Recently, National Malaria Control Week concluded in the Maekel (Central) Region. Organized by the Ministry of Health regional branch, the initiative was held under the theme, “Let’s Strengthen Our Effort to Eradicate Malaria.”
According to local reports, as well as comments from regional officials during a series of seminars and events, malaria incidence in the region has fallen steadily in recent years, while approximately 20,000 bed nets were distributed across the region last year. Importantly as was high highlighted during presentations, strong efforts continue to be exerted toward achieving complete elimination by the year 2030.
While the recent events in the Maekel Region are positive and encouraging, they are only a small part of the story of malaria in Eritrea. Accordingly, the following article takes a closer look at malaria and sheds some light on the country’s progress and efforts toward malaria prevention and control.
The deadliest of all mosquito-borne diseases
Malaria is a severe, life-threatening disease caused by Plasmodium parasites, which are spread to people through the bites of infected female Anopheles mosquitoes. Despite the fact that it is preventable and treatable, malaria continues to be a major public health problem worldwide. At present, it is found in more than 100 countries and territories around the world, with approximately half of the world’s population at risk.
According to the World Health Organization and the most recent edition of the World Malaria Report (WMR), its flagship publication, important advancements have been achieved over the past several decades. Notwithstanding this improvement, however, “in recent years, progress in reducing malaria has ground to a standstill.” Globally, there were an estimated 249 million malaria cases in 85 malaria-endemic countries and areas in 2022, an increase of around 5 million from 2021. Also, there were an estimated 608,000 deaths due to malaria in 2022, which was about 11,000 fewer than in 2021 but still around 32,000 higher than in 2019 (which is before the onset of the COVID-19 pandemic).
Again, while malaria remains a global public health issue, the African continent continues to carry the heaviest burden of the disease. To be specific, it accounts for about 94 percent of worldwide malaria cases (233 million) and about 95 percent of all deaths (580,000). Notably, just four African countries – Nigeria (27 percent), the Democratic Republic of the Congo (DRC, 12 percent), Uganda (5 percent), and Mozambique (4 percent) – account for about half of all cases globally, while slightly more than half of global malaria deaths occur in four African countries: Nigeria (31 percent), the DRC (12 percent), Niger (6 percent), and Tanzania (4 percent).
Work also shows that rural populations and those living in situations of poverty and with less access to education are the most impacted by malaria, while infants and young children continue to suffer the greatest mortality. In 2022, an estimated 80 percent of malaria-related deaths in Africa were among children under 5 years of age.
Taking a closer look at Eritrea
In Eritrea, malaria has been a longstanding challenge and the risk of malaria remains moderate to high within large swathes of the country. Of the country’s 58 sub-zobas, 41 are categorized as malaria endemic localities. Furthermore, of the country’s six zobas, the Gash Barka, Debub, and Semenawi Keih Bahri zobas account for more than 90 percent of the national burden. Much like with other countries, malaria has historically been a formidable threat to several vulnerable population groups, such as pregnant women and children.
Since independence, and particularly following the establishment of the National Malaria Control Program in 1995, Eritrea has made major inroads against the disease. Through the combination of an array of control and prevention interventions, which has included indoor residual spraying, drainage and larval source management, effective case management and surveillance, and strong community mobilization, awareness, and reception, the national malaria burden has been significantly reduced. The mass distribution of long-lasting insecticide-treated nets has also been important, and in the last three years, around 800,000 have been distributed in the nation.
Looking closer at malaria cases in the country, between 1998 and 2016, malaria incidence in Eritrea dropped significantly, declining from 157 to 34 cases per 1,000 people. Following further reductions to 18 cases per 1,000 in 2018, there has been a slight increase in cases in recent years, to 30 cases per 1,000 in 2020. The recent WMR estimates that the recent rise has been reversed, with total cases in Eritrea in 2022 decreasing by about 31 percent compared to 2019.
Shifting to focus on malaria-related deaths, they too have fallen, dropping from 405 in 1998 to 21 in 2016 and 5 in 2022 (an overall reduction of approximately 99 percent). Notably, in recent years, only a small percentage of all malaria cases in the country were in highly vulnerable populations, such as children under five years of age or pregnant women.
Eritrea’s progress over the years made it one of a small number of countries to achieve the United Nations Millennium Development Goals target related to malaria (Goal 6, which it met ahead of the 2015 target date). In 2016, during the 26th Summit of the African Union (AU), it even received an award from the African Leaders Malaria Alliance in recognition of its, “commitment, innovation, and progress in the fight against malaria.”
Moving toward the long-term goal of elimination
Looking ahead, despite a recent rise in cases in some areas of the country, Eritrea is steadily transitioning from pre-elimination toward elimination of malaria. As was declared during the recent events associated with National Malaria Control Week, the long-term national goal is to eliminate and prevent the reintroduction of malaria by 2030.
Towards this end, in recent years, it has sustained efforts to address factors that increase malaria risk and worked to promote malaria control interventions. As well, entomology laboratories for research have been established in places such as Elabered and Tesseney, helping in identification of species and parasites, while efforts continue to ensure early diagnosis and treatment, as it prevents deaths and contributes to reducing transmission. Additionally, progress is being made on the development of a refined sub-national stratification map based on epidemiological data triangulated with appropriate metrics, namely entomological, ecological/demography, and interventions coverage data, to better disaggregate the malaria situation and inform targeting of interventions.
With sustained investment, multifaceted efforts, cooperation of local, national, and international partners, and much hard work, Eritrea can continue to make strides in the battle against malaria.
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