Roll back malaria - An African success story in Eritrea

Background. High morbidity and mortality from malaria in Africa prompted the Abuja Declaration by African Heads of State in 2000. The goal set in the declaration for 2010 was to reduce malaria mortality by 50%. Countries were therefore expected to ensure that 60% of people suffering from malaria had access to treatment, that 60% of those at risk received intermittent prophylaxis, and that 60% of people in high-risk groups were using insecticide-treated nets (ITNs) by 2005. In 1999 Eritrea introduced malaria policies, strategies and multilevel interventions targeting households, communities and health facilities. Objectives. To assess Eritrea's progress towards meeting the Abuja Declaration goal, targets and key determinants. Methods. A retrospective study was undertaken using data from the Health Management Information System (HMIS) and reports of annual reviews. Correlation and regression analysis were used to assess associations between selected variables. Results. The incidence rate for malaria decreased from 6 000/100 000 in 1998 to 1 100/100 000 in 2003, representing > 80% decline in morbidity. The cumulative number of ITNs distributed increased from 50 000 in 1998 to 685 000 in 2003. The ITN impregnation rate increased from 15% to > 70% during the same period. Indoor residual spraying increased from 7 444 kg to 41 157 kg of insecticide in 2004 resulting in the protected population increasing from 117 017 to 244 315 respectively. The number of health workers recruited and trained rose from 936 to 4 118. There was a strong correlation between the malaria incidence rate, distribution of ITNs (R2= 0.76) and the total number of health workers trained (R2=0.72). The association was consistent in regression analysis (β=-0.05, p = 0.03 for ITNs, and β=-0.249, p = 0.05 for trained health workers). Conclusion. Within 5 years Eritrea met the Abuja Declaration objectives through multiple vector-control methods, case management and surveillance.