ELIMINATING MALARIA Case-study 1 Achieving elimination in Turkmenistan ELIMINATING MALARIA Case-study 1 Achieving elimination in Turkmenistan WHO Library Cataloguing-in-Publication Data Achieving elimination in Turkmenistan. (Eliminating malaria case-study, 1) 1.Malaria – prevention and control. 2.Malaria – epidemiology. 3.National health programs. 4.Turkmenistan I.World Health Organization. Global Malaria Programme. II.University of California, San Francisco. ISBN 978 92 4 150430 0 (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]). 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Photo credit cover: © Rossitza Kurdova-Mintcheva/WHO Design 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 Достижение элиминации малярии в Туркменистане .......................................................... xix Introduction ........................................................................................................................ 1 The malaria elimination case-study series .................................................................................. 1 Malaria in the WHO European Region .................................................................................... 1 Malaria in Turkmenistan ..................................................................................................... 2 Country background ............................................................................................................. 3 Geography, population and economy ...................................................................................... 3 Health system and population health profile .............................................................................. 4 History of malaria and malaria control ....................................................................................... 7 Parasites and vectors .......................................................................................................... 7 Pre-control ..................................................................................................................... 7 Initial control efforts .......................................................................................................... 7 Initial elimination efforts ..................................................................................................... 7 Prevention of reintroduction, 1961–1990 ................................................................................... 8 Outbreaks and their control, 1991–2003 ................................................................................... 10 Elimination of malaria, 2004–2010 ......................................................................................... 13 Prevention of reintroduction, 2010 onwards .............................................................................. 15 Factors contributing to changes in the malaria situation, 1990–2010 ................................................... 17 Why did malaria re-emerge and an outbreak occur in the 1990s? ...................................................... 17 Why did an outbreak occur in 2002–2003? ................................................................................ 18 Which populations were most affected by malaria?...................................................................... 19 Control of the 1998–1999 outbreak ........................................................................................ 20 Control of the 2002–2003 outbreak ........................................................................................ 22 Elimination of malaria, 2004–2010 ......................................................................................... 22 Cost of malaria elimination ................................................................................................. 32 Lessons learned and drivers of change ....................................................................................... 35 Problems and constraints overcome ....................................................................................... 35 Comprehensive strategies applied ......................................................................................... 35 Upgraded and motivated NMCP staff ..................................................................................... 36 Strengthening collaboration and community mobilization ............................................................. 37 Strong political commitment ............................................................................................... 37 WHO support ................................................................................................................ 37 Outlook for the future ....................................................................................................... 38 Conclusions ....................................................................................................................... 39 References ......................................................................................................................... 41 Eliminating Malaria | Achieving elimination in Turkmenistan | Contents v Annex 1: Data sources and methods applied ................................................................................ 45 Annex 2: Demographic data from the United Nations Population Division ........................................... 47 Annex 3: Administrative divisions, political organization and economy ............................................... 48 Annex 4: Health care policies .................................................................................................. 49 Annex 5: Main health indicators ............................................................................................... 50 Annex 6: Parasites, vectors and geographical distribution ................................................................ 52 Annex 7: Organization of malaria control/elimination within the structures of MOHMI ......................... 54 Annex 8: Standard form for malaria and other communicable diseases case investigation ......................... 55 Annex 9: Malaria focus record form (“passport”) .......................................................................... 63 vi Eliminating Malaria | Achieving elimination in Turkmenistan | Contents ACKNOWLEDGEMENTS This case-study is part of a series of malaria elimination The authors would like to thank the honourable case-studies conducted by the World Health Minister of Health, Dr Gurbanmammet Ylyasov, and Organization (WHO) Global Malaria Programme and his staff, as well as the staff of the WHO country office the University of California, San Francisco (UCSF), in Turkmenistan for their support and assistance in the Global Health Group. preparation of this case-study. The two groups wish to acknowledge the financial The authors acknowledge with