São Tomé and Príncipe committed to eliminate malaria

António de Oliveira is a community health worker from Praia das Burras, located on the north coast of the island of Príncipe. Having started his work as a community health worker at 19 years old, the 56-year-old is the main health focal person for his and three other neighbouring communities. Operating from a modest community post, he performs initial malaria screening tests and treats mild cases. He refers severe cases to the regional hospital. In January 2025, he diagnosed one malaria case in his community.

"Normally, if a person has fever, body aches, or complains of feeling unwell, I always do a rapid diagnostic test to rule out the possibility of malaria. In one instance when the test results of someone who had fever at home for several days came back positive, I called the ambulance immediately to take them to the hospital,” says Oliveira.

Bem Vindo, a nurse in the Autonomous Region of Príncipe, explains the protocol following a positive diagnosis: "As a community health worker, we go to the patient's house to check for mosquito breeding areas and stagnant water. We also administer preventive medication to family members, conduct tests and spray the house if necessary."

Oliveira actively raises awareness in his community about good household and environmental hygiene, draining stagnant water and the use of mosquito nets.

“Every morning, I get up and check if compounds are cleaned and talk to people about implementing preventive measures. Only with everyone's meaningful engagement can we eliminate this disease,” he says.

According to the Acting Regional Delegate in the Autonomous Region of Principe, Dr Wilson Soares, between 2018 and 2020 no indigenous cases of malaria were recorded in the region. This achievement made the island a central focus of the malaria elimination strategy for 2025.

Jairson Rosário, 28, lives in Praia das Burras and does not remember the last time he had malaria. "It was a long time ago, but we always sleep under mosquito nets at home. Better safe than sorry,” he says.

Although the intensification of integrated malaria control measures has yielded positive results, placing São Tomé and Príncipe within WHO's E2025 initiative for potential elimination in 2025, the recent increase in malaria cases has set back progress.

An average of 15 to 30 cases annually have been recorded. In 2024, 34 cases were reported.

"People have lost their immunity to the disease and if preventive measures such as house spraying, the use of impregnated mosquito nets, and environmental hygiene and sanitation measures are not implemented, the disease appears more intensely," says Dr Didiena Vilhete, PNEP coordinator.

“We are working hard to stop the spread of the disease. We won't be able to reach our initial goal in 2025, but we will strengthen our response to prevent new cases in Principe Island, to achieve our national goal of eliminating malaria by 2027,” says Dr Soares.

"We have medicines, insecticides, reactive treatment strategy as well as human resources to respond to cases. We also continue to strengthen sensitization, information and communications to raise the awareness among local policymakers, communities and health professionals. This is how we can defeat malaria in the Autonomous Region of Príncipe," he adds.

The country, with support from WHO, developed a new plan for 2023‒2027, which aims to achieve zero indigenous malaria cases in Caué and five other district in São Tomé, as well as in the Autonomous Region of Príncipe by 2027.

“This goal can only be achieved by reinforcing disease surveillance, implementing strong monitoring and evaluation strategy, ensuring the quality of laboratory diagnostics, implementing the correct treatment of all malaria cases, and ensuring integrated vector control interventions,” says Jessica Veiga Soares, head of public health and disease control at WHO in São Tomé and Príncipe. “It is also important to ensure the full engagement of everyone, including the community, through social mobilization, communication and training."

In line with the commitment to elimination, the National Malaria Control Programme was renamed the National Malaria Elimination Programme, with redefined strategies focused on targeted and reactive interventions and epidemiological milestones, at the national level, starting with the Autonomous Region of Príncipe and Caué district, then extending to other districts.

"In this process, WHO reaffirms its commitment to supporting the country in implementing evidence-based measures to accelerate malaria elimination and achieve the vision of a malaria-free future," says Veiga Soares.