local transmission of the disease should be brought down to zero, according to the World Health Organisation.
"We would declare the country malaria-free in phases and start province wise. We hope to complete the process in 2022," said Dr Prakash Prasad Shah, section chief at non-transmitted diseases and vector-borne disease control section of the division. "We have already started the preparations for the same."
The division conducted planning meetings in all seven provinces in which focal persons of the concerned agencies took part. Chief and deputy chief of local federal units were also invited to these planning meetings, as responsibilities to run the programmes lie with the local level in the federal set-up.
According to Shah, the division will start its malaria-free drive in provinces 1, 3 and 4 in the year 2020. In 2021, provinces 2, 5 and 6 will be declared free of malaria and province 7 in 2022. National vector control experts will report to the division before declaring zero local transmission.
"We will call international experts for final verification after we complete the process of declaring the country free of malaria and if we are able to sustain the same status for three years," said Shah. "If they confirm our claim, we will apply for WHO's certification.” To achieve certification from the World Health Organisation as a malaria-free country, Nepal will have to uphold its malaria-free status or zero transmission for the next three consecutive years.
Certification of malaria elimination is the official recognition by the UN health agency about a country's malaria-free status.
Malaria is caused by Plasmodium parasites. Infected female Anopheles called ‘malaria vectors’ carry these deadly parasites, according to the UN health agency. Nepal has committed to eliminating malaria by 2025 to achieve its Sustainable Development Goal target.
Public health experts and vector control specialists, however, express doubt over the ambitious plan of the Health Ministry to declare the country free of the deadly disease by 2022.
According to experts, imported malaria cases (about two-thirds of total cases), lack of trained human resource at the local level and rising global temperatures are some of the major hindrances in achieving the target.
In 2018, at least 229 people were infected with malaria in Mugu district, the highest number of cases in an area considered non-endemic in the past. The same year, 85 people of Bajura district were found infected with malaria, as per the number of reported cases, making it the third most malaria-affected district.
Mugu and Bajura were among the 10 mountain districts that were not considered endemic of vector-borne diseases. Due to rising temperatures, local transmission of malaria has become normal in those areas.
Most of the local governments, which are responsible for carrying out surveillance and response drives, lack trained human resources and budget.
"How can we expect effective and continuous surveillance and intervention measures from the local level, which lacks experts and resources and sufficient budget," said Dr Baburam Marasini, a public health expert. "Vector surveillance should also be continued in areas considered less risky."
The World Health Organisation says that malaria epidemics can occur when climate and other conditions favour transmission in areas where people have little or no immunity to malaria.
Marasini suggested setting up health screening facilities at border check posts and at the international airport to keep foreign malaria cases from spreading.