Malaria – the fight is still on
Windhoek – World Malaria day was commemorated in Angola this year on April 25 under the theme “Achieving Progress and Impact – heralds the international community’s renewed efforts make progress towards zero malaria deaths by 2015”. All over sub-Saharan Africa, already struggling economies are being battered by the economic burden of the disease, which is estimated to cost the continent US$12 billion a year. Malaria remains a leading cause of school and work absenteeism and puts tremendous pressure on household incomes. According to a recent Roll Back Malaria report, there are at least 300 million acute cases of malaria each year globally, resulting in more than a million deaths. Around 90 percent of these deaths occur in Africa, mostly in children. Malaria is Africa’s leading cause of under-five mortality (20 percent) and constitutes 10 percent of the continent’s overall disease burden. It accounts for 40 percent of public health expenditure, 30-50 percent of in-patient admissions, and up to 50 percent of out-patient visits in areas with high malaria transmission. There are several reasons why Africa bears an overwhelming proportion of the malaria burden. Most malaria infections in Africa south of the Sahara are attributable to Plasmodium falciparum, the most severe and life-threatening form of the disease. This region is also home to the most efficient, and therefore deadly, species of the mosquitoes that transmit the disease. Moreover, many countries in Africa lack the infrastructures and resources necessary to mount sustainable campaigns against malaria and as a result few have benefited from global efforts to eradicate the disease over the years. The Roll Back Malaria report says: “In Africa today, malaria is understood to be both a disease of poverty and a cause of poverty. “Annual economic growth in countries with high malaria transmission has historically been lower than in countries without malaria.” Economists believe that malaria is responsible for a growth penalty of up to 1.3 percent per year in some African countries. When compounded over the years, this penalty leads to substantial differences in GDP between countries with and without malaria and severely restrains the economic growth of the entire region. Malaria also has a direct impact on Africa’s human resources. Not only does malaria result in lost life and lost productivity due to illness and premature death, but it also hampers children’s schooling and social development through both absenteeism and permanent neurological and other damage associated with severe episodes of the disease. One of the greatest challenges facing Africa in the fight against malaria is drug resistance. Resistance to chloroquine, the cheapest and most widely used anti-malaria medication, is common throughout Africa – particularly in the southern and eastern parts of the continent Resistance to sulfadoxine-pyrimethamine (SP), often seen as the first and least expensive alternative to chloroquine, is also increasing in east and southern Africa. As a result of these trends, many countries have to change their treatment policies and use drugs which are more expensive, including combinations of drugs, which it is hoped will slow the development of resistance. Growing political commitment by African leaders for action on malaria was given a boost by the founding of the Roll Back Malaria global partnership in 1998. Less than two years later African Heads of State and Government and their representatives met in Abuja, Nigeria to translate RBM’s goal of halving the malaria burden by 2010 into tangible political action. The Abuja Declaration, signed in April 2000, endorsed a concerted strategy to tackle the problem of malaria across Africa. The Abuja Declaration also endorsed RBM’s goal and established a series of interim targets for the number of people having access to treatment, protective measures or, in the case of pregnant women, receiving intermittent preventive treatment to ensure that progress would be made towards the goal and malaria-endemic countries and other RBM partners held responsible. Considerable progress has been made since Abuja. Almost 20 African countries have reduced or eliminated taxes and tariffs on insecticide-treated nets to make them more affordable. More than half the malaria-endemic African countries, representing almost half the population at risk, have established Country Strategic Plans to achieve the RBM goals and the targets set in Abuja more than a decade ago. CSPs are all based on the four technical elements of Roll Back Malaria and the evidence-based interventions associated with them prompt access to effective treatment, promotion of insecticide treated nets and improved vector control, prevention and management of malaria in pregnancy and improving the prevention of, and response to, malaria epidemics and malaria in complex emergencies. Countries are now working through local partnerships to develop the capacity to fully implement their CSPs using ongoing health sector reforms and linkages to other initiatives, such as Integrated Management of Childhood Illness and Making Pregnancy Safer, to improve access to key interventions. CSPs have been successful in attracting new resources for malaria control.