Malaria is in retreat in many countries of sub-Saharan Africa after a huge effort in the last two years to get bed nets and indoor spraying into endemic areas, but the gains are fragile, according to the World Health Organisation.
Malaria cases or hospital admissions and deaths have been cut by half in 11 African countries over the past decade, the WHO’s world malaria report shows. Outside Africa, in 32 of the 56 remaining malaria endemic countries, the gains have been even greater. Eight more countries have seen reductions in the number of cases of between 25% and 50%. Last year Morocco and Turkmenistan were certified malaria free.
“The results set out in this report are the best seen in decades,” said WHO director general Dr Margaret Chan. “After so many years of deterioration and stagnation in the malaria situation, countries and their development partners are now on the offensive. Current strategies work.”
A huge push to get insecticide-treated bed nets (ITNs) to families in malaria ridden countries over the past three years, involving UN agencies, governments, charities and celebrities, will have supplied approximately 289-million nets to sub-Saharan Africa by the end of 2010, which is enough to protect 578-million people — 76% of the 765-million at risk.
Indoor insecticide spraying has protected 75-million people, or 10%, of those at risk in 2009. Many more people now have access to the best drugs to treat malaria — artemisinin combination therapies (ACTs).
‘Formidable challenge’
But what the WHO calls the fragility of the gains is clear. By the middle of this year, still only 35% of children in Africa — who are the most vulnerable to malaria — were sleeping under a net. “The percentage of ITNs is still below the WHA [World Health Assembly, the supreme decision-making body for WHO] target of 80%, partly because up to the end of 2009, ITN ownership remained low in some of the largest African countries,” says the report.
And the lifespan of the nets, at only three years, represents a “formidable challenge”, the report goes on. “Nets delivered in 2006 and 2007 are therefore already due for replacement, and those delivered between 2008 and 2010 soon will be. Failure to replace these nets could lead to a resurgence of malaria cases and deaths.”
There are other worries. A single class of insecticide is used at the moment in the nets and mostly for indoor spraying. There is a possibility that the mosquito-borne parasites that spread malaria could become resistant to it. Resistance is also a big fear in drug treatment. The ACTs were brought in after resistance developed to the older drugs. To maintain their efficacy, it is important they are sold only in combination — not as monotherapy. But, says the report, as recently as last month, 25 countries were still allowing the drugs to be sold alone and 39 pharmaceutical companies were still making them as single tablets.
Continued funding
Not all countries are experiencing a decline in malaria. In three countries — Rwanda, São Tomé and PrÃncipe and Zambia — the number of cases went up in 2009. The reasons, says the report, are not known with certainty. “The increases in malaria cases highlight the fragility of malaria control and the need to maintain control programmes even if numbers of cases have been reduced substantially.”
Continued funding for the fight against malaria will be important. The amount of money available went up steeply over the past 10 years, and yet it has not reached the estimated $6-billion needed this year. In 2009, $1,5-billion was available, but this year, the report says “new commitments for malaria control appear to have stagnated … at $1,8-billion.”
But Ray Chambers, the UN secretary general’s special envoy for malaria, was upbeat. “The strategic scale-up that is eroding malaria’s influence is a critical step in the effort to combat poverty-related health threats. By maintaining these essential gains, we can end malaria deaths by 2015,” he said. – guardian.co.uk