MALARIA ELIMINATION IN ZANZIBAR - Soper Strategies
MALARIA ELIMINATION IN ZANZIBAR - Soper Strategies
MALARIA ELIMINATION IN ZANZIBAR - Soper Strategies
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esponse capabilities will permit better control of malaria even if<br />
Zanzibar decides not to attempt elimination.<br />
The rate at which malaria is imported into Zanzibar is<br />
a crucial factor about which too little is known. Given the<br />
high uncertainty surrounding the level of importation risk and<br />
the importance of this measure for confident prediction of the<br />
operational requirements to ensure sustainable elimination, we<br />
strongly recommend that Zanzibar begin a series of rigorous<br />
surveys to identify the rate with which parasites are traveling to<br />
the islands. Additionally, Zanzibar should develop a careful plan<br />
for how it will prevent the reintroduction of malaria transmission<br />
before embarking on an elimination program.<br />
Continue to collect data and conduct surveys to improve the<br />
precision of models and their predictions and to monitor<br />
progress. The recommendations made here are based upon<br />
relatively simple mathematical models that are generalized<br />
representations of the real world. They are also dependent upon<br />
the available data, which is at times limited and/or outdated.<br />
As such, an important next step in considering and planning<br />
a potential elimination program will be for Zanzibar to collect<br />
additional data in a number of key areas.<br />
These include:<br />
�� Immigration and migration patterns<br />
32<br />
! Importance of informal traffic and ferries for bringing<br />
travelers to Zanzibar and returning potentially infected<br />
Zanzibar residents to the islands;<br />
! Prevalence of infection in travelers arriving in each case;<br />
! Travel patterns–where travelers go in Zanzibar and how<br />
long they stay; where and for how long residents of<br />
Zanzibar go on the mainland.<br />
�� More detailed prevalence data<br />
! Surveys conducted at the shehia level will permit<br />
identification of particularly high risk areas and will<br />
inform more specific modeling;<br />
! Within high risk areas, spatial analyses should be used to<br />
identify focal areas of transmission.<br />
�� Incidence data from all health facilities<br />
! Expanding MEEDS collection to all facilities will permit<br />
creation of a complete database of incidence in Zanzibar;<br />
! Using this information, algorithms can be developed to<br />
identify unusual spatiotemporal clustering of malaria and<br />
trigger outbreak response.