Turkmenistan certified malaria-free

On 19 October 2010, Turkmenistan was added to the official register of areas where malaria elimination has been achieved. Turkmenistan is the third country to be added to the list, after the United Arab Emirates and Morocco, since WHO reinitiated certification procedures in 2004, after they were abandoned in the 1980s.

Turkmenistan, with a population of over 5 million people in 2008, used to be endemic for Plasmodium falciparum, P. vivax and P. malariae malaria. Malaria transmission was seasonal from May–June to October with Anopheles pulcherrimus and A. superpictus asthe principal vector species.

Turkmenistan’s history of malaria control dates back to the 1920s. By 1952, malaria was eliminated as a major public health problem in the country, and P. falciparum disappeared completely by the late 1950s. By 1961, full elimination was achieved, although at that time not certified by WHO because Turkmenistan was part of the USSR, which still had endemic areas elsewhere. Since 1960, P. vivax has been the only malaria parasite known to be transmitted in Turkmenistan.

Over the period 1960–1980, sporadic cases of local P. vivax transmission were reported in Turkmenistan, and imported malaria, originating in Afghanistan, increased during the 1980s. After independence, the situation deteriorated in the 1990s owing to neglect of the problem and increased population movement. During 1990–1997, 79 cases of P. vivax malaria were registered, 49 of them imported. Indigenous cases, considered sporadic, were registered every year. In 1998, 108 cases of malaria were detected in Kushka (now Serhetabad) etrap in Mary velayat. To contain this outbreak, the most severe since 1960, the sanitary–epidemiological service carried out emergency measures focusing on indoor residual spraying with insecticides and seasonal chemoprophylaxis.

From 1999 to 2008, 150 malaria cases were detected in Turkmenistan. Most (78.6%) occurred in relatively high-risk areas in Mary (62 cases) and Lebap (56 cases) velayaty (Tedjen-Murgab estuary and valley and Amudarya valley). In addition, some parts of these regions (Serhetabad and Tagtabazar) border on Afghanistan, implying that some cases contracted in the two could be directly related to importation of malaria by infected mosquitoes or human beings. The last autochthonous cases (acquired in Turkmenistan) were registered in 2004, and probably resulted from infections acquired during the 2002 or 2003 transmission seasons. Most of the 150 cases were in males (127), rural residents (117) and young adults.

In consideration of the malaria burden in the country, in 2005 the President of Turkmenistan signed the Tashkent Declaration: “The Move from Malaria Control to Elimination”. Endorsed by all malaria-affected countries in the WHO European Region, the Declaration put in place an elimination strategy centred on intense malaria surveillance. By 2007, Turkmenistan’s Ministry of Health and Medical Industry decided to aim for certification of elimination, and began the procedures in 2009, after 4 years without local transmission. After following the WHO standard operating procedures, which include intensive external evaluation, Turkmenistan received certification as malaria free on 19 October 2010.

^{Table 1. Countries entered into the WHO official register of areas where malaria elimination has been achieved}