How Malaria is Practically Eradicated in Malaysia – A Reminiscence

Abstract

In 2010, 99 countries reported current malaria transmission, causing an estimated 219 million cases and 660,000 deaths, the deaths mostly in young children in Africa. In Malaysia, the country started on a Malaria Eradication Programme, MEP, in the third quarter of the past century. The MEP here is very much a success in the reason that the current rate (incidence) is very low, sporadic cases in Kelantan, Selangor, Pahang, Perak and Sarawak (mostly immigrants, imported-cases and illegal-loggers) - the disease practically eradicated except in Sabah where the disease remains endemic in the interior, although here much of monkey-malaria (P. knowlesi) spread to human. Vector-control played a big part in the MEP - the Anopheles spp breed in a wide variety of habitat depending on the species: drains and open pools of water (including seepage rain-water) had to be regularly and routinely sprayed with oil, and large unused-pools drained. But, much had been achieved by residual-spraying of homes with insecticide, and the use of mosquito-net. Residual-spraying is a big success in the reason that the Anopheles spp habitually settle (rest) on the walls after flying over to homes before starting on feeding.  Residual-spraying only requires done from time to time by a team of workers. Additional protection, achieved through community-education are: wearing fully covering light-coloured clothes in the evenings. Presently, mosquito-repellents can help - but these were unavailable in the MEP time. Chemoprophylaxis (i.e. the anti-malarial drugs) should be advised for those travelling to and through the endemic area. Armed-forces and Police-personnel were by regulation required to take chemoprophylaxis, besides such Government work. One additional very important success measure had been Active Case Detection, ACD, and Passive Case Detection (PCD) using slide-microscope followed by prompt treatment. Such ACD & PCD reduced the size of the human-reservoir from which transmission happened.