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Malaria in São Tomé and Principe: On the Brink of Elimination after Three Years of Effective Antimalarial Measures

In 2005, São Tomé e Príncipe began an initiative aimed at reducing malaria-related mortality to zero. The program included mass coverage with two antivector intervention methods (indoor residual spraying and long-lasting insecticidal nets), artemisinin-based combination therapy, and intermittent preventive therapy in pregnancy with sulfadoxine-pyrimethamine. At the end of 2007, three years after intensified interventions began, malaria-attributed outpatient consultations, hospitalizations, and deaths decreased by more than 85%, 80%, and 95%, respectively, in all age groups. Mean prevalence of parasitemia and splenomegaly were also significantly reduced to 2.1% (P < 0.0001) and 0.3% (P < 0.0001) after two rounds of spraying from baseline prevalences of 30.5% and 48.8%, respectively. The dramatic reduction in malaria morbidity and mortality now enable serious consideration of new goals and strategies aimed at completely interrupting malaria transmission on these islands. We report evidence of the program’s impact and the feasibility of and potential strategies for eliminating malaria from São Tomé e Príncipe.

Received July 26, 2008. Accepted for publication September 16, 2008.

Acknowledgments: We thank the Centro National de Endemias, Democratic Republic of São Tomé and Principe for allowing access to the information, and Paola Mejia for her comments and suggestions in preparing the manuscript.

Financial support: This study was supported by the Open Society Institute (grant nos. 20014547and 20015285) and United Nations Development Program grant no. Cu02792901 awarded to the Earth Institute, Columbia University. The sponsors had no role in the study design, data collection, data analysis, data interpretation, or writing of the manuscript.

^* Address correspondence to Hailay Desta Teklehaimanot, Earth Institute at Columbia University, 2910 Broadway New York, NY 10025 and Center for National Health Development in Ethiopia, PO Box 664, Code 1250, Addis Ababa, Ethiopia. E-mail: hailaycnhde{at}ethionet.et

Authors’ addresses: Hailay Desta Teklehaimanot, Earth Institute at Columbia University, 2910 Broadway, New York, NY 10025 and Center for National Health Development in Ethiopia, PO Box 664, Code 1250, Addis Ababa, Ethiopia, E-mail: hailaycnhde{at}ethionet.et. Awash Teklehaimanot, Earth Institute at Columbia University, 2910 Broadway New York, NY 10025, E-mail: thawash{at}ei.columbia.edu. Anthony Kiszewski, Bentley College, 175 Forest Street, Waltham, MA 02452, E-mail: akiszewski{at}bentley.edu. Herodes Sacramento Rampao, Ministry of Health, Centro Nacional de Endemias, Bo Qa St.Antonio, São Tomé and Principe, E-mail: sacramentosousa{at}yahoo.com.br. Jeffrey D. Sachs, Earth Institute at Columbia University, 314 Low Library, MC 4327, 535 West 116th Street, New York, NY 10027, E-mail: sachs{at}columbia.edu.

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