Malaria back with a vengeance, experts say

Malaria remains a source of concern in Tajikistan due in part to the collapse of preventive measures after the country gained independence in 1991. Cases of the deadly malaria falciparum have increased in the past year. "The current situation with malaria in Tajikistan is very similar to that of 2002," Nazira Artykova, head of the World Health Organisation (WHO) office in Tajikistan, told IRIN from the capital, Dushanbe, adding that according to official statistics, the total number of registered cases for the first six months of 2003 was 1,474, showing a decrease of 3.1 percent compared to 1,521 incidences in 2002. She said that the number of newly registered cases was 972 in 2003, while that figure stood at 930 in 2002. However, the number of reoccurring cases fell to 502 in 2003 from 591 in 2002, indicating an improvement in the quality of registration. Meanwhile, the number of malaria falciparum (Plasmodium falciparum), the most deadly type of the disease, had increased from 17 in 2002 to 39 in 2003, she said. Artykova said that the main cause of the increased number of falciparum cases was the return of ethnic Tajiks from neighbouring Afghanistan in recent years. The increase was also a reflection of improving registration and surveillance control of the disease, which had collapsed during the disintegration of the Soviet Union in 1991 and the civil war of the mid 1990's. Merlin, a British NGO with extensive international experience in malaria control, working in Tajikistan since 1997, has also noted that Plasmodium falciparum has been increasing more rapidly than other forms of malaria, with increased health risks for the affected populations. Additionally, during the last decade local populations had revived rice plantations in restricted areas, which also contributed to the spread of the disease, Artykova said, noting that drug resistance was a further issue of concern. The WHO official said the Tajik government was showing political commitment to dealing with the issue and had adopted the National Malaria Control Programme, which was operating successfully with international support. However, much needs to be done, health officials say. "The national budget of the country and international inputs are not sufficient to address all malaria related problems," Artykova claimed, calling for more resources to tackle it. She said WHO had facilitated the Tajik authorities' application to the Global Fund to Fight AIDS, Tuberculosis and Malaria for a grant for malaria control, adding that more resources and technical assistance in surveillance control were still needed. Meanwhile, Rano Mansurova, the health coordinator for Central Asia at ACTED, a French NGO working in the country since 1997 on the prevention of malaria, observed some signs of stabilisation. "The situation has improved a little bit recently," she told IRIN from the southeastern Tajik city of Kurgan-Tyube. She said the lack of coordination between sanitary-epidemiological units, central hospitals and hospitals in the rural areas had also contributed to the rise of malaria morbidity in the country. Mansurova said her organisation was distributing mosquito nets impregnated with insecticides every year and using insecticides within buildings. It was also introducing Gambusia fish, which consume the mosquito larvae, into bodies of water, and was cleaning lakes and ponds with the involvement of the local population. Education was also critical in eradicating the killer disease by raising local people's awareness, she said. She also said ACTED had been conducting parasitological research in order to identify the types of mosquitoes infesting the region as such information would help in developing the right strategy to fight them. ACTED had also been conducting research to detect parasites in human blood, emphasising the need for treatment. "We won't be able to resolve the problem while there are people carrying the disease," she warned. She also underlined the need to conduct prevention, monitoring and treatment of malaria in neighbouring Afghanistan, where malaria incidences were very high. "We need to stop the disease from spreading," she explained, adding that the malaria roll back efforts should be made globally in order to completely eradicate the problem. Since the early 1990s, malaria, which had almost been eradicated in Central Asia, has begun to return, owing to political and economic instability, massive population movements, and large-scale development projects. According to Merlin, at present nearly 18 million people, or more than 30 per cent of the Central Asian population, live in areas at risk from malaria.