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Malaria

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Introduction

Almost 45 million of Ethiopia's 68 million inhabitants are estimated to be at risk of malaria and the problem is compounded by increasing frequency and magnitude of malaria epidemics.

The malaria problem is increasing due to increasing drug and insecticide resistance. Efforts to combat the disease are constrained by shortage of trained manpower, particularly of vector control supervisors at zonal level and technicians at sector and district levels in all regions, weak surveillance systems, shortage of drugs and laboratory supplies, shortage of spray pumps, and shortage of field logistics. Above all, operational finances are inadequate.

Traditionally the malaria problem has been seen as a challenge for the health sector alone with little or no involvement by other sectors or the general community.

In Ethiopia, altitude and climate (rainfall and temperature) are the most important determinants of malaria transmission. Transmission is seasonal and largely unstable in character. The major transmission of malaria follows the June – September rains and occurs between September - December while the minor transmission season occurs between April – May following the February – March rains. Areas with bimodal pattern of transmission are limited and restricted to a few areas that receive the small/Belg rains. The major transmission season occurs in almost every part of the country.

There are four major eco-epidemiological strata of malaria in the country:

  • Malaria free highland areas above 2,500 meter altitude,
  • Highland fringe areas between 1,500 – 2,500 meter (which are affected by frequent epidemics),
  • Lowland areas below 1,500 meters (with seasonal pattern of transmission) and,
  • Stable malaria areas (characterized by all year round transmission)

Plasmodium falciparum and Plasmodium vivax are the most dominant malaria parasites in Ethiopia, distributed all over the country and accounting for 60% and 40% of malaria cases respectively. Plasmodium malariae accounts for less than 1% and Plasmodium ovale is rarely reported. The parasite is principally transmitted by the major mosquito vector known as Anopheles arabiensis. In some areas Anopheles pharoensis, Anopheles funestus and Anopheles nili also transmit the disease.


History of malaria control in Ethiopia

The control of malaria in Ethiopia has a history of more than four decades. Initially malaria control began as pilot control project in the 1950's and then it was launched a national eradication campaign in the 60's followed by a control strategy in the 70's.

In 1976 the vertical organization known as the National Organization for the Control of Malaria and Other Vector-borne Diseases (NOCMVD) evolved from the Malaria Eradication Service (MES). Until 1993, this organization was operating with one central office, 17 regional or zonal offices, consisting of 70 sector offices and more than 1,400 malaria detection and treatment posts. Some of the many contributions attributable to this program activities include reduced prevalence and level of transmission in many areas, the opening up of the fertile arable lowlands and major river valleys for expanded agriculture and settlement, rapid growth of many urban centres and the general population increase.

Since June 1993, under the general policy of decentralization and federalism in Ethiopia, malaria control became the responsibility of the regional health offices and the re-arrangement of the malaria control infrastructure as suited to the new regional situation is in process. At the central level, cores of professionals are now responsible for formulation of policies, provision of technical guidelines to regions, assistance in training, conducting operational research and support in anti-malarial drugs, insecticides and equipment.


Malaria control in the context of health sector development

The Government of the Federal Democratic Republic of Ethiopia plans to realize its health development objectives through a twenty years health development strategy, with a series of five-year investment programs. The first program, the Health Sector Development Program (HSDP), which covers the period 1997/98 – 2001/02 has been completed and the HSDP II that covers the period 2002/02 – 2004/05 has been started. The HSDP proposes a sector-wide approach to achieve the Government's objectives of the health sector and has eight components that include:

  1. Health service delivery and quality of care
  2. Health facility rehabilitation and expansion
  3. Human resource development
  4. Strengthening pharmaceutical services
  5. Information, Education and Communication
  6. Health management and information systems
  7. Health care financing
  8. Monitoring and evaluation

The main strategies for malaria prevention and control are planned and implemented in the context of the HSDP. Like any other communicable disease interventions, i.e. ARI, CDD, HIV/AIDS and tuberculosis, malaria is also handled by the general health services. The malaria prevention and control activities implemented include:

  • Early diagnosis and prompt treatment,
  • Epidemic forecasting & prevention and early detection and control monitoring,
  • Selective vector control including ITNs, and
  • Malaria prevention and control in pregnancy.
  • Other strategies supporting the program include: human resource development, information, education and communication, operational research, health management information system, and monitoring and evaluation.

Roll Back Malaria

A malaria support team has been formed in February 1999 with membership representing various partners. The members include Federal Ministry of Health, WHO, UNICEF, UNDP, World Bank, Italian Co-Operation, Ireland Aid, and Research & Academic Institutions.