-Dr.Sharad H. GajuryalMD(Hospital Administration) Resident

BPKIHS,Nepal

Malaria in its various forms has been the cause of Mortality in Nepal through out the ages.

First documented malaria survey was done by Major phillips of Indian military service in Makwanpur and chitwan where out of 889 children examined 80% had enlarged spleen.

After 1950,during the control of country by King Trivuwan , various vertical development project was started including efforts to control malaria.

Nepal began to realize success in controlling malaria when it launched a large-scale malaria control project as early as 1954 with financial assistance from the United States Agency for International Development (USAID

A National Malaria Eradication Programme (NMEP) was launched in 1958 to eradicate the disease.

Eradication in 1958-1977 focused primarily on insecticide spraying, vector control measures and distribution of anti-malarials.

Extreme geographical conditions and rudimentary data-collecting systems have always prevented scientists and health officials obtaining an entirely accurate picture of the full impact of malaria in Nepal.

With failure of global malaria effort aimed at eradication,program changed to Malaria control program in 1978.

In 1985, more than 42,000 cases of the disease were reported throughout the country. In the same year there was a massive epidemic in the western region of Nepal, with smaller epidemics in the central region from 1985 to 1988, when the cases were well above 15,000 annually for successive years.

Prevailing ecological,epidemiological and socio-economic suggested changes in malaria control strategy, as a result malaria control program was revised in 1992 in accordance with global malaria control strategy of WHO.

In 1993,Malaria control division was dissolved and activities were then carried out under Epidemiological and disease control section.

Malaria control services are provided to approx. 15.6 million people in malaria risk areas of 64 districts of the country.

In Nepal, about 84% (23 million) of the people were at risk of malaria in 2012 with 4% at high risk. One million people live in areas with a reported incidence of more than one case per 1,000 population per year

However, the scale of preventive interventions appears to have been limited in Nepal . In recent years, malaria control activities have been carried out in 65 districts at risk out of 75 administrative districts

In 2010, these 65 districts were further categorized for malaria control programme interventions. Based on the annual parasite incidence (API), there were

13 high-risk districts (API ≥1), 18 moderate-risk districts (API=0.5-1), 34 low-risk districts (API=0-0.5) and ten no-risk districts (API=0) as shown in Figure 

. The Global Fund to fight AIDS, tuberculosis and malaria (GFATM) started supporting a malaria control programme in high-priority, malaria-risk districts in Nepal in April 2004 .

Since 2011, The GFATM support is utilized for rapid diagnostic test (RDT) kits, artemisinin combination therapy (ACT), long-lasting insecticidal nets (LLINs), and information, education and communication/behaviour change communication (IEC/BCC) for LLIN use. After the introduction of these interventions, the number of confirmed malaria cases in Nepal declined substantially

Based on recommendations from the internal and external evaluation of Nepal’s malaria control programme in 2010, the country has been preparing for a pre-elimination phase since 2011. It has recently adopted a long-term malaria elimination strategy with the ambitious vision of a malaria-free Nepal by the year 2026

Early Diagnosis and promote treatment of uncomplicated malaria cases and development of referral system of complicated and severe cases.

Development of lab facilities for strengthening early diagnosis of case in health institution.

Selective application of indoor residual spraying

Promotion of PPM (personal protective measures through ICE

Encouragement to community for minor environmental manipulations facilitating malaria control.

Promotion of insecticide impregnation bed net whenever possible as a measure of vector control and transmission risk reduction

Development of skill of peripheral level health staffs on different aspect of malaria control.

Development of skill of MO and DHOs in management of severe and drug resistant malaria

Promote operational field research on malaria on regular basis.

Vision –Malaria Free Nepal by 2026 Mission _ To provide free, equitable, efficient

accessible and quality malaria intervention to all people in Nepal.

Goal-By 2016, incidence of locally transmitted malaria will be reduced by 90% of current level and and no. of VDC having indigenous malaria will be reduced by 75% of current level (2010)

To update the stratification of malaria endemic area and align activities outlined in strategic plan accordingly in different strata by 2012.

To achieve at least 90% of vector control coverage of malaria risk population residing in high and moderate risk area by 2016.

To achieve 90% screening of all suspected malaria case for all parasitological diagnosis and 100% effective treatment for all confirmed cases according to national guidelines by 2016.

To intensify passive malaria surveillance, introduce weekly reporting including mandatory zero reporting system, case notification and case based malaria surveillance and initiate early response of focal outbreak by 2016.

To ensure that 90% population at malaria risk adopt at least one malaria preventive measures by combination of BCC approaches by 2015.

To develop and sustain the required program management capacity and structure at all level to effectively and efficiently deliver a combination of targeted intervention by 2014.

Thank you