Emerging Challenges of Efforts towards Malaria Elimination in Africa

In the past decade there has been a significant reduction in malaria incidence globally. In some places continuous surveillance has indicated that the reduction in malaria cases has been sustained to the point of near elimination. The drastic reduction in malaria cases may be attributed to the unprecedented financial support to national malaria control programmes by several donors. The use of interventions such as insecticide treated nets, indoor residual insecticide spraying and to some extent environmental manipulation aimed at eliminating mosquito breeding sites have been responsible for the gains achieved. Application of a combination of these measures has brought about heterogeneity of malaria transmission within some countries. Some areas have recorded drastic reduction in the malaria burden, whereas in other parts of the same country transmission has remained relatively unchanged. This situation implicitly indicates that different approaches to malaria prevention and control or elimination are required in different parts of the same country. Changing malaria epidemiological patterns should also dictate the methods of malaria surveillance that are not only robust but also cost effective. Techniques for malaria diagnosis to support surveillance have to be sensitive and specific enough to pick up the lingering infections especially in low malaria transmission areas. In many malaria endemic countries application of such methods also require deployment of resources differentially in various parts of the same country, and that is a challenge. Chemoprophylaxis has been used in various ways to prevent malaria or avoid its complications in vulnerable populations. When transmission becomes low, new criteria are needed to identify populations that become more vulnerable to the adverse effects of malaria and qualify for chemoprophylaxis. The dynamic malaria epidemiological patterns emerging within countries are presenting unprecedented challenges that will need novel and cost effective ways of managing resources to sustain the reduction or elimination of malaria.