Malaria control in Afghanistan was managed by the government from the 1950s until 1979. After two decades of war and instability little of the original programme is left. Health experts now face the challenge of addressing malaria control in the context of health sector reconstruction.

Following the Soviet invasion of Afghanistan around 15 million people, a third of the population, fled the country. Whole regions were abandoned by their inhabitants: agriculture deteriorated when irrigation systems were not maintained, the public health system collapsed, and life expectancy fell to 46 years.

A malaria programme could not be sustained in such circumstances. In 1992 the situation in East Pakistan became stable enough to set up a network of clinics with the aim of fighting malaria. After the Taliban regime fell in 2001 international agencies provided aid to help rebuild the country’s health networks. For the first time in over two decades it was feasible to consider scaling-up of malaria to cover all endemic areas.

Afghanistan’s Malaria season runs from June to September with people living in rice-growing river valleys being the worst hit. The population is only partly immune to malaria and children and teenagers are the most likely to fall sick. Afghanistan poses specific challenges in the fight against malaria:

• In 2002 the World Health Organisation estimated there were three million cases of malaria in the country. In the 1970s before the war the annual figure was between 40,000 and 80,000.
• Only one percent of cases were caused by Plasmodium falciparum before the war.  By 1996 this had risen to 20 percent because the parasite had developed resistance to the drug chloroquine.
• Many people live in mountain valleys and cannot be reached for months during the winter while strong Islamic beliefs make it hard to reach women.

It is essential that both the diagnosis and treatment of malaria become a part of the general health service.  However, until the disease is under control, technical support is needed to carry out training of staff, research, to control outbreaks, and to promote ways of preventing the disease. In order to integrate malaria control into the health service the government will need to set up a forum. This body should:

• Involve the private sector in order to increase sales of insecticide-treated mosquito nets to a national level.
• Target limited resources at the poorest people and those most at risk of becoming infected.
• Find a way to expand new treatments for the increasing number of malaria cases which are chloroquine resistant and to finance these drugs.

The main obstacle to improving health care in Afghanistan is continuing instability in many regions of the country. Despite many other pressing health needs malaria control needs to be a priority. When malaria is fully under control the management of the disease can be fully integrated into the general health services.

Source(s):
‘Malaria control in Afghanistan: progress and challenges’, The Lancet 365(9469): 1506-1512, by Jan Kolaczinski et al, 2005 Full document.

Funded by: European Commission, Gates Malaria Partnership, UK Department for International Development, Wellcome Trust

id21 Research Highlight: 7 November 2005

Further Information:
Jan Kolaczinski
Disease Control and Vector Biology Unit
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
UK

Tel: +44 (0) 20 79272164
Contact the contributor: jan.kolaczinski@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

Other related links:
'A small price to pay: preventing malaria in rural Afghanistan'

'Repellents and nets combine to combat malaria in Afghanistan'

'Controlling malaria in times of emergency: East Timor’s experience'

'Unsafe haven? The risk of malaria in refugee camps'

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