Abstract
Background: Malaria is still a priority public health problem of Nepal where about 84% of the population are at
risk. The aim of this paper is to highlight the past and present malaria situation in this country and its challenges
for long-term malaria elimination strategies.
Methods: Malariometric indicator data of Nepal recorded through routine surveillance of health facilities for the
years between 1963 and 2012 were compiled. Trends and differences in malaria indicator data were analysed.
Results: The trend of confirmed malaria cases in Nepal between 1963 and 2012 shows fluctuation, with a peak in 1985
when the number exceeded 42,321, representing the highest malaria case-load ever recorded in Nepal. This was followed
by a steep declining trend of malaria with some major outbreaks. Nepal has made significant progress in controlling
malaria transmission over the past decade: total confirmed malaria cases declined by 84% (12,750 in 2002 vs 2,092 in
2012), and there was only one reported death in 2012. Based on the evaluation of the National Malaria Control
Programme in 2010, Nepal recently adopted a long-term malaria elimination strategy for the years 2011–2026 with the
ambitious vision of a malaria-free Nepal by 2026. However, there has been an increasing trend of Plasmodium falciparum
and imported malaria proportions in the last decade. Furthermore, the analysis of malariometric indicators of 31
malaria-risk districts between 2004 and 2012 shows a statistically significant reduction in the incidence of confirmed
malaria and of Plasmodium vivax, but not in the incidence of P. falciparum and clinically suspected malaria.
Conclusions: Based on the achievements the country has made over the last decade, Nepal is preparing to move
towards malaria elimination by 2026. However, considerable challenges lie ahead. These include especially, the need to
improve access to diagnostic facilities to confirm clinically suspected cases and their treatment, the development of
resistance in parasites and vectors, climate change, and increasing numbers of imported cases from a porous border with
India. Therefore, caution is needed before the country embarks towards malaria elimination.
Keywords: Anopheles, Climate change, Cross-border, Environment, Insecticide, Imported malaria, Malaria elimination,
Plasmodium, Resistance, Vecto.