PRB

According to the United Nations Children’s Fund (UNICEF), malaria is widespread in 100 countries and territories worldwide, largely in the less developed tropical areas of Africa, Asia, and Latin America. It kills at least 1 million people every year in Africa alone. Of the 300 million to 500 million annual cases of malaria, 90 percent occur in sub-Saharan Africa. The World Health Organization (WHO) reports malaria is responsible for one in five deaths of African children under age 5 every year.

Malaria takes its toll not only in lives lost, but also in medical costs, lost income, and reduced economic output. The annual direct and indirect costs of malaria in Africa are estimated to be more than US$2 billion, according to the WHO. Once seen as a consequence of poverty, malaria is now regarded as one of its causes. Experts say malaria slows economic growth in Africa by up to 1.3 percent per year.

Rural and poor people are especially at risk because they are least likely to have the means to prevent and treat malaria. Children miss school because of the disease, suffer physically and intellectually, and often cannot contribute to their families’ income though agricultural work. The WHO reports that many families spend up to a quarter of their annual income for malaria treatment.

The carrier of the disease, the female anopheline mosquito, has become resistant to many insecticides used to control its spread. Similarly, plasmodium (the disease-causing parasite that is carried in the gut of the mosquito and transmitted through its saliva when it feeds) has become resistant to many of the drugs used to treat the disease. P. falciparum, the most severe form of malaria in humans and the cause of most cases in sub-Saharan Africa, is now resistant to chloroquine, the most commonly used antimalarial drug, in practically all malaria-endemic countries in Africa.

The risk of malaria and malaria epidemics grows along with climate change and changes in land use associated with mining, logging, road building, and agricultural and irrigation projects. These changes often increase the breeding sites of malaria-carrying mosquitoes, and, consequently, promote transmission of the disease. Military conflicts also contribute to malaria’s spread by forcing people into new areas of exposure and by limiting access to malaria prevention and treatment. The movement of nonimmune individuals — be they refugees, laborers, or international travelers — places more people at risk and has allowed malaria to re-emerge in places where it was previously in control. Declining health services and increasing drug resistance also contribute to the spread of malaria.

Malaria Is Preventable, Treatable, and Curable

Individuals can protect themselves against malaria by wearing protective clothing and using insect repellents and bed nets. According to the WHO, field trials indicate that insecticide-treated bed nets and curtains have the potential to reduce childhood mortality by 15 percent to 35 percent. Despite their proven efficacy, fewer than 2 percent of African children sleep under protective bed nets. Drugs are used to prevent (chemoprophylaxis) and treat infection in individuals. However, given increasing levels of chloroquine-resistant malaria, new drugs are needed. User-friendly drug packaging helps ensure that patients take their medicine correctly. Better compliance helps prevent the development of drug-resistant malaria. While many new antimalarial drugs have been developed in the last 20 years (mefloquine, halofantrine, artmisinin, malarone, atovaquone and proguanil, co-artemether), there is still need for an affordable, effective, safe alternative to chloroquine.

Global Actions to Roll Back Malaria

In 1998, the WHO, the United Nations Development Programme (UNDP), UNICEF, and the World Bank initiated the global Roll Back Malaria (RBM) partnership. By 2010, this coalition of governments, development agencies, commercial organizations, research groups, and the media seeks to cut by half the global incidence of malaria by focusing on:

• Early diagnosis and prompt treatment;
• Insecticide-treated bed nets and vector control;
• Malaria treatment for pregnant women; and
• Prevention and response to epidemics.

In 1998, African leaders signed the Abuja Declaration calling for specific actions to be taken by governments so that by 2005:

• At least 60 percent of malaria victims have access to effective treatment within 24 hours of symptoms;
• At least 60 percent of those at risk, especially pregnant women and children under 5, receive treated mosquito nets or other preventive measures; and
• At least 60 percent of all pregnant women at risk of malaria have access to antimalaria medication and preventive intermittent treatment.

As part of the global effort, the Medicines for Malaria Venture seeks to discover, develop, and commercialize new antimalarial drugs and make them available in developing countries. This public/private partnership combines the expertise of the pharmaceutical industry with the field experience of the public sector. In addition, the WHO is working with the Swiss pharmaceutical company Novartis to provide people in malaria-endemic countries with the antimalarial combination drug Coartem at the significantly reduced price of 10 cents per tablet or less than US$2.50 per treatment.

In 1997, the Multilateral Initiative on Malaria was created. It is an alliance of organizations (including UNDP, the World Bank, and the WHO Special Programme for Research and Training in Tropical Diseases) that seeks to promote capacity building, collaboration, and coordination to maximize the impact of scientific research on malaria in Africa.

Several possible vaccines are now in development, and there is hope that in the next seven to 15 years one will prove effective. To be useful in the battle against malaria, however, a vaccine has to provide long-term immunity as well as be cost-effective. Researchers at the Karolinska Institutet in Sweden recently identified the mechanism by which the malaria parasite attaches itself to the placenta in a pregnant woman. This information can help in the development of a vaccine to protect mothers in malaria-endemic areas.

Other international efforts to control malaria are focusing on genetically modifying the malaria-carrying mosquito, mapping the malaria genome, and prohibiting the malaria parasite from traveling from the gut of the mosquito to its saliva.

In early 2001, discussions were held between representatives from more than 50 countries, multilateral and nongovernmental organizations, private foundations, and other key stakeholders about creating a Global AIDS and Health Fund. In April 2001, UN secretary general Kofi Annan formally called for the establishment of this fund to finance efforts to combat HIV/AIDS, malaria, and tuberculosis. As much as US$7 billion is needed annually to fight AIDS in low- and middle-income countries, and another US$3 billion annually is required to address malaria and tuberculosis. As of October 2001, contributions pledged by countries, private organizations, and individuals totaled US$1.5 billion. The fund is to be administered by the World Bank in collaboration with the WHO and UNAIDS to strengthen existing efforts to combat the three diseases. The fund will focus on improving the coordination, transparency, and flexibility of these efforts, while supporting national-level decisionmaking and leadership.

Successes

Although malaria continues to take a toll on millions worldwide, particularly in sub-Saharan Africa, different policy and program efforts are effectively addressing some of the challenges posed by this disease.

Bed Nets Prevent Malaria in Kenya
In Kenya, a public-private partnership involving workplace promotion of bed nets along with payroll purchasing schemes for employees at a cement factory reduced malaria cases by 80 percent and hospital admissions by 90 percent in one year, according to the World Bank. The African Medical and Research Foundation (AMREF), with funding from the international pharmaceutical company GlaxoSmithKline, created a bed-net industry by supplying community groups with sewing machines and netting material. Along with the drop in malaria cases, there is less absenteeism at work, increased productivity, and reduced health care costs.

Countries Roll Back Tariffs and Taxes
A number of countries have reduced or removed taxes and tariffs on mosquito nets and accessories, including Cameroon, Côte d’Ivoire, Ghana, Kenya, Mozambique, Namibia, Nigeria, Tanzania, Uganda, and Zambia. At the state level in Nigeria, governors are distributing bed nets at subsidized prices, supplying antimalarial drugs free of charge to children and pregnant women, and have allocated funds to the malaria budget. Private-sector banks and oil companies are making bed nets available on credit for their employees.

Vietnam Reduces Malaria Death Toll by 97 Percent in Five Years
In the early 1990s, the government of Vietnam began a concerted effort to control malaria through the provision of free insecticide-treated bed nets, the promotion of indoor spraying with insecticides, and the use of locally produced antimalarial drugs. From 1992 to 1997 the death toll from malaria dropped by 97 percent, and the number of malaria cases fell by almost 60 percent, according to the WHO. These actions required major investments in training, disease reporting systems, supervision, and volunteer health workers.

Community-Based Malaria Treatment Is Effective in Ethiopia
The WHO reports that in Tigray, northern Ethiopia, a community-based program is using more than 700 volunteers to educate and provide malaria medication to more than 1.7 million people. Over three years, there has been a 40 percent drop in deaths of children under age 5, and death rates from malaria are a third lower in villages participating in the program.

For More Information

Malaria Foundation: www.malaria.org
Medicines for Malaria Venture: www.mmv.org
Multilateral Initiative on Malaria: mim.nih.gov
PATH: www.path.org and www.malariavaccines.org
Roll Back Malaria: www.rbm.who.int
UNICEF: www.unicef.org/media/solutions.htm
WHO: www.who.int/inf-fs/en/fact094.html
www.who.int/inf-pr-2000/en/pr2000-28.html
NetMark Project: www.netmarkafrica.org