The Influence of Social Factors towards Resurgent Malaria and its Mitigation Using Sri Lanka as a Case-study

Abstract

Social factors of malaria were examined using the case-study of malaria incidence in Sri Lanka. Sri Lanka has currently achieved eradication of malaria but as it is a small island, developing country, it is vulnerable to climate change threats. Therefore the social influences, host immunity, anti-malarial resistance, prosperity and travel, were investigated with particular reference to potential climate change-induced malaria. Development of immunity depends on the intensity and stability of transmission within the region. Although Sri Lanka recently eradicated malaria, it was previously considered a region of low to moderate transmission, with most individual inoculation resulting in infection and disease at all ages. Self-medication when unrequired is particularly significant in contributing to the global issue of anti-malarial resistance. Despite known drug resistance, distribution continues to be widespread due to low over-the-counter cost and rapid relief of symptoms. Poverty promotes transmission of malaria and in turn malaria impedes economic growth. Malaria imposes economic loss beyond direct medical costs and associated effects to macroenomic costs by impacts on worker productivity, school children performance, etc. However improved economic growth is insufficient to eradicate malaria e.g. Oman. Air travel is a vital factor in malaria transmission due to conveyance of asymptomatic carriers from endemic to non-endemic countries, leading to outbreaks of epidemic malaria. Incidence of imported malaria has been observed mainly due to lapse or absence of prophylaxis. The management of malaria was examined under the categories of public healthcare services and mitigation measures. Mitigation measures were evaluated in relation to social factors, to determine their efficacy in the event of resurgent malaria. Mitigation techniques of prominence were anti-malarial therapy, Indoor Residual Spraying, Insecticide Treated Nets and Long Lasting Insecticide Treated Nets and lastly environmental management. Malaria is borne out of multiple risks; both environmental (i.e. climate change and environmental degradation) and social (i.e. anti-malarial resistance, migration and poverty). As observed in Sri Lanka, strong political commitment in prioritising malaria control with sustained resource allocation is vital to eliminate malaria. A multi-measure approach cross cutting public health care services and malaria interventions has proven effective despite some evident climate change impacts