Insecticide spraying & effective case
management reduce malaria cases in Azerbaijan
Public-private partnership in Azerbaijan helps reverse malaria epidemic
Azerbaijan has reversed an alarming upsurge in malaria cases. During
its first year of operation the malaria programme, funded by a private
sector multinational company and supported by international and other
UN agencies, helped reduce malaria cases by over 50%.
An alarming upsurge in malaria cases in Azerbaijan during the mid-1990s
is being reversed through the efforts of a public-private partnership
brokered in 1998 by the Roll Back Malaria global partnership.
A 3-year malaria control programme to support the Ministry of Health
within the partnership agreement with WHO is being funded by a US$ 760
000 contribution from the Italian oil company Eni. The company, which
operates out of Baku, has already supported other development projects,
including vector control activities. The programme, which is intended
to reach about 1.5 million people, aims to reduce the incidence of malaria
to only sporadic cases by the year 2004 and to avoid the social and
economic impact of the malaria burden. RBM partners committed to rolling
back malaria in Azerbaijan include the International Federation of Red
Cross and Red Crescent Societies (IFRC), Médecins Sans Frontiňres Belgium,
UNICEF, and other UN agencies.
The new venture is in response to the resurgence of a disease that
was all but eradicated in Azerbaijan more than a quarter of a century
earlier. In 1967, only three indigenous cases of malaria were reported.
Then, in 1991, the break-up of the former Soviet Union severed traditional
links with the former USSR republics which had provided support and
expertise for malaria control activities in Azerbaijan. To make matters
worse, the Nagorno Karabakh conflict erupted in the south-west of the
country -- sparking off massive population movements. By 1996, about
one million refugees and displaced persons were living in refugee camps
and other makeshift dwellings in malaria-endemic areas in the south.
As the economic situation deteriorated, the health sector was unable
to buy adequate supplies of medicines and equipment from abroad. Environmental
management was abandoned. Irrigation and drainage systems collapsed
through lack of maintenance. The mosquito was back in business. And
with a vengeance.
As the number of cases rose from 667 in 1994 to over 13 000 in 1996,
the government struggled with limited funds and international assistance
to bring the epidemic under control. Agricultural production was threatened
and there was concern that the epidemic would spread to neighbouring
countries. The government established a special malaria epidemic control
board headed by the Minister of Health. In 1997, about one sixth of
the population -- including those at highest risk of infection -- were
given weekly chloroquine treatment to prevent malaria. The government
also provided widespread health education about malaria. Meanwhile,
WHO worked with UNICEF and NGOs to ensure that malaria control measures
were in place in camps for displaced persons and refugees. Within a
year, the number of cases had dipped below 10 000. By the end of 1998,
only 5175 cases had been reported. The tide had begun to turn.
In an effort to accelerate and sustain this downward trend, the public-private
partnership programme was established in 1998. The aim is to improve
the capacity for and ensure wider access to early diagnosis and rapid
treatment for malaria, to improve surveillance and epidemic response,
to promote cost-effective and sustainable vector control, and to strengthen
operational research capacity within the Ministry of Health.
Today, a new generation of doctors are being trained to recognize and
treat malaria. And laboratory technicians are being provided with the
equipment they need to ensure accurate screening of large numbers of
blood samples during the high transmission season. Meanwhile, weekly
visits are made to refugee camps and resettlement areas during the malaria
season to detect and treat malaria cases.
Elsewhere, efforts are under way to reduce the density of mosquitoes
through the use of insecticides in the highest risk areas -- especially
refugee camps -- and through the introduction of larva-eating fish in
mosquito breeding grounds such as stagnant waters and slow running streams.
During 1998, 400 000 people at risk of malaria were given preventive
malaria drugs and case detection was actively carried out throughout
the country. As a result, the number of cases was slashed by over 50%.
In the longer term, efforts will be needed to find a permanent solution
to existing water management problems that encourage the proliferation
of mosquitoes. To achieve this, close collaboration will be needed between
the government ministries responsible for health, agriculture, and water
management as well as the private sector, and other sectors of the economy.