Liberia was making steady progress against malaria in the years after the civil war. Despite the devastation of Ebola, the health authorities have continued to push against malaria. The DHS Program has released key findings from the 2016 Malaria Information Survey. We have compared those against the 2011 MIS, and while there is progress, much work needs to be done in this highly endemic area – not just in fighting malaria, but in rebuilding health systems damaged by war and Ebola.
Targets for Intermittent Preventive Treatment in pregnancy of malaria have risen from at least 2 doses in 2011 to three or more when the 2016 data were collected. While the IPTp2+ doses have increased by a little less than 5%, the challenge of IPTp3 and greater has become quite evident. It is interesting that coverage of IPTp is slightly better in rural areas, but there is still a long way to go to protect pregnant Liberian women.
The situation with access to and use of insecticide treated nets has also improved over the 5-year period, but still remains well below the targets of universal coverage. Even though nearly two-thirds of households have at least one ITN, only a quarter have enough nets to reach the goal of one net for every two people. Net use by children below the age of 5 years is better than that of pregnant women, though in both cases less that half of these vulnerable populations are covered. Nets are particularly important for pregnant women who cannot take IPTp in the first trimester.
Care for febrile children also has improved, but questions remain about appropriate care due to the nature of the questioning processes in the MIS. Seeking advice increased by 20% as did getting blood tests (RDT or microscopy) once care is sought. Double the number of febrile children received artemisinin-based combination therapy in 2016 compared to 2011, but since the rate of testing is low, we do not know if they were being appropriately treated – given ACT only is tests were positive.
Liberia does receive support from donors such as the Global Fund and the US President’s Malaria Initiative. These and other partners need to strategize with the Liberian Ministry of Health and other local partners (NGOs, Businesses, etc.) in order to mobilize the support to put Liberia more squarely on the road to malaria elimination.