Abstract
BackgroundMalaria is still a priority public health problem of Nepal where about 84% of the population are at risk. The aim of this paper is to highlight the past and present malaria situation in this country and its challenges for long-term malaria elimination strategies.MethodsMalariometric indicator data of Nepal recorded through routine surveillance of health facilities for the years between 1963 and 2012 were compiled. Trends and differences in malaria indicator data were analysed.ResultsThe trend of confirmed malaria cases in Nepal between 1963 and 2012 shows fluctuation, with a peak in 1985 when the number exceeded 42,321, representing the highest malaria case-load ever recorded in Nepal. This was followed by a steep declining trend of malaria with some major outbreaks. Nepal has made significant progress in controlling malaria transmission over the past decade: total confirmed malaria cases declined by 84% (12,750 in 2002 vs 2,092 in 2012), and there was only one reported death in 2012. Based on the evaluation of the National Malaria Control Programme in 2010, Nepal recently adopted a long-term malaria elimination strategy for the years 2011–2026 with the ambitious vision of a malaria-free Nepal by 2026. However, there has been an increasing trend of Plasmodium falciparum and imported malaria proportions in the last decade. Furthermore, the analysis of malariometric indicators of 31 malaria-risk districts between 2004 and 2012 shows a statistically significant reduction in the incidence of confirmed malaria and of Plasmodium vivax, but not in the incidence of P. falciparum and clinically suspected malaria.ConclusionsBased on the achievements the country has made over the last decade, Nepal is preparing to move towards malaria elimination by 2026. However, considerable challenges lie ahead. These include especially, the need to improve access to diagnostic facilities to confirm clinically suspected cases and their treatment, the development of resistance in parasites and vectors, climate change, and increasing numbers of imported cases from a porous border with India. Therefore, caution is needed before the country embarks towards malaria elimination.
Highlights
Malaria is still a priority public health problem of Nepal where about 84% of the population are at risk
Based on the achievements the country has made over the last decade, Nepal is preparing to move towards malaria elimination by 2026
Nepal has made significant progress in controlling malaria transmission over the past decade: The total number of confirmed malaria cases declined by 84%, the number of diagnosed P. falciparum cases by 81%, and only one malaria death was reported in 2012
Summary
Malaria is still a priority public health problem of Nepal where about 84% of the population are at risk. The aim of this paper is to highlight the past and present malaria situation in this country and its challenges for long-term malaria elimination strategies. Based on recommendations from the internal and external evaluation of Nepal’s malaria control programme in 2010, the country has been preparing for a pre-elimination phase since 2011 It has recently adopted a long-term malaria elimination strategy with the ambitious vision of a malaria-free Nepal by the year 2026 [3,4,6]. This paper aims to highlight the past milestones, the present malaria situation in Nepal, and the challenges for future prevention and control strategies that need to be mastered to pave the way towards malaria elimination in this country
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