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Eliminating Malaria Case Study 2 ELIMINATING MALARIA Case-study 2 Moving towards sustainable elimination in Cape Verde ELIMINATING MALARIA Case-study 2 Moving towards sustainable elimination in Cape Verde WHO Library Cataloguing-in-Publication Data Moving towards sustainable elimination in Cape Verde. (Eliminating malaria case-study, 2) 1.Malaria - prevention and control. 2.Malaria - epidemiology. 3.National health programs. 4.Cape Verde. I.World Health Organization. Global Malaria Programme. II.University of California, San Francisco. ISBN 978 92 4 150438 6 (NLM classification: WC 765) © World Health Organization 2012 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for non-commercial dis- tribution – should be addressed to WHO Press through the WHO web site (http://www.who.int/about/licensing/ copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The named authors alone are responsible for the views expressed in this publication. Suggested citation: Ministry of Health Cape Verde and the World Health Organization and the University of Califor- nia, San Francisco (2012). Eliminating malaria. Moving towards sustainable elimination in Cape Verde, Geneva: The World Health Organization. Photo credit cover: © Alex3 - Fotolia.com Designed by Paprika-Annecy /University of California San Francisco Global Health Group Printed by the WHO Document Production Services, Geneva, Switzerland Publications of the University of California, San Francisco are available on the UCSF web site (http://globalhealthsciences.ucsf.edu/global-health-group), Global Health Group, the University of California,San Francisco CONTENTS Acknowledgements ..............................................................................................................vii Acronyms and abbreviations ..................................................................................................viii Glossary ............................................................................................................................ ix Summary ..........................................................................................................................xv History of malaria and malaria control ................................................................................... xv Gearing up for elimination ................................................................................................. xvi Outlook for the future ...................................................................................................... xvi Introduction ........................................................................................................................ 1 The malaria elimination case-study series .................................................................................. 1 Malaria elimination initiatives in Africa .................................................................................... 1 Malaria elimination in Cape Verde .......................................................................................... 2 Country background ............................................................................................................. 3 Geography, climate, population and economy ............................................................................ 3 Health system and population health profile .............................................................................. 5 History of malaria and malaria control ...................................................................................... 7 Parasites and vectors .......................................................................................................... 7 Pre-control ..................................................................................................................... 7 Elimination campaigns ...................................................................................................... 8 Outbreaks and their control, 1986 onwards ................................................................................ 8 Factors contributing to changes in the malaria situation over time .................................................... 13 Why does malaria transmission keep coming back? .................................................................... 13 Elimination of malaria in the 1950s and 1960s............................................................................ 16 Elimination of malaria after the resurgence on Santiago in the 1970s ................................................. 17 Control of malaria after the resurgence on Santiago in 1986 ........................................................... 19 Events that have shaped the policy-setting process over time........................................................... 19 Which population groups were most affected by malaria in recent years? ........................................... 21 How is the programme changing to achieve elimination? ................................................................ 23 Epidemiological surveillance and control activities ...................................................................... 24 Prevention of imported malaria and its consequences .................................................................. 24 Management of disease ..................................................................................................... 25 Field (epidemiological) investigations, recording and reporting, flow of information, data processing, analysis and use .......................................................................................... 25 Vector (entomological) surveillance ....................................................................................... 26 Vector control activities ..................................................................................................... 26 Monitoring key social, demographic and behavioural risk factors ..................................................... 26 Laboratory support for surveillance, external quality assurance/control ............................................. 27 Supportive legislation and regulation ...................................................................................... 27 Programme management ................................................................................................... 28 Programme funding ......................................................................................................... 28 Lessons learned and outlook for the future ................................................................................. 31 Conclusion ........................................................................................................................ 34 References ......................................................................................................................... 35 Eliminating Malaria | Moving towards sustainable elimination in Cape Verde | Contents v Annex 1: Data sources and methods applied ................................................................................ 37 Annex 2: Population and distribution of health structures by island and local health authority, 2009 ........... 38 Annex 3: Development and health profile ................................................................................... 40 Annex 4: Parasites and vectors ................................................................................................. 41 Annex 5: Number of cases by island and local health delegation, 1996–2009 ......................................... 43 Annex 6: Form used for individual case notification and follow-up ..................................................... 44 Annex 7: Structure of the Ministry of Health ............................................................................... 45 vi Eliminating Malaria | Moving towards sustainable elimination in Cape Verde | Contents ACKNOWLEDGEMENTS This case-study is part of a series of malaria elimination The authors would like to thank the Honourable Mrs case-studies conducted
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