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GLOBAL HEALTH GROUP

Asia Pacific - Country Support

Bhutan

Over the last ten years there has been a significant decline in malaria cases in Bhutan - from 5,935 cases in 2000 to 433 in 2010. While portions of the country are malaria free, the southern foothill region bordering India is considered malaria endemic, and migrant populations are a major risk group.

In 2010, the Global Health Group's Malaria Elimination Initiative, through its partnership with the Asia Pacific Malaria Elimination Network (APMEN), provided assistance to the Bhutan Ministry of Health and Vector-borne Disease Control Programme in the development of the Round 10 Global Fund grant for phased elimination of malaria. The Global Health Group also collaborated with Bhutan, World Health Organization (WHO), and other partners in the region to produce a case study of its malaria control and elimination program, which documents progress as well as the enabling and challenging factors Bhutan faces in its elimination goals. An academic paper highlighting some of the case study's findings was published in the Malaria Journal in January 2012, and the full case study will be available in 2013.

China

In the past half century, China has dramatically decreased malaria incidence. Prior to 1949, malaria affected most parts of the country and there were approximately 30 million cases per year. Today, large parts of the country are malaria-free with only 26,868 reported cases in 2008. Given these dramatic successes, China's malaria program is shifting from control to elimination.

In 2009, the Malaria Elimination Initiative provided intensive technical support to the development of China's Revised National Malaria Strategy for 2010-2015, as well as a successful Global Fund National Strategy Application (NSA).

The Malaria Elimination Initiative is also working with China to help share its knowledge and expertise with the greater global malaria community:

  • In Jiangsu Province, the Malaria Elimination Initiative gathered data from the 1970s on the use of Mass Drug Administration (MDA) with primaquine, as well as data from 2000-2009 in four counties where MDA has been employed recently. These data are being analyzed to look at the relationship between MDA use and P. vivax incidence. This is a strategy which has not been described yet and holds promise for elimination.
  • The Malaria Elimination Initiative and researchers from UCSF are collaborating with the China and Hainan Centers for Disease Control on operational research projects to improve diagnostic and surveillance techniques for malaria elimination. Projects are underway in Hainan and Jiangsu provinces to evaluate the utility of PCR and serology. This work is partially funded by the APMEN Research Grant Program.

Malaysia

Confirmed malaria cases in Malaysia have declined by 91.0% since 1991, indicating substantial success in malaria control over recent decades. Nationally, caseloads have decreased from a high of 59,208 cases in 1995 to 5,306 in 2011. The Sabah State on Borneo has traditionally contributed the most number of cases nationally. However, due to intensive control efforts, the state's dramatic declines over the past 16 years have substantially reduced national incidence, despite significant technical, logistical and geographic challenges.

Malaysia was designated with WHO pre-elimination status in 2011, declaring its intent to eliminate. The country currently has a staggered goal of achieving zero local transmission in West Malaysia by 2015, and in Sabah and Sarawak States by 2020. A strong emphasis on robust surveillance and vector control and early detection of cases has been instrumental in helping to decrease incidence. Further, regional networks like APMEN and the Asian Collaborative Training Network for Malaria (ACTMalaria) have been critical to developing innovative approaches to the challenge imported cases from higher-endemic countries.

The Global Health Group has worked closely with the Malaysia malaria control program, both through APMEN and a collaborative case study on malaria elimination with WHO. This case study will add to the growing evidence base on malaria control history and elimination strategies in the Asia Pacific region, and will be published in 2013.

Melanesia: the Solomon Islands & Vanuatu

In 2007, the governments of Australia, Solomon Islands and Vanuatu launched a bold initiative to eliminate malaria from Vanuatu and the Solomon Islands, one province at a time. The Pacific Malaria Initiative (PacMI) was launched with initial four-year, AUD $25 million funding from the Australian government, followed by an additional USD $21 million Rolling Continuation Channel grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Technical support for the Initiative is provided through the Pacific Malaria Initiative Support Centre (PacMISC), a consortium of partners in Brisbane, Australia, including the University of Queensland, the Queensland Institute for Medical Research, and the Australian Army Malaria Institute. PacMI is guided by the Malaria Reference Group (MRG), which is chaired by Global Health Group Director Sir Richard Feachem.

The Solomon Islands is now working to eliminate malaria in the provinces of Temotu and Isabel, and Vanuatu is working to eliminate malaria in Tafea Province. Large-scale entomological and parasitological baseline assessments have been conducted in these provinces and comprehensive scale-up of interventions is underway.

Dr. Jimee Hwang, a medical epidemiologist with the US Centers for Disease Control Malaria Branch who is based at the Global Health Group, supported the design and implementation of the 2011 Malaria Indicator Surveys (MIS) in Vanuatu and Solomon Islands.

Philippines

The Philippines has experienced a substantial reduction in its annual malaria caseload in the past decade, decreasing from over 36,000 cases in 2000 to fewer than 15,000 in 2011. As of 2010, 20% of the population was living in malaria-free areas and 73% in areas of low transmission. The National Malaria Control Programhas set goals of achieving zero malaria deaths by 2014, and countrywide elimination by 2020.

Since 2012, the Global Health Group, the Infectious Diseases Office (IDO) of the Philippines Department of Health, the WHO Global Malaria Programme, the WHO Philippines Country Office, and APMEN have collaborated to fund and conduct a case study on the Philippines' malaria elimination activities. To further understand the strategic and programmatic needs for malaria elimination, retrospective program expenditures are also being collected in selected provinces to document the financial inputs needed to shift from malaria control to elimination to prevention of reintroduction and to understand how financing needs vary across different eco-epidemiological evironments and governmental/non-governmental program partner configurations. The study will be published in 2013.

Sri Lanka

Malaria in Sri Lanka has been dramatically reduced over the past decade. Cases have declined 99.9%, from approximately 265,000 cases in 1999 to just 124 local cases in 2011. Achieving such success despite ongoing conflict is rare in the history of disease control; however, Sri Lanka was able to reduce its malaria burden by adapting its program to conflict conditions and ensuring consistent implementation of key interventions throughout the country.

In 2009, the Sri Lanka Anti-Malaria Campaign requested the Global Health Group to support them in conducting a case study of the country's malaria program, to characterize the program's progress toward elimination and identify the key factors that led to the sustained decline in malaria. The case study was published as part of a joint series with the WHO in October 2012. A peer-reviewed paper on Sri Lanka's malaria control program was also published in PLOS ONE in August 2012, and was deemed as one of the journal's 'most influential' articles since January 2011.