Efforts To Contain Malaria In Nepal

Balaram Chaulagain

Nepal’s malaria control programme began in 1954 AD with support from the United States. Initially, the programme was launched only in the Terai belt of central Nepal. After the period of four years, in 1958 the then government converted it into Nepal Malaria Eradication Programme. In 1978 AD, the concept reverted to a control programme which in 1998 again renamed as Roll Back Malaria (RBM).
The control measure was launched in the foothills of inner Terai and hill river valleys of entire country. This area is accounted for more than 70 per cent of malaria cases in Nepal. Malaria symptoms include fever, chills and vomiting and it can kill if not treated early. It mainly attacks children under five, mostly in densely populated areas of Terai and low hill parts of Nepal below the height of 4,000 feet.
Malaria poses greater risk in areas with an abundance of mosquitoes, amongst mobile and vulnerable section of society, in relatively inaccessible areas, and during times of hot temperatures. It is a communicable disease and has been known since time immemorial. Based on the number of cases, geo-ecology, vector breading and vulnerability due to migration and population movement in 54 districts of high risk areas, Nepal conducted micro-stratification exercise in 2013. This exercise identified 47.9 per cent of population as living in malaria prone areas, out of which around 3.62 per cent in high risk areas. The exercise reveals that 9.8 per cent of people reside in moderate risk areas and 34.5 per cent people live in low risk areas. A total of 52.1 per cent people are estimated to live in areas with no malaria transmission in Nepal.
The goal of eradicating malaria in our lifetime may sound ambitious, but it is achievable. At a time when communicable diseases like tuberculosis, hepatitis and cholera are raising their ugly head more vigorously than before the cases of malaria are also on the rise. Besides, Nepal is facing the growing challenge to tame imported cases of this disease. Cross border movement of people between Nepal and India has become a major challenge in freeing Nepal from malaria.
A national study on the decade-long malaria prevalence rate in Nepal revealed that imported cases of malaria remained a big burden on Nepal. According to the study of 2016, a total of 1,036 new cases of malaria were reported from across the country. Of them, a total of 541 cases were indigenous or locally transmitted and the remaining cases were detected in the people returning from India. As per a government report, Nepal has achieved notable success in reducing the burden of locally transmitted cases of malaria but it has completely failed to tame the imported cases.
The global malaria incidences was marginally but consistently increasing between 2014 and 2016, with 216 million cases in 2016, 5 million more cases than in 2015, which marks a return to 2012 levels. In the same way, the number of deaths remains largely unchanged from 44,000 in 2015 to 44,5000 in 2016. In this regard, African countries were more affected compared to other countries of the world. History shows that when malaria control is relaxed, the disease bites back with vengeance. Deliberate and sustained efforts must be initiated to ensure that the domestic and international funding envelope is substantially increased.
Malaria is a parasitical disease transmitted by mosquito bite. The parasite named Plasmodium is the real cause of this disease. It used to be a high burden disease in Nepal for the past seven decades. Keeping this in mind, government of Nepal has applied full efforts to curb the menace of this malady from the surface of our soil. It is all set ready to implement Malaria Elimination Programme throughout the country. The Government of Nepal has already conducted an entomological study of mosquitoes transmitting malaria in Nepal. The study has given priority on case finding of malarial incidence, finding out nature of mosquitoes and their biting times.
Besides, the study focused on finding the places where they breed and spread. After overall study of malaria prevalence rate, the government has intensified all activities to contain the scourge as soon as possible. The government has so far distributed around 250,000 insecticidal nets in places with high and moderate risk of malaria through the local health institutions. The government will study the effectiveness and durability of nets being supplied to free of cost to denizens of malarial areas.
Despite the investment of huge amount of resources and efforts to combat this deadly scourge of Malaria, it continues to proliferate than before. As a previous government-run organisation named Nepal Malaria Eradication Organisation had tried its best to avert the untoward effect of disease. The organisation was passionate about building a prosperous, inclusive and sustainable Nepali economy. But achieving that goal requires accelerating progress towards eradicating the disease that continues to deplete our society of their most valuable resource like healthy people for national development. One such disease is malaria.

Morbidity
Nepal has lately made significant progress in combating malaria. Nepal achieved Millennium Development Goal (MDG) in six areas ahead of time by reducing malaria morbidity and mortality rate by more than 50 per cent in 2010. Despite political instability, Nepal’s anti-malaria drive has successfully implemented planned interventions to eliminate the remaining active malaria foci in concerned VDCs of that period. But malaria remains a serious threat to the Nepali populace.
The Ministry of Health, with support from its external development partners, has implemented a strong malaria control programme. The trends of malaria epidemiological situation between 2070|71 and 2072|73 BS shows a decreasing trend of confirmed cases, and case severity with zero deaths.

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