How can malaria best be controlled in times of crisis, in war zones or during a natural disaster? The Roll Back Malaria Partnership (RBM) Technical support Network (TSN) introduced a programme to prevent an increase in infection and disease in East Timor. This programme was aimed at controlling malaria in the aftermath of a complex emergency involving both war and mass migration. Malaria control specialists from the London School of Hygiene and Tropical Medicine, and HealthNet International looked at the experience of dealing with malaria in East Timor.

The violence that followed the referendum for independence in East Timor left more than 100 000 people homeless. The risk of a malaria epidemic increased due to destroyed homes, a collapsed health service and the approaching rainy season. RBM was first introduced in East Timor in 1999 when the political situation became more stable. The programme involved:

• health education to make people more aware of the risk of catching malaria
• prevention through distribution of mosquito nets treated with insecticide
• training of medical staff to ensure correct diagnosis and effective treatment
• training of laboratory staff and re-establishment of a basic system for microscopic diagnosis
• residual insecticide spraying of houses in presumed high risk locations.

The study found that:

• The programme was quickly and effectively introduced, providing diagnosis, prevention and treatment of malaria.
• An overall plan to achieve the goal of controlling malaria was not developed beyond the acute phase of the emergency.
• There was a lack of co-ordination between the difference organisations involved, the local health teams and the foreign non-governmental organisations (NGOs).
• Problems arose when East Timor moved from ‘emergency’ into the transitional phase towards independence and a new health service was being established. Compounded by the lack of monitoring and evaluation, the malaria control programme did not adapt to the new situation.
• As a result of the programme the local population became used to nets being provided free of charge.

The following lessons can be learned from East Timor’s experience:

• The roles and responsibilities of the different RBM partners should be clearly defined.
• Planning, monitoring and evaluation should be introduced at the very beginning of the programme.
• Expert advice is needed at all stages to make sure the programme is correctly put into practice.
• The programme needs to be flexible enough to react to a changing situation.
• It needs to be made clear who will take over malaria control when the RBM complex emergency partnership finishes and a country moves towards transition and stability.

While preventing malaria and saving lives in times of crisis is essential, it is also important to ensure that appropriate malaria control activities are continued once the situation has stabilised.

Source(s):
‘Malaria control in complex emergencies: the example of East Timor’, Tropical Medicine and International Health 8(1): 48-55.by J. Kolaczinski and J. Webster, 2003
HINARI subscribers can access the full-text article here. Full document.

id21 Research Highlight: 17 March 2003

Further Information:
J H Kolaczinski
Disease Control and Vector Biology Unit
Department of Infectious and Tropical Diseases
London School of Hygiene and Tropical Medicine
Keppel Street
London
WC1E 7HT
UK

Tel: +44 20 7927 2213
Fax: +44 20 7467 9536
Contact the contributor: jan.kolaczinski@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

HealthNet International, the Netherlands

Other related links:
'Unsafe haven? The risk of malaria in refugee camps'

'Running battle - international intervention in post-conflict healthcare'

See id21's collection of links relevant to infectious diseases.