1. Objectives of Luxor malaria elimination course 2012 Describe the epidemiological bases for malaria control and elimination. Give an account on the historical background on malaria control and elimination, including lessons learnt and current concepts of malaria elimination. Identify areas in which malaria elimination may be feasible with currently available tools. Describe the basic principles of malaria elimination in order to develop a national programme, or modify an existing programme, to eliminate malaria in a particular area. Select control measures appropriate to the local situation and design strategies and approaches to achieve the objectives set. Write a plan for malaria elimination including operational targets, activities, milestones and monitoring and evaluation. Outline operational research projects to address problems in malaria elimination Describe the process for WHO certification of malaria elimination

2. UNIT 2: INTRODUCTION TO MALARIA ELIMINATION Allan Schapira Elimination course, Luxor, 17/11/12

3. Learning objectives Define malaria control, elimination and eradication Explain the concept of malaria elimination and the control– elimination continuum Specify key differences between malaria control and elimination approaches Classify malaria programmes based on their activities and monitoring efforts Explain the concepts, achievements and shortcomings of the 1960s Global malaria eradication programme, including lessons learned Place the elimination “debate” in the context of historical and recent elimination developments and the current world malaria situation.

5. The Global Eradication Campaign 1956-69 aimed at “the ending of the transmission of malaria and the elimination of the reservoir of infective cases, in a campaign limited in time and carried out to such a degree of perfection that, when it comes to an end, there is no resumption of transmission”.

6. Definitions since the 1990s Malaria control Reducing the malaria disease burden to a level at which it is no longer a public health problem. (or : to a locally acceptable level) Malaria elimination The interruption of local mosquito-borne malaria transmission; reduction to zero of the incidence of infection caused by human malaria parasites in a defined geographical area as a result of deliberate efforts; continued measures to prevent re-establishment of transmission are required. Certification of malaria elimination The official recognition of malaria-free status granted by WHO after it has been proven beyond reasonable doubt that the chain of local human malaria transmission by Anopheles mosquitoes has been fully interrupted in an entire country for at least 3 consecutive years and there is evidence that the elimination can be maintained. Malaria eradication Permanent reduction to zero of the worldwide incidence of infection caused by a particular malaria parasite species. Intervention measures are no longer needed once eradication has been achieved.

7. Elimination A process Set of sequential activities with a well-defined target Malaria-free status The result of a process Which always needs to be defended by a set of activities In practice, we do not distinguish so rigorously, we talk about for example achieving elimination

8. Global Malaria Action Plan (GMAP): control malaria to reduce the current burden and sustain control as long as necessary, eliminate malaria over time country by country, and research new tools and approaches to support global control and elimination efforts.

9. Groups A: Exercise 2.6.1.,2 and 3 B: Exercise 2.6.4 and 5. C: Exercise 2.6.6., 7 and 8

10. Exercise 2.6.1 Review the latest Wold Malaria Report and answer the following – What are the countries that have been certified as malaria free. – Locate these countries in the World map in relation to endemic countries. – What are latest additions to this list (in the previous year). – What do you conclude from the spatial distribution and trend of countries which eliminated malaria?

11. Exercise 2. 6.2: What do you think are the benefits of malaria elimination? Exercise 2. 6.3 : What are the risks associated with malaria elimination programmes?

12. Exercise 2.6.4: Apart from intensity of transmission, what are the determinants, which greatly reduce the chances of elimination in certain areas and countries.

13. Exercise 2.6.5 What are the main lessons learned from the malaria eradication program that could benefit antimalarial activities in the future? Exercise 2 6.6 Do you think malaria elimination efforts now could have a better chance of success compared to the previous failed eradication attempt? Justify your answer.

14. Exercise 2.6.8 What are the main differences between near-elimination with only a few small foci now and then and malaria-free status? Exercise 2.6.7 Compare malaria control and malaria elimination by filling the Table 2.1 below.

15. ControlElimination Objective Area of operations Duration of operations Integration with other health programmes Case-finding Imported case Investigation of cases Epidemiological evaluation Efficiency, quality required

16. Papyrus Ebers “world’s oldest medical textbook” includes the oldest written record of malaria. Written about 1500 BC, but believed to be copied from earlier texts, perhaps dating as far back as 3400 BC. Found in Luxor around 1862.