Korea-Malaria Situation in SEAR Countries

Malaria Situation in SEAR Countries

DPR Korea

Bangladesh

Malaria Situation

Malaria was eradicated from DPR Korea in 1970s. However, it was re-introduced in the country through the southern border in 1998 as malariogenic conditions persist there in the form of epidemics. A substantial increase in malaria incidence was seen in all seven provinces and two municipalities. Currently, 50% of the population of DPR Korea is at risk. May to October is the peak transmission period. Only P. vivax malaria is prevalent with around 13,520 cases reported in 2010 (Fig. 1) However, the confirmative diagnosis rate is very low. Recently, IRS has been also been adopted as vector control measure along with ITNs / LLINS. Around 2.0 million people were covered under IRS and 413000 people were LLINs / ITN respectively. However, the bednet coverage is poor (Fig. 2) and needs to be scaled up. The malaria control efforts are supplemented by early diagnosis and prompt treatment. In high risk areas, mass treatment with Primaquine was observed to prevent and control malaria. The country is showing good progress in malaria control and there has been a steep decline in confirmed malaria cases as well as in probable malaria cases enabling country to reach the pre-elimination phase.

Fig 1: Trend of confirmed malaria Cases in DPRK, 1998-2010

Malaria situation in DPRK, 2010 : At a glance
Total population	: 24.05 million
Population in malarious areas	: 14.99 million
Number of Lab confirmed malaria cases	: 13,520
P. falciparum proportion	: 0%
Number of probable malaria cases	: N.A.
Number of deaths due to malaria	: 0
Cases treated with ACTs	: 0
No of LLINs Distributed	: 166,600
No. of effective LLINs+ITNs (cumulative) availability	: 206,600
No. of population Protected with ITNs / LLINs	: 413,200
Population protected with IRS	: 2.0 million
Vectors : An. Sinensis & An. Anthropophagus - Frequent outbreaks in southern part of the country bordering Republic of Korea Supported by GFATM since Rd 8 Reached to pre-elimination phase

Malaria control is financed mainly by the government and the International Red Cross Federation. However, country is getting support from last 3-4 years regularly from Republic of Korea and in 2010, received support from Global fund also (Fig.3).

Click on the image to enlarge
Fig. 2: Cumulative Availability of Effective ITNs & LLINs in DPRK, 2005-2010	Fig. 3: Availability of Funds by Source, 2001-2010

Programme Goals and Targets:

Goal:

To reduce malaria morbidity and mortality until the disease is no longer a public health problem in the country.

Targets	Baseline data in 2005	2010
Reduction in malaria morbidity	0.98/1000 pop	0.67/1000 pop
No. of HF with microscopes and regents	210	1060
% HHs in high risk areas covered under IRS	0	80
% Lab technicians trained	20	90
% Ri’s in endemic areas received IEC materials	46	90

Control strategy:

Early detection and prompt radical treatment of P. vivax malaria cases

Strengthen the existing EDPT through timely supplies, training and supervision

Mass Chemoprophylaxis with using primaquine in accordance with the strategic option of national authority and supportive recommendation of WHO

Monitoring of the quality and coverage through health facility surveys and population surveys

Vector control is an essential part of reducing malaria cases and selective IRS is recommended but not put in to practice so far.

Use of insecticide treated bed nets (with permethin) in endemic areas

Strategic priorities for improving performance:

Vector control and community protection by LLINs and IRS

Issues and Challenges:

Insufficiency of anti-malarials as malaria has been eliminated so there was no malaria control programme and surveillance was relaxed and the country could not cope with the resurgence of the out break . It took 5-6 years to reestablish the malaria control programme..

Lack of microscopes and inadequate skill of laboratory technicians in the PHC level to provide early Diagnosis and prompt treatment

Insufficient availability of insecticides leads low impregnation of bednets as well as affects Indoor Residual Spraying activities.

Lack of trained manpower in malaria epidemiology and entomology.

No materials for monitoring & evaluation activities at the provincial level in the malarious areas.

Best practices and success stories

Dramatic reduction in malaria cases in high- risk areas due to mass Primaquine chemotherapy.

Partners and donors

WHO