Ethiopia

Moving towards evidence-based malaria elimination program

Abstract

As affirmed in the 2010 review (MOH 2010) and repeatedly underscored in articles in this special issue (Nigatu et al. 2019.1, 2019.2; Yohannes 2019; Mekuriaw et al. 2019; Waldetensai et al. 2019) and all major government (MOH 2010; MOH 2011; MOH 2014) and other review (Deressa et al. 2006; Alemu et al. 2012; WHO 2017; Deribew et al. 2017; Vajda and Webb 2017; EPHI 2016) documents, malaria remains a major challenge in Ethiopia. In spite of important gains in anti-malarial interventions “Almost three-fourths of the total landmass and above half of the total population are at malaria risk” (Nigatu et al. 2019.1). Major challenges remain and in the perpetual dance a duo [or is it a trio/parasite-vector-host?] (McCann 2014) we should anticipate surprise moves such as new vectors (Kinfe et al. 2019); more outdoor transmission (Nigatu 2019.2; Gatton et al. 2013 citing cases from Ethiopia); peak biting activity shifting to the early part of the night or “ … shifting behavior of malaria vectors following prolonged deployment of indoor based vector control interventions (IRS and LLINs)” (Nigatu 2019.2); potential for reintroduction in areas where it has been eliminated (Yukich et al. 2013); climate change induced malaria shifting to higher altitude areas (Vajda and Webb 2017; Alonso et al 2011; Siraj et al. 2014; Bouma et al. 2016); development related e.g. dams increases (Deribew et al. 2017; Vajda and Webb 2017; Lautze et al. 2007; Kibret et al. 2016); or malaria considered a predominantly rural disease becoming a considerable urban health problem (Donnelly et al. 2005). On the opportunities side, note the possible return of chloroquine-sensitive Plasmodium falciparum parasites (Mekonnen et al. 2014) and Ethiopians holding lead positions as CEO of the Roll Back Malaria (RBM) Partnership or director-general of the World Health Organization (PATH MACEPA 2017). In this context of high burden of disease and major social and economic impact (Nkumama et al. 2017) and even famine (Mengesha et al. 1998), the lure of resolving the problem once for all – elimination/eradication - is compelling.