Supporting countries to achieve their malaria elimination goals: the WHO E-2020 initiative.

Background: Malaria causes more than 200 million cases of illness and 400,000 deaths each year across 90 countries. The World Health Organization (WHO) set a goal for 35 countries to eliminate malaria by 2030, with an intermediate milestone of 10 countries by 2020. In 2017, the WHO established the Elimination-2020 (E-2020) initiative to help countries achieve their malaria elimination goals and included 21 countries with the potential to eliminate malaria by 2020.

Country-Owned, Country-Driven: Perspectives from the World Health Organization on Malaria Elimination.

Malaria has infected and killed humans since long before history began recording evidence of the parasite's pernicious influence. The extraordinary discoveries of the Plasmodium parasite by Charles Louis Alphonse Laveran in 1880, and the role of the Anopheles mosquito in transmission of the parasite to humans by Sir Ronald Ross in 1897, led to an understanding of the parasite life cycle and ultimately to the development of interventions that would interrupt disease transmission. Almost as soon as the insecticidal properties of dichlorodiphenyltrichloroethane (DDT) were discovered in 1939, the public health profession began battling to achieve a world free of malaria.

A comparison of the larvivorous habits of exotic Poecilia reticulata and native Aplocheilus parvus.

Background: The exotic fish Poecilia reticulata is promoted in the tropics as a biological control agent for aquatic pathogenic carriers, such as mosquitoes. Such control measures are often adopted blindly, ignoring the potential of native species and the adverse effects of introduced species. The present study was conducted to assess the diet composition of two species of fish, the native Aplocheilus parvus and exotic P.

Use of a public-private partnership in malaria elimination efforts in Sri Lanka; a case study.

Background: In special circumstances, establishing public private partnerships for malaria elimination may achieve targets faster than the state sector acting by itself. Following the end of the separatist war in Sri Lanka in 2009, the Anti Malaria Campaign (AMC) of Sri Lanka intensified malaria surveillance jointly with a private sector partner, Tropical and Environmental Diseases and Health Associates Private Limited (TEDHA) with a view to achieving malaria elimination targets by 2014.

Methods: This is a case study on how public private partnerships can be effectively utilized to achieve malaria elimination goals.

Treatment Failure of Dihydroartemisinin/Piperaquine for Plasmodium falciparum Malaria, Vietnam.

We conducted a study in Binh Phuoc, Vietnam, in 2015 on the therapeutic efficacy of dihydroartemisinin/piperaquine for Plasmodium falciparum malaria. A high number of treatment failures (14/40) was found, and piperaquine resistance in Vietnam was confirmed. A change in the malaria treatment policy for Vietnam is in process.

Species composition and population dynamics of malaria vectors in three previously ignored aquatic systems in Sri Lanka.

Background: In 2015 alone there were an estimated 214 million new cases of malaria across the globe and 438,000 deaths were reported. Although indigenous malaria has not been reported in Sri Lanka since 2012, to date 247 imported cases of malaria have been identified. Knowledge of the locations, behaviour and vectorial capacity of potential malarial vectors is therefore needed to prevent future outbreaks.

Mobility dynamics of migrant workers and their socio-behavioral parameters related to malaria in Tier II, Artemisinin Resistance Containment Zone, Myanmar.

Background: Areas with dynamic population movements are likely to be associated with higher levels of drug-resistant malaria. Myanmar Artemisinin Resistance Containment (MARC) Project has been launching since 2012. One of its components includes enhancing strategic approaches for mobile/migrant populations.

The importance of accuracy in diagnosis of positive malaria cases in a country progressing towards malaria elimination.

Background: With Sri Lanka aiming towards malaria elimination by 2015, the National Anti Malaria Campaign has stressed on the importance of identification of the species of Plasmodium either by examination of stained blood smears for malaria parasites or by Rapid Diagnostic Tests for malaria antigens before the initiation of treatment. This study aims at confirmation of the accuracy of clinical and/or microscopical malaria diagnosis using serology.

Materials And Methods: Study population comprised 51 individuals diagnosed with malaria either microscopically or clinically during the first half of 2011.

Comparison of microscopy, nested-PCR, and Real-Time-PCR assays using high-throughput screening of pooled samples for diagnosis of malaria in asymptomatic carriers from areas of endemicity in Myanmar.

Asymptomatic infection is an important obstacle for controlling disease in countries where malaria is endemic. Because asymptomatic carriers do not seek treatment for their infections, they can have high levels of gametocytes and constitute a reservoir available for new infection. We employed a sample pooling/PCR-based molecular detection strategy for screening malaria infection in residents from areas of Myanmar where malaria is endemic.

On the road to eliminate malaria in Sri Lanka: lessons from history, challenges, gaps in knowledge and research needs.

Malaria is one of the most important tropical diseases that has caused devastation throughout the history of mankind. Malaria eradication programmes in the past have had many positive effects but failed to wipe out malaria from most tropical countries, including Sri Lanka. Encouraged by the impressive levels of reduction in malaria case numbers during the past decade, Sri Lanka has launched a programme to eliminate malaria by year 2014.

Containing artemisinin resistance of in Myanmar: achievements, challenges and the way forward.

Artemisinin resistance is a major threat to global malaria control and elimination efforts. Myanmar detected the first indication of the resistance in 2009 in the eastern part of the country, bordering Thailand. Since 2010, WHO has played a vital role in ensuring that a comprehensive programme on the containment of the resistance is in place.

Primaquine for preventing relapse in people with Plasmodium vivax malaria treated with chloroquine.

Background: Plasmodium vivax infections are an important contributor to the malaria burden worldwide. The World Health Organization recommends a 14-day course of primaquine (0.25 mg/kg/day, giving an adult dose of 15 mg/day) to eradicate the liver stage of the parasite and prevent relapse of the disease.

Active case detection for malaria elimination: a survey among Asia Pacific countries.

Background: Moving from malaria control to elimination requires national malaria control programmes to implement strategies to detect both symptomatic and asymptomatic cases in the community. In order to do this, malaria elimination programmes follow up malaria cases reported by health facilities to carry out case investigations that will determine the origin of the infection, whether it has been imported or is due to local malaria transmission. If necessary, the malaria programme will also carry out active surveillance to find additional malaria cases in the locality to prevent further transmission.

Irregular Migration as a Potential Source of Malaria Reintroduction in Sri Lanka and Use of Malaria Rapid Diagnostic Tests at Point-of-Entry Screening.

Background. We describe an irregular migrant who returned to Sri Lanka after a failed people smuggling operation from West Africa. Results.

Knowledge, attitudes and practices relevant to malaria elimination amongst resettled populations in a post-conflict district of northern Sri Lanka.

Background: Malaria-related knowledge, preventative methods and treatment-seeking behaviours were investigated in a post-conflict district of Sri Lanka in order to guide the development of components of malaria interventions and to support future programme evaluation.

Methods: A structured questionnaire was used to collect data from a random sample of 300 households in four Divisional Secretariat Divisions (DSD) of the district where internally displaced populations were being resettled after a 30-year civil war.

Results: The surveyed community had a good overall level of knowledge of malaria.

Malaria control and elimination in Sri Lanka: documenting progress and success factors in a conflict setting.

Background: Sri Lanka has a long history of malaria control, and over the past decade has had dramatic declines in cases amid a national conflict. A case study of Sri Lanka's malaria programme was conducted to characterize the programme and explain recent progress.

Methods: The case study employed qualitative and quantitative methods.

Malaria control in Bhutan: case study of a country embarking on elimination.

Background: Bhutan has achieved a major reduction in malaria incidence amid multiple challenges. This case study seeks to characterize the Bhutan malaria control programme over the last 10 years.

Methods: A review of the malaria epidemiology, control strategies, and elimination strategies employed in Bhutan was carried out through a literature review of peer-reviewed and grey national and international literature with the addition of reviewing the surveillance and vector control records of the Bhutan Vector-Borne Disease Control Programme (VDCP).

Malaria is an important differential diagnosis in visitors returning from Sri Lankan National Safari Parks.

Diagnostic confusion may occur between dengue and malaria when febrile patients with thrombocytopenia return from travel to previous malaria endemic areas. Laboratory tests should include blood smear examination for malaria parasites even though current malaria endemicity in Sri Lanka is low.

Trends in malaria research in 11 Asian Pacific countries: an analysis of peer-reviewed publications over two decades.

Background: Quantitative data are lacking on published malaria research. The purpose of the study is to characterize trends in malaria-related literature from 1990 to 2009 in 11 Asian-Pacific countries that are committed to malaria elimination as a national goal.

Methods: A systematic search was conducted for articles published from January 1990 to December 2009 in PubMed/MEDLINE using terms for malaria and 11 target countries (Bhutan, China, North Korea, Indonesia, Malaysia, Philippines, Solomon Islands, South Korea, Sri Lanka, Thailand and Vanuatu).

Geographic structure of Plasmodium vivax: microsatellite analysis of parasite populations from Sri Lanka, Myanmar, and Ethiopia.

Genetic diversity and population structure of Plasmodium vivax parasites can predict the origin and spread of novel variants within a population enabling population specific malaria control measures. We analyzed the genetic diversity and population structure of 425 P. vivax isolates from Sri Lanka, Myanmar, and Ethiopia using 12 trinucleotide and tetranucleotide microsatellite markers.

Absence of asymptomatic malaria infections in previously high endemic areas of Sri Lanka.

As the goal of malaria elimination from Sri Lanka is currently being pursued, this study was planned to determine the prevalence of asymptomatic malaria infections. Five health areas in Trincomalee and Kurunegala districts that reported high prevalence in the recent past were purposively selected. The smallest administrative units (GN divisions) having high malaria risk within each area were identified.

Epochal changes in the association between malaria epidemics and El Niño in Sri Lanka.

Background: El Niño events were suggested as a potential predictor for malaria epidemics in Sri Lanka based on the coincidence of nine out of 16 epidemics with El Niño events from 1870 to 1945. Here the potential for the use of El Niño predictions to anticipate epidemics was examined using enhanced climatic and epidemiological data from 1870 to 2000.

Methods: The epidemics start years were identified by the National Malaria Control Programme and verified against epidemiological records for consistency.

Temporal correlation between malaria and rainfall in Sri Lanka.

Background: Rainfall data have potential use for malaria prediction. However, the relationship between rainfall and the number of malaria cases is indirect and complex.

Methods: The statistical relationships between monthly malaria case count data series and monthly mean rainfall series (extracted from interpolated station data) over the period 1972 - 2005 in districts in Sri Lanka was explored in four analyses: cross-correlation; cross-correlation with pre-whitening; inter-annual; and seasonal inter-annual regression.

Models for short term malaria prediction in Sri Lanka.

Background: Malaria in Sri Lanka is unstable and fluctuates in intensity both spatially and temporally. Although the case counts are dwindling at present, given the past history of resurgence of outbreaks despite effective control measures, the control programmes have to stay prepared. The availability of long time series of monitored/diagnosed malaria cases allows for the study of forecasting models, with an aim to developing a forecasting system which could assist in the efficient allocation of resources for malaria control.

Island-wide diversity in single nucleotide polymorphisms of the Plasmodium vivax dihydrofolate reductase and dihydropteroate synthetase genes in Sri Lanka.

Background: Single nucleotide polymorphisms (SNPs) in the Plasmodium vivax dihydrofolate reductase (Pfdhfr) and dihydropteroate synthetase (Pvdhps) genes cause parasite resistance to the antifolate drug combination, sulphadoxine/pyrimethamine (SP). Monitoring these SNPs provide insights into the level of drug pressure caused by SP use and presumably other antifolate drugs. In Sri Lanka, chloroquine (CQ) with primaquine (PQ) and SP with PQ is used as first and second line treatment, respectively, against uncomplicated Plasmodium falciparum and/or P.