A city official uses a fogging machine to disinfect a surrounding in Kathmandu, Nepal. — THE KATHMANDU POST/ANN Photo

KATHMANDU — As the deadline to eliminate malaria approaches, cases of new infections – both indigenous and imported – have risen alarmingly in Nepal.

Nepal had committed to achieving ‘malaria-free’ status by 2026. For this, the country needs to bring down indigenous cases or local transmission to zero, achieve zero deaths starting from 2023, and maintain zero indigenous cases for three consecutive years.

However, the country has failed to bring down indigenous cases to zero in both 2023 and 2024.

Instead, cases of infections–both Indigenous and imported have risen alarmingly, which shattered any prospects of eliminating the disease within the deadline.

“Only 16 cases of local transmission or indigenous cases were confirmed in 2023, but we already have more than 20 cases this year,” said Dr Gokarna Dahal, chief of the Vector Control Section at the Epidemiology and Disease Control Division. “We had 649 imported cases in 2023, but in 2024, the number could reach 1,000.”

Malaria is caused by Plasmodium parasites. Infected female Anopheles mosquitoes carry these deadly parasites, according to the World Health Organisation.

Indigenous malaria cases are locally transmitted, meaning the infected person does not have a history of travel to a malaria-affected country. Officials say that the number of indigenous cases of malaria infection could rise further, as concerned health authorities have been verifying the reports.

“Now, it is impossible to meet the malaria elimination target, as we could not stop local transmission,” said Dr Yadu Chandra Ghimire, director of the division. “The new deadline for disease elimination could be 2030, the final deadline set by the UN health body.”

Officials say that open borders, budget cuts in the health sector, and mosquitoes moving to higher altitudes due to climate change have hindered Nepal’s malaria elimination goal.

They say that of the total imported cases, over 80 per cent came from India. Some cases were imported from African countries. Nepali security personnel serving in UN peacekeeping missions in conflict-hit African countries also get tested positive for malaria.

Officials say the disease is unlikely to be eliminated in Nepal unless India eliminates it first. They say that due to proximity, and an open and porous border between Nepal and India and unregulated travel of people of both countries, it is impossible to eliminate malaria in Nepal, until the disease gets eradicated in the southern neighbour.

Several other factors, including cuts in the health budgets of government and aid agencies and shifts in vectors transmitting malaria to the hills and mountains due to global warming, also pose serious challenges to meeting the elimination target. Apart from this, most health facilities across the country lack entomologists, who are necessary for conducting surveillance.

Malaria has also been reported in mountain districts of Mugu, Bajura, and Humla, which were considered non-endemic in the past.

Officials say carrying out surveillance in the hill and mountain districts is more challenging than in the Tarai districts due to geographical difficulties.

According to Health Ministry officials improved surveillance measures could be a reason for the detection of more cases of infections.

Malaria-related deaths had stopped since 2016, but five years later, in 2021, the country recorded one death from the disease.

Officials at the health ministry said that until recent years, Plasmodium Vivax, a protozoan parasite, had been responsible for most of the malaria cases in the country, which caused relatively less severe diseases.

However, cases of Plasmodium falciparum, which most often cause severe and life-threatening malaria, have been rising. The parasite is common in many countries in Africa and the Sahara desert. — THE KATHMANDU POST/ANN