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Analytical summary - Malaria

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Malaria in Swaziland is very responsive to control interventions. Malaria reached a peak in 1995-96 when 9700 confirmed cases and over 38000 clinical cases were reported nationwide. At present, wide scale use of IRS in the Lowveld has reduced the reported number of laboratory confirmed malaria cases to 478 during the 2010-2011 transmission season, with 3 malaria-related deaths.

Frequent commuting between Swaziland and Mozambique further complicates the pinpointing of the exact localities where people get infected. A good understanding of malaria epidemiology in the various transmission foci and of their physical characteristics will be critical for targeting the elimination program activities in Swaziland and bordering areas of Mozambique, and for advancing towards zero transmission in a safe, cost-effective and efficient manner.

The government financial commitment has sustained large scale program implementation over the years. The implementation of cross border collaboration through the Lubombo Spatial Development Initiative has been very successful and stands as a best practice in the African Region. The success of the Swaziland malaria program over the last decade has raised expectations for malaria elimination.

Malaria elimination is a top priority in the national development agenda and the national health policy. In 2008, the country adopted a strategic plan to move towards elimination of malaria by 2015. The program is in the process of reorienting its policies, structures and a strategy to achieve this objective. The program was successful in mobilization of additional resources from the GF in order to strengthen the required system for program re-orientation. Elimination program development is on-going, with dedicated malaria staff in every thematic area and additional expertise in IT and GIS.

Artemisinin-based combination therapy (ACT) and RDT have been made available to health facilities nationwide, providing access at 8km throughout the country. The policy is that RDT and microscopic examination of suspected malaria cases and treatment for confirmed cases are provided free of charge to the user in government health facilities.

The current vector control policy is to provide universal coverage of IRS and LLIN in at risk areas, in combination with selective larviciding. The country has a successful vector control program in place, supported by effective management systems. In 2010-11, the coverage of IRS was 93% of targeted structures, and LLIN were distributed to 74%of the households in the same area. In a KAP survey after the distribution campaign, reported use of LLIN was 34%. Seven sentinel sites for vector monitoring are established and there is insecticide resistance monitoring in collaboration with the Medical Research Council in South Africa.

The health promotion activities are a key component of a malaria elimination program. A Malaria Elimination Communication and Advocacy Plan have been developed and are used to guide program activities. At national level, malaria-related health promotion activities are spearheaded by NMCP health promotion coordinators. As the country transitioned from a control to an elimination approach, the NMCP has adopted an innovative surveillance strategy and system. A surveillance manual is in place to guide the implementation of activities.

The NMCP retrieves its disease reports from two sources, Health Management Information System (HMIS) and the Immediate Disease Notification System (IDNS). The web-based Malaria Surveillance Database System (MSDS), linked to GIS mapping, supports field operations. Malaria surveys have been regularly conducted in the past to measure the malaria infection rate in the population.