The advent of long-lasting nets and artemisinin-based (artemisinin is the miracle drug of Malaria) combination therapy plus a revival of support for indoor residual spraying of insecticide, presents a new opportunity for malaria control..
A WHO (World Health Organisation) report (called the World Malaria Report 2008) released recently speaks of not only the progress made in controlling malaria but also the challenges posed by it. The global burden of malaria remains enormous, though progress in malaria control has accelerated dramatically since 2006. The report states that half of the world’s population is at risk of malaria. An estimated 247 million malaria cases out of the 3.3 billion people at risk in 2006 caused nearly a million deaths, mostly of children under 5 years of age. Malaria was endemic in 109 countries in 2008 and 45 of them were within the WHO African region. 86 per cent or 212 million (152–287 million) cases were from the African Region. 80 per cent of the cases in Africa were detected in 13 countries and over half were in Nigeria, the Democratic Republic of the Congo, Ethiopia, the United Republic of Tanzania and Kenya. Among the cases that occurred outside the African region, 80 per cent were from India, Sudan, Myanmar, Bangladesh, Indonesia, Papua New Guinea and Pakistan.
The World Malaria Report 2008 describes the global distribution of cases and deaths. It also explains how the WHO-recommended control strategies have been adopted and implemented in Malaria-endemic countries, the sources of funding for malaria control and recent evidence that prevention and treatment can alleviate the burden imposed by the disease. The report states that the advent of long-lasting insecticidal nets and artemisinin-based (artemisinin is the miracle drug of Malaria) combination therapy plus a revival of support for indoor residual spraying of insecticide, presents a new opportunity for large-scale malaria control. Some salient features and points raised in the report are:
1. It talks of renewed efforts to control malaria worldwide; elimination in some countries is founded on the latest generation of effective tools and methods for prevention and cure.
2. The report raises concern that little children remain by far the most likely to die of the disease.
3. It puts forward policies and strategies for malaria control - the various national malaria control programmes have adopted many of the WHO-recommended policies on prevention and cure, but with variation among countries and regions.
4. It talks about prevention of malaria – it says that despite big increases in the supply of mosquito nets, especially of long-lasing insecticidal nets in Africa, the number available is still far below the requirement in most countries.
5. On the issue of treatment of malaria, the report says that the procurement of anti-malarial medicines through public health services increased sharply between 2001 and 2006, but access to treatment, especially of artemisinin-based combination therapy, was inadequate in all the countries surveyed in 2006.
6. It states that funding for malaria control in 2006 was reported to be greater than ever before, but it is not yet possible to judge from NMCP budgets which countries have adequate resources for malaria control.
7. It also brings out the impact of malaria control - some countries that have implemented aggressive programmes of prevention and treatment in Africa and other regions, have reported significant reduction in malaria incidence. For the first time, three African countries reported dramatic reduction in malarial deaths - by 50 per cent or more. Eritrea, Rwanda and Sao Tome and Principe achieved this result between 2000 and 2006/2007 through a mix of bednet (protective netting) distribution, indoor spraying, improved access to treatment and advances in disease surveillance.
Contributed by Anil Gulati