Politics and malaria elimination do not mix

The New York Times reported this week that …

Malaria cases jumped 25 percent in Sri Lanka from 2009 to 2010, the country’s ministry of health is reporting. And while this year’s total is still small, at 580, the trend is unsettling to experts. Sri Lanka is a bellwether for the dream of malaria eradication — and Exhibit A for the argument that politics affects the disease more than climate or public health measures do.

Major strides had been made during the first malaria eradication effort when cases fell from half a million to 18 (in 1963).  Unfortunately, “Malaria persisted, with cases highest in the north and east, where the Tamil Tiger insurgency was strongest.”

malaria-operational-plan-unhcr2.jpgConflict scenarios that inhibit malaria control progress are more common that we often acknowledge.

Côte d’Ivoire is in a precarious position again. Researchers reviewed “household data that were collected before and after an armed conflict in a rural part of western Côte d’Ivoire, and investigated the dynamics of socioeconomic risk factors for neglected tropical diseases (NTDs) and malaria. We identified a worsening of the sanitation infrastructure, decreasing use of protective measures against mosquito bites, and increasing difficulties to reach public health care infrastructure.”

East Timor was luckier than most. “Although the political crisis affected malaria programs there were no outbreaks of malaria.” What may have saved the day was a focus on malaria services on camps of internally displaced persons (IDPs). The experience gave rise to policy changes to ACT medicines and rapid diagnostic testing.

East Timor may also have experienced a fortunate juxtaposition of factors including previously decreasing prevalence from interventions prior to the conflict, IDP camps were located close to service organizations, and the timing occurred at the end of the rainy season when incidence normally decreases. The authors note that other conflict locations like the Democratic Republic of the Congo have not faced such a positive scenario.

Researchers have rightly pointed out the challenges to understanding disease dynamics in conflict situations: “Situational constraints and methodological obstacles are inherent in conflict settings and hamper conflict-related socioeconomic research.”

Charles Mgone observed that conflict zones within countries often receive less funding and of course research capacity development to help understand the nature of the problem and potential solutions. He therefore recommended “Special attention should also be given to those with more acute capacity needs and high disease burden, such as communities in conflict-affected regions.”

Paul Spiegel and colleagues give a wake up call. Less that half of national strategic plans (NSPs) and Global Fund proposals for HIV and malaria address the needs of refugees and IDPs. They conclude that, “For NSPs, strong and concerted advocacy at global, regional and country levels needs to occur to successfully ensure that affected populations are included in their plans. It is essential for their inclusion to occur if we are to reach the stated goal of universal access and the Millennium Development Goals.”

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