14 December 2010 A massive scale-up in malaria control programmes between 2008 and 2010 has resulted in the provision of enough insecticide-treated mosquito nets (ITNs) to protect more than 578 million people at risk in sub-Saharan Africa, according to a United Nations report issued today.
But new commitments for malaria control appear to have levelled off in 2010 at $1.8 billion, still far short of the estimated $6 billion required for the year in the battle against a disease that kills a child in the world every 45 seconds, nearly 90 per cent of them in Africa, the World Malaria Report 2010 says.
The survey by the World Health Organization (WHO) notes that indoor residual spraying protected 75 million people, or 10 per cent of the population at risk in 2009, and describes how the drive to provide access to anti-malarial programmes to all those who need them is producing results.
“The results set out in this report are the best seen in decades,” WHO Director-General Margaret Chan said. “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.”
But although significant, the recent gains are fragile and must be sustained. “It is critical that the international community ensure sufficient and predictable funding to meet the ambitious targets set for malaria control as part of the drive to reach the health-related Millennium Development Goals by 2015,” WHO said in a news release, referring to the ambitious targets set by the UN Millennium Summit of 2000 to slash a host of social ills, including malaria.
In Africa, a total of 11 countries showed a greater than 50 per cent reduction in either confirmed malaria cases or malaria admissions and deaths over the past decade, the report shows. A decrease of more than 50 per cent in the number of confirmed cases of malaria was also found in 32 of the 56 malaria-endemic countries outside Africa during the same period, while downward trends of 25 per cent to 50 per cent were seen in eight additional countries.
Morocco and Turkmenistan were certified by WHO in 2009 as having eliminated malaria. In 2009, the WHO European Region for the first time reported no cases of Plasmodium falciparum malaria, which has the highest rate of complications and mortality.
“The phenomenal expansion in access to malaria control interventions is translating directly into lives saved, as the WHO World Malaria Report 2010 clearly indicates,” Secretary-General Ban Ki-moon’s Special Envoy for Malaria Ray Chambers said. “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.”
Inexpensive, quality-assured rapid diagnostic tests are now available that can be used by all health care workers, including at peripheral health facilities and at the community level. Using these tests improves the quality of care for individual patients, cuts down the over-prescribing of artemisinin-based combination therapies (ACTs) and guards against the spread of resistance to these medicines.
While progress in reducing the burden of malaria has been remarkable, resurgences in cases were observed in parts of at least three African countries, Rwanda, Sao Tome and Principe, and Zambia. The reasons are not known with certainty but illustrate the fragility of malaria control and the need to maintain intervention coverage even if case numbers have been reduced substantially.
The report stresses that much work remains to attain international targets for malaria control. Financial disbursements reached their highest ever in 2009 at $1.5 billion, but new commitments for malaria control appear to have levelled off in 2010, at $1.8 billion.
In 2010, more African households (42 per cent) owned at least one ITN, and more children under five years of age were using an ITN (35 per cent) compared to previous years. Household ITN ownership reached more than 50 per cent in 19 African countries. The percentage of children using ITNs is still below the World Health Assembly target of 80 per cent partly because up to the end of 2009, ITN ownership remained low in some of the largest African countries.
By the end of 2009, 11 African countries were providing sufficient courses of ACTs to cover more than 100 per cent of malaria cases seen in the public sector; a further five African countries delivered sufficient courses to treat 50 to 100 per cent of cases. These figures represent a substantial increase since 2005, when only five countries were providing sufficient ACT to cover more than 50 per cent of patients treated in the public sector.
The number of deaths due to malaria is estimated to have decreased from 985,000 in 2000 to 781,000 in 2009. Decreases in malaria deaths have been observed in all WHO regions, with the largest proportional decreases noted in the European region, followed by the Americas. The largest absolute decreases in deaths were observed in Africa.
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