MALARIA ELIMINATION IN ZANZIBAR - Soper Strategies

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the available data, which is at times limited and/or outdated.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