Abstract
BackgroundBotswana has made substantial progress towards malaria elimination across the country. This work assessed interventions and epidemiological characteristics of malaria in Botswana, during a period of decreasing transmission intensity.MethodsNational passive malaria surveillance data for five years (2008–2012) were analysed. A district-level, random effects model with Poisson regression was used to explore the association between malaria cases and coverage with long-lasting insecticide-treated nets (LLINs) and indoor residual spraying (IRS). Malaria cases were mapped to visualize spatio-temporal variation in malaria for each year.ResultsWithin five years, a reduction in malaria prevalence (approximately 98%) and number of deaths (12 to three) was observed. Between 2008 and 2012, 237,050 LLINs were distributed and 596,979 rooms were sprayed with insecticides. Coverage with LLINs and IRS was not uniformly distributed over the study period and only targeted the northern districts with a high malaria burden. The coverage of IRS was associated with a reduction in malaria cases.ConclusionsBotswana has made significant strides towards its goal of country-wide elimination of malaria. A major challenge in the future will be prevention and management of imported malaria infections from neighbouring countries. In order to accurately monitor progress towards the elimination goal, the malaria control programme (NMP) should strengthen the reporting and capturing of data at household and individual level. Systematic, periodic operational research to feedback the NMP will help to guide and achieve elimination.
Highlights
Botswana has made substantial progress towards malaria elimination across the country
The current paper describes trends in malaria morbidity and mortality, improved diagnosis system, indoor residual spraying (IRS) and long-lasting insecticide-treated nets (LLINs) coverage, and association of IRS, LLIN and reported malaria cases using passive surveillance data routinely collected by the national malaria programme (NMP), Botswana from 2008 to 2012
The prevalence of malaria in all districts in 2012 was less than 0.02% except in Bobirwa district where prevalence was 0.1%
Summary
Botswana has made substantial progress towards malaria elimination across the country. To achieve the objectives of malaria control and elimination programmes, endemic countries are deploying a combination of established and newly-available highly effective malaria interventions, including: diagnosis and treatment of confirmed cases with artemisinin-based combination therapy (ACT), Malaria control activities in Botswana started in the 1950s with a programme that focused mainly on vector control using IRS with diethyl-dichloro-trichloroethane (DDT) [2]. Following the comprehensive national malaria programme (NMP) review of 2009, Botswana adopted the move towards malaria elimination and the target was set for 2015 [2]. This process implemented strengthened vector control by scaling-up other interventions, such as mass distribution of LLINs and introduction of winter bio-larviciding. IRS has remains the main stay of malaria vector control as outlined in the 2010–2015 national malaria control strategic plan [2]
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