Malaria elimination in Botswana, 2012-2014: achievements and challenges

Area of Science:

• Malariology
• Epidemiology
• Public Health

Background:

• Botswana achieved significant malaria reduction between 2000-2012, with incidence dropping from 0.99% to 0.01% and deaths from 12 to 3.
• The nation launched malaria elimination strategies in October 2012, necessitating an examination of implementation progress and challenges.

Purpose of the Study:

• To evaluate the progress and challenges encountered during Botswana's malaria elimination program implementation.
• To identify future needs for achieving successful malaria elimination in Botswana.

Main Methods:

• A national rapid notification and response strategy was implemented.
• Cases detected via passive surveillance triggered contact screening (household members within 100m) using rapid diagnostic tests (RDT) and microscopy within 48 hours.
• Spatial analysis was performed on malaria cases detected in health facilities.

Main Results:

• 1808 malaria cases were recorded between October 2012 and December 2014, with 60% in the Okavango district.
• Challenges included incomplete notification forms (63.5%) and limited household monitoring (12.6%).
• Human movement, both national and international, contributed significantly to malaria transmission (8.7% imported, 6.01% from other countries), alongside the detection of asymptomatic infections.

Conclusions:

• Botswana's elimination efforts highlight challenges such as human migration and persistent asymptomatic infections.
• Programmatic improvements are needed in case notification speed and response thoroughness.
• Sustainable interventions targeting the infection reservoir are crucial for Botswana to achieve malaria elimination.