Roll Back Malaria Progress & Impact Series:
Focus on Swaziland
Progress and impact of malaria control in Swaziland at a glance
Swaziland is making remarkable progress towards the elimination of malaria transmission. A committed National Malaria Control Programme (NMCP) has benefited from strong political support and the experience of coordinating malaria control activities since 1946.
External funding, coming from the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), surged in 2009 to US$ 2.6 million, and will total US$ 9.4 million between 2009 and 2014 to support malaria elimination. Government expenditure shifted from programme management and indoor residual spraying (IRS) during the control phase (2003–2007) to logistics and personnel costs, which reflects the transition towards malaria preelimination and elimination (2008–2015).
Elimination interventions are focused on integrated vector management, case management, case investigation and transmission containment, and information, education, and communication (IEC)/behaviour change communication (BCC). The effort to roll out universal diagnosis with rapid diagnostic tests (RDTs) in February 2010 has led to an 82% decrease in the number of reported malaria cases in 2011–2012, compared with 2009–2010 levels. The Ministry of Health, with the NMCP, has implemented case-based passive surveillance and active surveillance systems, which are essential to any malaria elimination programme.
The strengthening of elimination interventions has resulted in improved coverage, as well as better diagnosis, treatment, and reporting:
- 53% of the population at-risk was protected by insecticide-treated mosquito net (ITN) or IRS in 2010 (2010 Malaria Indicator Survey [MIS]).
- Between 2009–2010 and 2011–2012, the portion of reported malaria cases confirmed by RDT/microscopy increased from 5% to 57%.
- Aside from the administration of quinine when clinically appropriate, all malaria cases are now treated with artemisinin-based combination therapies (ACTs).
- In 2011–2012, 60% of confirmed malaria cases were investigated at household level to identify the source of infection, using the strengthened surveillance system.
With this progress, the Government of Swaziland has been able to reduce the disease burden to negligible levels for the second time in the history of the country and to save lives:
- Confirmed cases decreased by 42%, from 428 to 248, between the high transmission seasons (January to June) of 2011 and 2012. Both local and imported cases have decreased between 2011 and 2012. Imported cases now represent the majority of investigated cases (78% in 2012).
- Between 2000 and 2012, 33 000 estimated malaria cases have been averted through control efforts.
The country is committed to achieving its goals of reducing and sustaining locally-acquired malaria cases to zero by 2015, and to be certified malariafree by 2019:
- A strong and well-funded programme, established collaboration with neighbouring countries, and political commitment will help Swaziland meet its objectives.
- However, the risk of reintroduction and a shifting focus from external donors represent challenges ahead. Increasing coverage of at-risk areas with vector control interventions, and bringing diagnostic confirmation and investigation rates to 100% will also be necessary.
The experience gained can offer useful lessons for other countries about to move into a malaria elimination phase. They include the essential role of national leadership, the need to maintain significant human and financial resources in spite of a decreasing public health burden, and the reliance on a prompt, comprehensive, and proactive surveillance system.
Swaziland has been close to elimination before. Let’s hope that, this time, focus and human resources will remain steady until the goal is achieved.