Surge in malaria a major health challenge

The impact of the civil war and a steady decline in Tajikistan’s infrastructure and public services since the late 1980s has led to a sharp rise in the incidence of infectious diseases, with malaria among the most significant of these, according to health officials in Tajikistan. “Malaria is the biggest health challenge facing Tajikistan at the moment,” said Dr Lyubomir Ivanov, head of the World Health Organisation (WHO) in Tajikistan, told IRIN. The mosquito-borne disease was virtually eliminated when Tajikistan was part of the Union of Soviet Socialist Republics (USSR) and anti-malarial spraying extended even into parts of northern Afghanistan, but the mass sprayings stopped with independence. According to Ivanov, malarial mosquitoes returned with refugees who had fled to Afghanistan during the five-year Tajik civil war. Conditions have been ripe for malaria to spread through the region, particularly to the two million people living south of the capital, Dushanbe. “Many people think the drought would have limited the range of mosquitoes but just the opposite has happened, with mosquito larvae hatching earlier in the drier season,” he said. Another contributing factor was the emergence of ideal breeding conditions for mosquitoes. With the failure of rain-fed wheat crops, many farmers in irrigated parts of the south began growing rice in paddy fields near their homes, unaware that they were providing mosquitoes with the very conditions they thrive in. The incidence of malaria rose sharply among a population unfamiliar with anti-malarial practices. Ivanov said there were 16,000 diagnosed malaria cases officially recorded last year, the majority in Khatlon region, the agricultural heartland to the south of the capital, Dushanbe. The sharp rise in malaria has led to a concerted mitigation effort by the local health authorities and international medical agencies. With funds provided by donors, notably the European Union (EU), the Tajik component of the global ‘Roll Back Malaria’ programme has involved an intense effort to contain the northern spread of the disease. However, strategies employed to good effect in Africa may not necessarily apply to Central Asia and, for example, the Tajik authorities consider the use of bed nets to be an ineffective barrier to malarial mosquitoes. “People are not locked away in the dark after nightfall. Even in the remotest villages they watch TV, prepare lessons, feed their children. This is the prime time for mosquito bites,” Ivanov told IRIN. Although nets may be used in some areas, experts contend that they will be of limited effect, he said, adding that there were other methods of individual protection, using sprays and protective clothing. “We are conducting scientific trials financed by WHO to focus on the real benefits of various [anti-malarial] techniques, and which strategies are applicable to what areas,” Ivanov added. Meanwhile, the Tajik health services and partner agencies are aiming to provide preventive treatment for 200,000 people in the most affected areas this year. As a means of containing the spread of the disease, all those who contracted malaria last year were screened to see if they were carriers. Out of 16,000 people, 530 were found to be carriers who, if left untreated, would continue to unwittingly spread the disease. Once identified, the carriers underwent a longer anti-malarial treatment. “We estimate that for every one of the these people that remain untreated, 10 others risk contracting malaria,” said Ivanov. “We could argue that nearly 6,000 cases of malaria were prevented in this manner. This method of screening and treating those who contracted malaria is unique as far as I know - and it has been successful so far.” Given the previously low incidence of malaria in the region, resistance to anti-malarial drugs has not developed and standard treatments of paludrine and chloraquine remain highly effective. Meanwhile, the World Food Programme (WFP) is supporting the ‘Roll Back-Malaria’ programme by ensuring that those people involved in malaria control projects, such as insecticide spraying, are given monthly food rations. Despite the resurgence of malaria in the last 10 years and a budget of just US $1.2 million this year, Ivanov maintained that its incidence in Tajikistan could be achieved with the right approach.