A new article by Wickramage and Galappaththy raises numerous challenges facing a country like Sri Lanka that is approaching malaria elimination.Â Human trafficking takes people from a malaria free zone, transits them through malarious areas in West Africa, and then in this case they are rescued and returned home, some carrying malaria parasites.
Other island nations are also addressing the problem of preventing future reintroduction of malaria, but they are not in a post-conflict situation that creates what Wickramage and Galappaththy euphemistically called “irregular migrants.” Seychelles has addressed both vector control as well as provision of malaria chemoprophylaxis and health education to outbound citizens.
Trafficked citizens would obviously and unfortunately miss the opportunity to get prophylaxis (as well as many other opportunities in life).Â In Sri Lanka those returning from trafficking transit in West Africa were screened at the airport and treated. Seychelles could learn from this experience.
Mauritius has not had an indigenous malaria case in over a decade although the vectors are still present. Mauritius actively screens people return from malaria endemic areas at both airport and seaport.
Malaria Journal reports that in Sao Tome and Principe “A steep decline of ca. 95% of malaria morbidity and mortality was observed between 2004 and 2008 with use of the combined control methods. Malaria incidence was 2.0%, 1.5%, and 3.0% for 2007, 2008, and 2009, respectively. In April 2008, a cross-sectional country-wide surveillance showed malaria prevalence of 3.5%, of which 95% cases were asymptomatic carriers.”
So yes, countries approaching elimination must have a surveillance system that finds both obvious clinical cases as well as asymptomatic infections among residents and people returning to or visiting from the outside.Â Island nations are among the first to put this process to the test.Â But the bigger lesson from Sri Lanka’s ‘irregular migrants’ is that as long as conflicts, human trafficking and human rights violations persist, malaria will be difficult to eliminate.Â Malaria demonstrates that no man or woman is an island.