Eritrea: Eradicating malaria

By Lwam Kahsay

Malaria is one of the world’s killer diseases. According to the World Health Organization (WHO) reports, in 2020, the number of infection worldwide was 241,000,000, while the number of deaths stood at 627,000, with 95 % of malaria incidences and 96% of deaths occurring in Africa.

Prior to Eritrea’s independence malaria incidence was very high as well as mortality rates were. For example, between 1987 and 1989 there was a malaria endemic that claimed many lives. Even after independence, malaria incidence was relatively high in the early period.

But in 1998, the government launched a five-year strategic plan to drastically reduce the infection rate of malaria. It aimed at lowering the incidence rate, the spread of malaria and death rate by 80%. The efforts and commitment of the government and people’s awareness about prevention gave results that exceeded the set goal. Malaria infection rate went down by 82 % while the death rate caused by malaria decreased by 91% between the years 1999 and 2004.

Eritrea was able to achieve a lot in controlling malaria because of the concerted efforts of many parties and the government’s strategies. The parties include the government and its partners and the public. The government’s strategies focus on prevention and include efforts to raise people’s awareness about malaria and ways of prevention through mass media and public gatherings; covering swampy areas with soil; making healthcare services accessible in all parts of the country, including remote locations; distributing mosquito bed nets to communities that live in malaria-prone regions; and spraying antibiotic around very infectious areas. Mosquito nets are given for free, and in the past 25 years around 10 million nets have been distributed.

Another strategy that is playing an important role in efforts to contain malaria is the introduction and distribution of modern diagnostic modalities, including microscopic detection and rapid blood detection tests (RDT).

There are many febrile illnesses with symptoms and clinical presentations similar to that of malaria. However, in the last 20 years, malaria has been treated only after definitive diagnosis of the disease has been confirmed. Patients diagnosed with malaria are often given Artesunate and Amodiaquine for three days; in some cases, Primaquine is also prescribed in addition.

The graph shows that in 1998 the spread of malaria was high even in Maekel region and the Southern Red Sea region, areas that had not been vulnerable to replication of mosquitoes. As the graph indicates the prevalence of malaria in 1998 was 39% in Gash Barka region, 28% in Southern region, 12% in Anseba region and the remaining 21 % in the other three regions and at referral hospitals. The concerted efforts paid off. In 2020, the incidence of malaria in Maekel and Southern Red Sea regions dropped to 0%. It also went down significantly in Anseba and Northern Red Sea regions.

The only regions that are now targeted for intervention are Gash Barka and Southern regions, and the Ministry of Health (MoH) continues to make efforts to eradicate malaria in both regions. It is also building the capacity of the healthcare facilities and raising people’s awareness of the causes of malaria and means of prevention. Every year the MoH sets action plans to help sustain its achievements and conducts annual monitoring and evaluation to determine its success and areas for improvement. And it sets strategic plans every five years.

In recent years the MoH has established malaria entomology laboratories for research in Elabered, Anseba region, and Tesseney, Gash Barka region. The laboratories play an important role in identifying the mosquito species and the types of malaria plasmodium parasites. For all its efforts in combating malaria, Eritrea received ‘ALMA Award of Excellence,’ an award given to the best malaria controlled countries.

Eritrea has registered a sustained progress in the reduction of malaria over the past two decades and has now moved towards eliminating malaria. According to Demographic Health Information System (DHIS) 2018 data, at least 67 % of the population is under continuous risk of malaria with overall incidence of 10.0 per 1000 people per year. However, the incidence varies greatly between and within the different regions from zero to 33.1 per 1,000 people per year. Malaria incidence rate dramatically declined from 157 per 1,000 people per year in 1998 to about 10 in 2018. Similarly, malaria-related mortalities declined from 0.186 per 1,000 people in 1998 to 0.0015 in 2018. There has been an exponential decline in malaria deaths from a total of 405 in 1998 to five in 2018.

This year, Malaria Day was commemorated under the theme ‘’Harness innovation to reduce the malaria diseases burden and save lives.’’ In 2020, the death rate due to malaria was 900 % higher than the previous year’s worldwide, and this indicates the seriousness of the disease and the disaster it causes, especially for Africa. This calls for an urgent and integrated global malaria prevention and treatment efforts. Considering its track record, Eritrea is expected to sustain its achievements and be successful in totally eliminating malaria in the coming few years.