Malaria deaths on the decline

21 December, 2010, Esther Nakkazi

Malaria deaths could be eliminated by 2015

In many countries, the total number of malaria deaths and hospital admissions have been more than halved in a decade as a result of increased control interventions particularly the provision of insecticide-treated mosquito nets.

According to the World Malaria Report 2010, released by the World Health Organisation (WHO) last week, malaria-related deaths have fallen from 985,000 in 2000 to 781,000 in 2009 the largest absolute decreases observed in Africa.

Ban Ki-moon, the UN Secretary General, said it is possible that when a broad range of partners join forces malaria deaths could be eliminated by 2015.

The affiliation between committed African leaders, financial support from donor countries providing more than $5 billion in new money since 2008 and the Roll Back Malaria partnership has already brought success.

“If we heed to the lessons highlighted in this report we can achieve our goal of ending malaria deaths by 2015, accelerate progress toward the MDGs and usher in a better future for all,” said Ban Ki-Moon.

According to the World Malaria report, in eleven African countries including Rwanda in east Africa, the malaria burden dropped by more than 50 percent in 2000 to 2009.

For Kenya, Tanzania and Uganda there was a wide scale implementation of malaria control activities to more than 50 percent of the populations at high risk over this same time period. Most of these populations where able to access Insecticide Treated mosquito Nets (ITNs).

Already, enough nets have been delivered to sub-Saharan Africa to protect nearly 580 million and more than 75 million people have received protection from Indoor Residual Spraying (IRS).

Now the World Health Organisation has promised an additional 54 million nets to be delivered to sub-Saharan by early 2011, totaling 350 million, bringing the goal of universal coverage declared by UN Secretary-General Ban Ki-moon in 2008 within reach.

This achievement represents the largest scale-up of a malaria control intervention in Africa ’s history.

The WHO Director-General, Dr Margaret Chan, said the results set out in the report are the best seen in decades after so many years of deterioration and stagnation in the malaria situation.

“The phenomenal expansion in access to malaria control interventions is translating directly into lives saved, as the WHO World Malaria Report 2010 clearly indicates. By maintaining these essential gains, we can end malaria deaths by 2015,” said Ray Chambers, the UN Secretary-General’s Special Envoy for Malaria.

In the east African region, other countries could emulate Zanzibar and Rwanda’s persistence and maintenance of successful malaria control campaigns and programmes.

According to the report, Rwanda has significantly scaled up malaria control interventions including distribution of 6.4 million mosquito nets over the last three years.

Most of these Long Lasting Insecticide-treated mosquito nets (LLINs) were distributed during a measles vaccination campaign to children below 5 years, and each of them were given as well as all households to avoid further malaria cases and deaths.

Inpatient malaria cases and deaths in Rwanda have now fallen by more than 50 percent from 2000 to 2009 says the report.

New nets replace old

However, Rwanda noted an upsurge in cases of malaria beginning in 2009 but a new mosquito net campaign was launched in April 2010 to replace older nets, which then reduced malaria cases and deaths.

By 2009, the number of malaria admissions and deaths in Zanzibar were 81 percent lower than those recorded in 2000, says the report.

Zanzibar’s malaria success is largely attributed to free for all anti-malarial drugs (ACTs) in all public health facilities since September 2003 and universal coverage of nets to the 1.3 million islanders.

Annually, indoor residual spraying is carried out to cover nearly all households and there is improved diagnosis of malaria cases as Rapid Diagnostic Tests (RDTs) began to be more widely used from 2005.

In the rest of Africa, by 2009 more than a third of suspected malaria cases were confirmed with a diagnostic test, an increase from less than 5 percent by 2000.

Now the WHO recommends that all suspected malaria cases undergo diagnostic confirmation prior to treatment. Already, a number of African countries including Uganda have been able to scale up malaria diagnostic testing at a national level.

“Not only has this resulted in saving the unnecessary use of hundreds of thousands of courses of ACTs annually, but has also allowed for the implementation of timely and accurate surveillance for malaria,” said Dr Chan.

Research shows that using RDTs improves the quality of care for individual patients, cuts down the overuse of drugs, protects their therapeutic life, and allows for timely and accurate malaria surveillance.

However, the report cautions that these gains are fragile and all supporting partners should keep in the loop or the opportunity could be lost.

For instance insecticide-treated bed nets remain effective for three years and their supply must be replenished while the development of parasite resistance to antimalarial drugs and mosquito resistance to insecticides are perennial threats.

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