MALARIA IS in retreat in many countries of sub-Saharan Africa after a huge effort in the last two years to get bed nets and indoor spraying into areas where the disease is endemic, but the gains are fragile, according to the World Health Organisation.
Malaria cases or hospital admissions and deaths have been cut by half in 11 African countries over the past decade, the WHO’s world malaria report shows. Outside Africa, in 32 of the 56 remaining malaria endemic countries, the gains have been even greater.
Eight more countries have seen reductions of 25-50 per cent. Last year, Morocco and Turkmenistan were certified malaria-free.
“The results set out in this report are the best seen in decades,” said WHO director general Dr Margaret Chan. “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.”
A huge push to get insecticide-treated bed nets (ITNs) to families in malaria-ridden countries over the past three years, involving UN agencies, governments, charities and celebrities, will have supplied approximately 289 million nets to sub-Saharan Africa by the end of 2010. This is enough to protect 578 million people – 76 per cent of the 765 million at risk.
Indoor insecticide spraying protected 75 million people, or 10 per cent, of those at risk in 2009. Many more have access to the best drug treatment – artemisinin combination therapies (ACTs).
However, what the WHO calls the fragility of the gains is clear.
By the middle of this year, still only 35 per cent of children in Africa were sleeping under a net, while the nets’ lifespan, at only three years, represents a “formidable challenge”, the report says.
“Nets delivered in 2006 and 2007 are therefore already due for replacement. Failure to replace these nets could lead to a resurgence of malaria cases and deaths.”
There are other worries. A single class of insecticide is used in the nets and mostly for indoor spraying. There is a possibility the mosquito-borne parasites that spread malaria could become resistant to it. Resistance is also a big fear in drug treatment.
The ACTs were brought in after resistance developed to the older drugs. To maintain their efficacy, it is important they are sold only in combination, but, says the report, as recently as last month, 25 countries were still allowing the drugs to be sold alone and 39 companies were still making them as single tablets.
Not all countries are experiencing a decline in malaria. In Rwanda, São Tomé and Príncipe, and Zambia, the number of cases rose in 2009. The reasons, says the report, are not known with certainty. “The increases in malaria cases highlight the fragility of malaria control and the need to maintain control programmes.”
The amount of money available went up steeply over the past 10 years, yet it has not reached the estimated $6 billion needed this year. Ray Chambers, the UN secretary general’s special envoy for malaria, was upbeat.
“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.” – (Guardian service)