Abstract
BackgroundSuriname was a high malaria risk country before the introduction of a new five-year malaria control program in 2005, the Medical Mission Malaria Programme (MM-MP). Malaria was endemic in the forested interior, where especially the stabile village communities were affected.Case descriptionThe interventions of the MM-MP included new strategies for prevention, vector control, case management, behavioral change communication (BCC)/information, education and communication (IEC), and strengthening of the health system (surveillance, monitoring and evaluation and epidemic detection system). After a slow first year with non-satisfying scores for the performance indicators, the MM-MP truly engaged in its intervention activities in 2006 and kept its performance up until the end of 2009. A total of 69,994 long-lasting insecticide-treated nets were distributed and more than 15,000 nets re-impregnated. In high-risk areas, this was complemented with residual spraying of insecticides. Over 10,000 people were screened with active case detection in outbreak and high-risk areas. Additional notification points were established and the national health system was strengthened.Discussion and evaluationIn the current paper, the MM-MP is evaluated both on account of the targets established within the programme and on account of its impact on the malaria situation in Suriname. Malaria vector populations, monitored in sentinel sites, collapsed after 2006 and concurrently the number of national malaria cases decreased from 8,618 in 2005 to 1,509 in 2009. Malaria transmission risk shifted from the stabile village communities to the mobile gold mining communities, especially those along the French Guiana border.ConclusionsThe novel strategies for malaria control introduced in Suriname within the MM-MP have led to a significant decrease in the national malaria burden. The challenge is to further reduce malaria using the available strategies as appropriate in the affected areas and populations. Elimination of malaria in the country will require a thorough understanding of transmission dynamics and a dedicated investment in key effective interventions.
Highlights
Suriname was a high malaria risk country before the introduction of a new five-year malaria control program in 2005, the Medical Mission Malaria Programme (MM-MP)
The novel strategies for malaria control introduced in Suriname within the MM-MP have led to a significant decrease in the national malaria burden
The interventions of the MM-MP were in line with the Roll Back Malaria Partnership strategy [1] including activities in prevention, case management, behavioral change communication (BCC)/information, education and communication (IEC), and strengthening of the health system
Summary
Malaria control efforts around the globe have gained a significant importance. Reports exist on the mass killing of mosquitoes and significantly reduced indoor biting after the introduction of insecticide treated nets (ITNs) in malaria endemic areas [27,28] This would support the hypothesis that the decrease of the (local) vector population density, and the ultimate disappearance of the vector from collections, may be a result of the mass distribution of LLINs and it may at the same time explain the lack of recovery of the mosquito populations after the floods. An important step towards the goal of elimination is the start-up of a new malaria control programme in 2009, managed by the MoH, which targets the high-risk group for malaria transmission, the (immigrant) gold miners This programme provides these remote, ethnically diverse and mobile communities with easy access to malaria prevention, diagnosis and treatment. The findings presented here support the hypothesis that financial investment in key effective interventions can have significant impact in reducing and even eliminating malaria in countries with low transmission
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