Malaria in Sri Lanka: one year post-tsunami

One year ago, the authors of this article reported in this journal [1] on the malaria situation in Sri Lanka prior to the tsunami that hit on 26 December 2004, and estimated the likelihood of a post-tsunami malaria outbreak. Here they report on changes in malaria incidence recorded by the Anti Malaria Campaign (AMC) since the tsunami. Also, they discuss the control measures taken in response to the tsunami by the Anti Malaria Campaign (1), international donors and non-governmental organizations (NGOs) (2), and their effects on the surveillance system.Figure 1 shows the monthly malaria incidence January 2004 – December 2005 at district resolution, and the percentage difference between the successive years. On the north, east and south coasts, most of the districts show a strong decline (except Trincomalee [-4%]), whereas malaria incidence increased in the districts of Colombo, Gampaha and Puttalam on the west coast, which were the least tsunami-affected coastal districts of the country. A possible reason for the slow decline of malaria in Trincomalee, when compared to other coastal districts in the east, is that, particularly in Trincomalee, there was increased civil unrest and political protests in 2005 in comparison to 2004, hindering the control efforts of the regional malaria officer (RMO). There is no indication that the physical impact of the tsunami has affected the malaria case load in Trincomalee District, as 85% of the cases were reported from Trincomalee Ministry of Health (MoH) administrative area (representing about 28% of the population in the District), which was relatively unaffected by the tsunami in terms of buildings destroyed and people killed or missing as compared to other coastal MoH administrative areas in Trincomalee district [2]. Only eighteen cases (six percent of the total cases in Trincomalee District) occurred in the Kinnyia MoH area among tsunami-displaced people. Note that, despite the "dramatic" increases in malaria incidence in some