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Preventing Cross Border Transmission of Malaria

Added on 20 Jul 2016

Authors: Discussion Brief by Pierre Bush, PhD; Reviewed by Dr. Sungano Mharakurwa and Dr. Maimunat Alex-Adeomi

Despite an increase in funding for malaria control during the last decade, and notable achievements in the treatment of malaria, we still have a long way to go to eliminate the disease. In December 2014, the World Health Organization reported that 3.5 billion people are still at risk of contracting malaria. In 2013, there were 198 million cases and 584,000 deaths from malaria, the majority among children in Africa.

One of the biggest challenges we face in the control of malaria is cross border malaria transmission. In recent years, there has been mass migration of populations across borders, making it difficult to implement control measures and halt the spread of the disease. Imported cases of malaria have been reported in Argentina, South Africa, and Southeast Asia, to name a few [1, 2, 3]. Cross border transmission presents a number of challenges, including the introduction of infection in disease-free areas and in areas that had achieved elimination or control, and the introduction of new drug-resistant malaria parasite strains.

This Expert Panel examined the barriers to achieving complete control and elimination of malaria transmission across borders and examined strategies for collaboration, training, and operational research to support these efforts across countries.

Key Points

  • The main challenge in controlling cross border malaria transmission is the current lack of measures and practices that are feasible and easy to implement.
    • It is important to consider screening methods at airports--how can countries ensure methods are followed in high-traffic environments, without missing travelers?
    • Borders are porous and, in many cases, imaginary, especially in areas without natural border demarcations, like rivers.
      • Communities exist across borders and share many things, including malaria.
  • Political will, mobilization of populations, and involvement of all stakeholders are key in achieving proper implementation of strategies to prevent cross border transmission.
    • Competing activities across countries must be identified and reconciled.
    • Adopted measures must be rigorously monitored and enforced by all countries.
    • Countries should create buffer zones by implementing indoor residual spraying (IRS) along borders.
    • Effective integrated vector management (IVM) programs across countries are essential; governments and NGOs should revisit the way vector control funding is allocated.
      • IVM must be actively implemented in all communities across borders.
    • It is critical to establish formal and informal checkpoints for malaria detection across borders, like the one in Southeast Asia.
    • Efforts must consider strategies for engaging vulnerable populations in remote areas that often lack sound public health infrastructures.
    • It is important to gain political will from high-level politicians who can help design and implement malaria elimination roadmaps, such as the one implemented in the Southeast Asia region.
      • Successful programs should be studied to inform future efforts, such as the “Prevent, Test, Treat and Track” strategy implemented in Cambodia.
  • There are valuable lessons to be learned from TB and HIV communities focusing on cross border transmission.
    • For example, the Border Lookout program implemented between the US and Mexico, that was used to detect and treat migrants with TB, could be useful for informing cross border malaria transmission programs.

Key Resources

References

  1. Gueye CS, Teng A, Kinyua K, Wafula F, Gosling R, McCoy D. Parasites and vectors carry no passport: how to fund cross-border and regional efforts to achieve malaria elimination. Malaria Journal. 2012;11(1):344. doi:10.1186/1475-2875-11-344.
  2. Phillips A, Cotter C, eds. Eliminating Malaria in Argentina.; 2012. http://globalhealthsciences.ucsf.edu/sites/default/files/content/ghg/country-briefings/argentina.pdf.
  3. Xu J, Liu H. The Challenges of Malaria Elimination in Yunnan Province, People's Republic of China. Southeast Asian J Trop Med Public Health. 2012;43(4):819-824. http://www.tm.mahidol.ac.th/seameo/2012-43-4/01-5208-25.pdf.

Download: Cross-Border_Malaria_Discussion_Brief.pdf (153.1 KB)