Africa Makes Progress Against Malaria

By William Eagle
Washington,DC
28 April 2007

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This past week, global health activists marked Africa Malaria Day (April 25) with a campaign to educate the public about the disease and a pledge to work for increased cooperation and funding. It was also an occasion to highlight progress made against malaria, which kills up to a million children under five each year in sub-Saharan Africa. From Washington, VOA's William Eagle reports.

The figures are daunting. According to U.N. health agencies, there are about 500 million new cases of malaria in the world each year and three-fourths of these cases -- 375 million -- occur in Africa.

Caused by malaria parasites that are transmitted by female Anopheles mosquitoes, malaria is a treatable disease that often kills.

About 90 percent of the more than one million malaria-related deaths per year occur on the continent. An estimated three thousand people die of the disease every day. One African child dies of malaria every 30 seconds.

But increased global financial support and growing international coorindation between governments, private enterprise and development and civic groups are achieving some successes against the disease. Among the leaders in the effort is the Roll Back Malaria partnership created by the WHO, UNICEF, the U.N. Development Program and the World Bank. The partnership announced that it is working to ensure that 80 percent of all malaria grant applications receive the necessary funding. So, far the U.N.-backed Global Fund to Fight AIDS, Tuberculosis and Malaria has approved grants of nearly three billion dollars.

TREATMENT EXPANDS, AFRICA BENEFITS

U.S. Ambassador to Tanzania Michael L. Retzer, writing in an embassy news release, says a U.S. government program, The President's Malaria Initiative (PMI), has already helped provide lifesaving or treatment services -- including support for anti-malaria drugs, bednets, and indoor spraying -- to over six million people in Tanzania, Uganda and Angola. The U.S. effort -- which commits more than a billion dollars into the fight against malaria -- will eventually reach an additional 11 million people in up to 15 of the hardest-hit African countries.

Activists in the fight against malaria say many African countries are making strides against the disease.

In Zimbabwe, malaria cases have dropped by 40 percent over the past two years, to under two million last year.

Kenya has announced free indoor spraying against malaria-carrying mosquitos; the U.N.'s IRIN news service says up to four million people in the country's western highland areas are expected to be among the beneficiaries. Meanwhile, Uganda is expected to begin spraying with DDT within the next few months in an effort to cut malaria cases in half over the next two years. IRIN reports that the southwestern districts of Kabale and Kiningu are among the targets, as are camps for the internally displaced in northern Kenya.

RWANDA AVAILS ACT THERAPY TO HOMES AND COMMUNITIES

Rwanda has announced the launch of an effort to integrate the delivery of bed nets with the completion of vaccines for children against childhood disease. Rwanda is also one of the first countries to use community-based agents and pharmacies to dispense Coartem, an anti-malarial drug. Until now, the drug was only available in public health facilities, which are frequently far away from those most in need.

Desmond Chavasse is the global director of Malaria Control for Population Services International, based in Nairobi, Kenya.

He says the Rwanda program is an example of an integrated approach that uses established health care services to provide a platform for improved delivery of malaria prevention and treatment services.

"Once children come to a health facility, for example for vaccinations, they can receive an insecticide-treated mosquito net on completion of their vaccinations [against childhood diseases] which takes place after nine months ...[In this way] you are not only providing a range of integrated interventions but an incentive [to] mothers to bring children repeatedly for the different vaccines," he said.

Rwanda is also launching a Home Management of Malaria -- HMM -- initiative to increase access to Coartem in the community through health workers and pharmacies. Coartem which also includes the drug lumefantrine is one of four WHO recommended combinations used to fight malaria. They include a derivative of a potent Chinese anti-malarial drug called artemether with other drugs in what health experts call ACTs -- Artemesinin-based Combination Therapies.

Rwanda's new pre-packaged therapy for HMM -- carrying the brand name Primo -- includes a packet of tablets that can be delivered by community health officials and selected pharmacies at heavily subsidized prices.

Chavasse say health workers will be trained to supply the medication to children under five years who are suffering from fever -- a classic symptom of malaria.

"The total package is for treating one episode of malaria," he said, "and with it are low literacy instructions that allow the caregiver to fully understand how to take the drugs. If you treat a child under the age of one [for example] tablets [are required] to be crushed with some form of food - honey, sugar or milk [in order to swallow]. That is hard to get across without using locally pre-tested illustrations and low literacy instructions in local languages [included in the packet]."

Several African countries have been working with pre-packaged anti-malarials at the community level. Few of them have experimented with the ACTs yet. Some were using older anti-malarials, which are not nearly as effective as the new drugs. .

So far, few countries have actually launched large-scale programs for ACT delivery beyond health facilities; Rwanda is one of the first. But this is a new theme and a number of other countries are planning to use this method. Health officials say they expect to see country-specific ACT anti-malarials in most endemic countries across Africa in the coming months and years.

Corrine Karema is the acting coordinator of the National Malaria Control Program in Rwanda.

In the past year, she says the country has treated over 400-thousand children under the age of five in 21 out of 30 districts that have high rates of malaria. That treatment campaign relied on older malaria drugs -- amodiaquine and fansidar [sulfadozine-pyrimethamine]. She expects an even greater number of children will be reached in the coming months with the ACT-based strategy.

The new strategy comes on the heels of a public education campaign against the disease that included an effort in mid-April to reach over 360 Rwandan villages with videos showing how malaria is contracted -- and can be controlled.

Other malaria information materials were distributed by religious groups at regular monthly meetings for public municipal cleanup (Umaganda), as well as through regular public gatherings of the traditional system of community justice called gacaca.