World Malaria Day 2014 – How Best to Invest in Malaria Prevention and Control

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Each year, April 25 provides an opportunity to reflect on the current status of the fight against malaria. We are in the middle year of the World Malaria Day theme of “Invest in the Future. Defeat Malaria,” which is set to last until 2015.

Funding for malaria control and prevention, as with all international public health endeavors, has always been perceived as a critical issue, but there is a refreshing diversity to the ways in which it is being discussed this World Malaria Day.  The U.S. Centers for Disease Control and Prevention (CDC), who spear-headed the successful eradication of malaria in the U.S. back in the 1950s, specifically mention their efforts to maximize effectiveness, and their strategies for using and evaluating new tools such that they can get the most impact per precious dollar spent.  The WHO has highlighted the importance of sustained political commitment, as a crucial factor related to ensuring continued financial support for malaria initiatives. The Global Fund to Fight AIDS, TB, and Malaria recently announced a new funding model, designed to enable “strategic investment for maximum impact.” [Read more…]

Malaria Deaths

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QUESTION

How many people have died from malaria since 1966?

ANSWER

Accurate counts of the number of people who die from malaria are notoriously hard to make, since often the infection goes diagnosed, or the cause of death is not reported. However, the World Health Organization has estimated that until recently, about 1 million died each year from malaria. So, without taking into account changes in population size or other demographic factors, that means roughly 45 million people have died from malaria since the mid 1960s.

In the last few years, large-scale coordinated global efforts as well as numerous grass-roots campaigns have sought to reduce the number of deaths from malaria, mainly through improved preventive methods, education, diagnosis and treatment availability. As such, in 2010, it was estimated that deaths were down to about 700,000 per year, though that figure is contested by some, who argue it should be far higher. Organizations such as Malaria No More and the Roll Back Malaria consortium seek to prevent all deaths from malaria by the year 2015, and are working tirelessly to achieve that target.

Organizations Against Malaria

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QUESTION

What is a good organization that helps stop malaria?

ANSWER

There are many organizations that work very hard to control malaria. The most well known are those that design policies and implement projects to control malaria on the ground, in places where the disease is most deadly. These include multilateral international organizations such as UNICEF and the World Health Organization (as well as its regional counterparts, such as the Pan-American Health Organization, PAHO), country-led aid organizations such as DIfD in the UK and USAID in the US (the President’s Malaria Initiative, PMI, is largely implemented via USAID) as well as non-governmental organizations which seek to improve the lives of people in developing countries, such as Save the Children, Malaria No More and many other such groups.

Some of these groups have also joined forces to create multi-faceted organizations and programmes dedicated to controlling malaria, such as the Roll Back Malaria consortium and the Global Fund to fight AIDS, TB and Malaria, which provides millions of dollars of funding to projects throughout the world.

Secondly, there is also an aspect to malaria control which is not so easily seen on the ground, and that is the vast numbers of researchers who are dedicated to finding new drugs to treat malaria, new methods for control and new insecticides to prevent transmission from mosquitoes, among many other examples. These researchers are found in universities and research institutes all over the world, including many in sub-Saharan Africa, India and other places where the burden of malaria is very high.

On our website, you can find some personal accounts of scientists, working for the global pharmaceutical company AstraZeneca, who are doing drug discovery research in Bangalore, India. There are also blog posts from scientists at Princeton looking at transmission of malaria between monkeys and humans in south-east Asia, and information about cutting edge research at the Global Health Group at the University of California, San Francisco, whose members conduct work on a variety of aspects of malaria biology and control initiatives.

Malaria in Kitwe Zambia

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QUESTION

Is it dangerous for my children two years old in Kitwe?

ANSWER

Kitwe has been part of the Roll Back Malaria campaign to control malaria in Zambia—the program has been very successful, reducing deaths by malaria by over 65% nationwide. However, there still is a risk of contracting malaria in most parts of the country, and so preventative measures should be taken when visiting or living in Kitwe, such as sleeping under a long-lasting insecticide treated bednet, wearing long-sleeved clothing in the evening and at night and screening doors and windows to prevent mosquitoes from entering.

Malaria In Africa

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QUESTION

What factors cause Africans to get this disease?

ANSWER

The highest number of malaria cases every year occur in Africa, not because of anything specifically due to the people living there (in fact, they may be better protected against malaria than most—I will come onto this later) but because malaria transmission is very high in many parts of sub-Saharan Africa and sufficient preventative measures are still lacking in some places.

Malaria transmission requires specific environmental criteria, such as sufficient temperature and rainfall. These conditions are met in many countries in Africa, and unlike some other parts of the world, temperatures are suitable year-round for the development of the Anopheles mosquitoes that act as the vector for mosquito, meaning that in some places, transmission can occur throughout the year. In addition, many people do not take appropriate preventative measures against malaria; in some cases, this is due to a lack of means to buy items such as insecticide-treated bednets, and in other cases people have not been educated about the dangers of malaria or how to prevent it, so they do not know what preventative measures they should be undertaking.

Organisations such as the World Health Organisation, the US Agency for International Development, the Global Fund, the Roll Back Malaria consortium and Malaria No More are working to improve both access to preventative measures, such as bednets and indoor residual spraying, while also educating people about the need for prevention and also what to do if they suspect themselves or a family member has malaria. These efforts have already reduced the burden of malaria in Africa; the number of deaths is dropping every year, and they hope to have eliminated deaths from malaria altogether by the year 2015.

I mentioned that Africans may be better protected against malaria naturally—scientists have noted that populations living in areas with high levels of malaria have some genetic protection against infection. One example of this is the Duffy antigen. People who are negative for this gene seem to be protected against Plasmodium vivax and P. knowlesi malaria (it was originally thought they were resistant to infection, but more recent evidence from Kenya suggests in fact they still get infected, but do not get as sick). Another is the gene for sickle cell anaemia; despite causing highly debilitating and even lethal anaemia if both copies of the gene are inherited, a single copy of the gene confers strong resistance against malaria. Both of these genetic traits are highly prevalent in African populations.

In addition, early exposure to malaria results in the acquisition of immunity to infection. This, over time, Africans who survive childhood malaria go on to be less susceptible as adults. The exception to this are pregnant women; in order to support the growing foetus, a pregnant women’s immune system becomes much weaker (otherwise there is a risk of the immune system rejecting the foetus). As such, even if she had high levels of acquired immunity to malaria prior to her pregnancy, once pregnant she becomes much more susceptible. This is particularly true for a woman’s first pregnancy.

Malaria in Africa

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QUESTION

What is the current problem for malaria in Africa?

ANSWER

Malaria is a particularly severe problem in Africa due to a number of reasons. First of all, transmission in many parts of Africa occurs year round, due to favourable conditions for the development of the mosquitoes malaria requires as its vector.

Secondly, the dominant and most widespread species of malaria in Africa is Plasmodium falciparum, which is most fast-acting and deadly form of the disease.

Thirdly, Africa has a very young population; birth rates are high across much of the continent, and in many countries, more than 40% of the population is under 15 years old. Given that young children are are higher risk of malaria than adults, this also increases the burden of malaria in Africa compared to other parts of the world.

Finally, access to health care and malaria control interventions in Africa has been plagued by more general issues of slow development. While national health systems are slowly emerging, many countries are still reliant on foreign aid and NGOs to provide even basic health services.

Even where these organisations can provide health care, they often face challenges such as reaching remote populations without good road access, finding ways to provide medical services without reliable electricity or communications networks and maintaining supply chains of diagnostic tools and crucial medicine.

However, signs of progress are being seen. Long-lasting insecticide treated bednets have been put forward as a key preventative measure against malaria, and to date millions have been distributed to people living in malarial areas in Africa, and particularly to high risk groups such as young children and pregnant women.

Simultaneously, other control initiatives, such as indoor residual spraying, are gaining traction and being deployed in more areas. An emphasis on local capacity building has encouraged community involvement in drug distribution and access to health care initiatives, as well as training local health workers in diagnostic methods in rural areas.

Encouraging reports from groups such as Malaria No More and the Roll Back Malaria consortium suggest that the number of deaths from malaria in Africa last year was the lowest in history, and efforts are underway to reduce that number to zero, worldwide, by the year 2015.

Side Effects of Treatment

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QUESTION

What are the probable side effects / reaction of “Artemether with Lumefantrine” to a 4.5 years, 5ml syrup, 2 doses – 0 & 8 hours?

ANSWER

Artermeter with Lumefantrine is often sold under the brand name “Coartem” and is widely distributed in areas of high P. falciparum prevalence, and particularly where known resistance to chloroquine occurs.

Coartem is also the drug of choice for the Roll Back Malaria programme. A study of 1332 children, mainly in sub-Saharan Africa, revealed that few children experienced any side effects while taking Coartem, and of these, the vast majority of side effects were mild, did not prevent the child from continuing to take the medication, and were resolved.

The most common symptoms that were observed in children were pyrexia (fever), cough, vomiting, loss of appetite and headaches. Other, more clinically significant but also more rare, side effects which have been observed include tinnitus (ringing in the ears), blood disorders, problems sleeping, heart palpitations, mood swings, gastrointestinal upset, itchiness, back pain and vertigo.

Higher Research Funding Leads to 4x Rise in New Anti-Malaria Product Pipeline

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A new analysis of progress in the global fight against malaria finds a four-fold increase in annual funding for malaria research and development (R&D) in just 16 years—increasing from US$121 million in 1993 to US$612 million in 2009, with a particularly rapid increase since 2004. The funding has generated the strongest pipeline of malaria control and prevention products in history.

The report warns, however, that even a small decline in annual funding could jeopardize this pipeline, derail development of needed products, and paradoxically also increase development costs later. The report’s authors assessed progress to date against the R&D funding goals in the 2008 Global Malaria Action Plan and what will be needed in the coming decade to deliver the suite of products needed to manage, eliminate and—ultimately—eradicate malaria from the world. The answer is sustained, relatively modest increases that will boost total annual funding to US$690 million by 2015, followed by a larger jump in 2016 to US$785 million. [Read more…]

Equatorial Guinea Reduces Malaria in Children by 57% in Four Years

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The Republic of Equatorial Guinea has decreased the prevalence of the malaria parasite in children by 57% in just four years and has increased the number of children protected by bed nets or indoor spraying of insecticides from 4% to 95% in that same period, according to a report by Roll Back Malaria.

Research carried out on the Island of Bioko, funded by the government of Equatorial Guinea and a private consortium led by Marathon Oil Corporation, showed a reduction in infant mortality in nearly one third of the population. The program to control malaria is part of a broader effort by the government, through the Ministry of Health and Social Welfare, to improve public health in the West African nation.

The anti-malaria project is currently focused on the island of Bioko, where more than half the population of Equatorial Guinea lives, and has been extended to 2013 to develop local capacity and enable the campaign to reach the mainland. The project has won numerous high-profile awards for social responsibility and good citizenship.

The sixth report on Business Investing in Malaria Control: Economic Returns and a Healthy Workforce for Africa showcases how malaria control investment has significantly improved in Africa. “Companies in Equatorial Guinea, Ghana, Mozambique, and Zambia have worked to prevent malaria among their workers and workers’ dependents and have seen an excellent return on investment, with significant reductions in malaria-related illnesses and deaths, worker absenteeism, and malaria related spending.”

The Malaria Control Project is a fundamental part of the government-wide effort to meet the goals of the Horizon 2020 development plan set by President Obiang Nguema Mbasogo.

Equatorial Guinea has heavily invested in public health. The government has donated $1.5 million and a headquarters facility to the World Health Organization (WHO) to support research for global health. It has also provided technical assistance to the local United Nations Population Fund (UNFPA) to improve the effectiveness of its Assistance Program as well as the implementation of a host of health programs geared towards improving the health of Equatorial Guineans.

Source: Republic of Equatorial Guinea

EDITORIAL – Reflections on World Malaria Day 2011

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How far have we come in the last four years?

Four years ago, it was estimated that a child died every 30 seconds from malaria, and that more than a million people each year were killed by this devastating and debilitating disease. Four years ago, the malaria advocacy partnership Roll Back Malaria organized the first World Malaria Day, and published the Global Malaria Action Plan (GMAP), which set comprehensive goals for the control of malaria world-wide, with the ultimate aim to eradicate malaria completely. [Read more…]