• Fadéla Chaib
WHO communications officer
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South Africa is one of nine African countries that has managed to slash malaria-induced illness and death by half, according to the World Health Organisation (WHO).
This was revealed in the WHO’s World Malaria Report 2009, released in December. The document profiled the status of malaria in 108 countries around the world.
The nine African nations are Botswana, Cape Verde, Eritrea, Namibia, Rwanda, Sao Tome and Principe, South Africa, Swaziland, and Zambia. The semi-autonomous region of Zanzibar in the United Republic of Tanzania also achieved a 50% reduction. This can be attributed to the use of insecticidal nets and proper treatment of patients, said the WHO.
Aggressive malaria control strategies have been implemented across the continent, according to WHO director-general Dr Margaret Chan. This is due to a drastic increase in funding for malaria control and prevention, which gives health workers the opportunity to cover greater areas with preventive measures.
Between 2003 and 2009, global funding rose from $US300-million (R2.2-billion) to $1.7-billion (R12.6-billion) – although this falls short of the estimated $5-billion (R37-billion) needed annually to successfully combat the disease.
Chan said the world health body is cautiously optimistic that the spread of malaria is slowing, and the main beneficiaries are the children of sub-Saharan Africa.
The report said that four of the 31 African nations considered to be high-burden, as well as five of the seven low-burden countries, have achieved more than a 50% reduction in malaria cases compared to 2000.
The report also showed that incidence of the disease has been halved in 29 of 56 countries surveyed outside the African region.
One of the aims of the UN’s Millennium Development Goals is to reduce the under-five mortality rate by 66% between 1990 and 2015. According to the WHO, the survey shows that some countries are on track to meet this significant goal, as well as other malaria targets set.
Download the World Malaria Report 2009 (PDF, 1.16MB).
More nets and better treatment
The report revealed that, compared to 2006, more insecticidal nets and treatments were made available to those in need during 2007 and 2008.
More African households, 31% in 2008 compared to 17% in 2006, own at least one insecticide-treated net. Consequently, more children under five years of age were able to use this life-saving item. In 13 high-burden countries, more than 50% of households owned at least one net.
The use of rapid diagnostic tests as well as artemisinin-based combination therapies (ACTs), which are well tolerated by patients and are most recommended by experts, are on the rise.
However, the percentage of African patients with access to these vital therapies is still unacceptably low, said the report. Although the World Health Assembly has set a target of 80%, in 11 out of 13 countries surveyed, fewer than 15% of young patients were treated with ACTs.
Resistance to anti-malarial drugs is a continuing threat to achieving control of the disease, but the WHO and other agencies are working hard to prevent the spread of drug resistance. Steps to be taken include reducing the spread of the disease itself, ensuring that malaria outbreaks are correctly diagnosed and treated, doing away with artemisinin monotherapies in favour of combination therapies, and monitoring medication so that any sign of resistance will be detected immediately.
The report documented the significant impact of the combination of effective treatment and bed nets, and suggested that the Millennium Development Goal for malaria is not out of reach, provided these key strategies become more widely available. It also said the two-thirds reduction in infant mortality can also be achieved with a sustained effort to control malaria.
Funding needs to be spread more evenly. At the moment many funding sources concentrate on smaller countries with lower infection rates. More attention must be given to bigger countries with a higher malaria burden, said the report.
Malaria is caused by the transmission of parasites of the genus Plasmodium into the blood. P. falciparum is the most deadly of the four human-infecting species, being the only one that kills. The vector, or carrier, is the female Anopheles mosquito.
An Anopheles bite results in large numbers of parasites moving through the bloodstream into vital organs, which become vulnerable to damage and failure. Patients with low immunity can die from organ failure, and in pregnant women and children the disease contributes to anaemia, low birth weight, premature birth and neurological damage. Cerebral malaria is a particularly dangerous form of the disease.
Malaria is both preventable and curable, but can only be successfully combated using a multi-faceted approach. This involves not only effective treatment of patients, but also insecticide-impregnated bed nets, indoor spraying, bite prevention and the development of an effective vaccine by 2015. The ultimate goal is the development by 2025 of a vaccine that would provide more than 80% protection and last for more than four years.
With about half of the entire global population at risk of contracting malaria, it is not surprising that a staggering 243-million cases and almost 863 000 deaths were registered in 2008. Of the deaths, around 767 000, or 89%, occurred in Africa. Malaria kills one child under the age of five every 30 seconds.