Category Archives: Malaria

Maps of Malaria Hotspots to Save Lives

30 September 2014

Major Progress in Malaria Fight

Malaria is one of the world’s biggest killers. In 2010, an estimated 660,000 people lost their lives to the disease – most of them children in Africa, where a child dies from malaria every minute.

Until recently, however, it was difficult to access information about the locations of Africa’s malarial hotspots or how they are influenced by the weather there. Information about the continent’s malaria distribution was scattered across published and unpublished documents, often gathering dust in libraries.

But now, thanks to a digitised malaria mapping database that brings together all available malaria data, the disease no longer has the ‘blind killer’ status of past decades. MARA – Mapping Malaria Risk in Africa – was launched in 1996, with initial support of US$10,000 from the WHO’s Special Programme for Research and Training in Tropical Diseases to map information on malaria prevalence across Africa. The project’s first phase (1997-1998) aimed to produce an accurate atlas of malaria risk for Sub-Saharan Africa.

The project was set up as a pan-African enterprise, not owned by any specific organisation but coordinated by South Africa’s Medical Research Council, in the spirit of open collaboration.

A group of scientists, based at institutions across Africa and Europe, worked together on the project. Further funding came from donors including Canada’s International Development Research Centre, the Wellcome Trust, TDR and the Multilateral Initiative on Malaria (MIM), and the Roll Back Malaria Partnership. African institutions contributed through expertise, staff time and facilities.

Five regional centres – each using a standardised data collection system, were established across Africa. French-speaking West had an office in Bamako, Mali, while English-speaking West had a base in Navrongo, Ghana. Yaoundé, Cameroon hosted the Central Africa office; Nairobi, Kenya hosted the East Africa post and Durban in South Africa became home to the Southern Africa centre.

The project built expertise among local malaria control staff to enable them to reference the collected data, and it trained epidemiologists, medical doctors and researchers. In total it trained: 33 people to use GIS (geographic information systems) and databases, 23 to study climate change effects on the spread of the disease and 45 to interpret the results for people who might want to use them. Eight people got master’s degrees and PhDs on malaria.

The mapping project tracked down information on malaria prevalence from both published and unpublished sources to identify malarial mosquito hotspots, disease prevalence and the weather conditions that fuel transmission.

The MARA database contains more than 13,000 malaria prevalence surveys collected over 12,000 locations: with 37 per cent in Southern Africa, 33 per cent in West Africa, 25 per cent in East Africa and five per cent in Central Africa. The data remains live but no new material is being added.

The project then disseminated this information to national and international policymakers, distributing 3,000 poster-sized malaria distribution maps to malaria control programmes, health departments and research institutions in malaria endemic countries.

Whereas previously the absence of centralised records had made choosing appropriate solutions very difficult, the new data systems help countries identify transmission periods, implement control programmes and tailor control measures according to individual contexts – which also saves valuable resources. Rajendra Maharaj, director of the Malaria Research Unit at South Africa’s Medical Research Council, says the project has a strong legacy in the support it provides for the planning of malaria control programmes.

Konstantina Boutsika, an epidemiology and public health researcher from the Swiss Tropical and Public Health Institute (Swiss TPH), in Basel, Switzerland, where the database is now hosted, says the original maps are still available as downloads from the MARA website, as is a CD-rom developed by South Africa’s Medical Research Council to enable easy access to MARA project data.

Boutsika, who has been at MARA’s helm from 2006, says a project highlight is the first accurate assessment of the malaria burden in Africa, which has been made possible by advances in geographical modelling. “We can now give useful answers with regards to malaria,” she says.

MARA has made its results available through the technical reports published regularly on its website in both English and French.

The programme’s main beneficiaries have been identified as scientists, malaria control programme staff and local communities.

Maharaj says the scheme helps alleviate disease and death, especially in children and pregnant women, and has contributed to the efforts to reach the sixth Millennium Development Goal on combating HIV/AIDS, malaria and other diseases.

MARA was also one of 700 projects – selected for their exemplification of practical solutions to challenges – presented at the EXPO2000 world fair in Hanover, Germany. The programme owes its success to its strong team of investigators from participating organisations, Maharaj says: “The big lesson was inter-country collaboration, which is essential for malaria control”.

It has not all been smooth sailing, however. The main challenge was the collection of non-digitised data, explains Maharaj.

“But this was overcome by teamwork, whereby malariologists from all walks of life worked within ministries, academic and scientific institutions to source data that was stored in archive boxes, university libraries and government storerooms,” he says. And Boutsika adds that obtaining funding to sustain the programme was difficult because harmonising various databases required a heavy investment.

When funding for research ran dry in 2006, the project was given a new lease of life by the Bill & Melinda Gates Foundation and Swiss TPH, and moved from Durban to Basel, where phase II was launched. In 2009, the software team at Swiss TPH merged the MARA databases from phases I and II and developed a new web interface.

Since then, the MARA database has been in the public domain accessible to registered users and can be downloaded in different formats. Boutsika says researchers individually continue to collect data in Africa and use the MARA database as a sounding board.

[Courtesy AllAfrica News]

Africa:Major Progress in Fight Against Malaria

24 December 2013
Geneva/ Washington DC — Global efforts to control and eliminate malaria have saved an estimated 3.3 million lives since 2000, reducing malaria mortality rates by 45% globally and by 49% in Africa, according to the World Malaria Report 2013 published by the World Health Organization (WHO).

An expansion of prevention and control measures has been mirrored by a consistent decline in malaria deaths and illness, despite an increase in the global population at risk of malaria between 2000 and 2012. Increased political commitment and expanded funding have helped to reduce incidence of malaria by 29% globally, and by 31% in Africa.

The large majority of the 3.3 million lives saved between 2000 and 2012 were in the ten countries with the highest malaria burden, and among children aged less than five years – the group most affected by the disease. Over the same period, malaria mortality rates in children in Africa were reduced by an estimated 54%.

“This remarkable progress is no cause for complacency: absolute numbers of malaria cases and deaths are not going down as fast as they could,” says Dr Margaret Chan, WHO Director-General. “The fact that so many people are infected and dying from mosquito bites is one of the greatest tragedies of the 21st century.”

In 2012, there were an estimated 207 million cases of malaria, which caused approximately 627 000 malaria deaths. An estimated 3.4 billion people continue to be at risk of malaria, mostly in Africa and south-east Asia. Around 80% of malaria cases occur in Africa.

Malaria prevention suffered a setback after its strong build-up between 2005 and 2010. The new WHO report notes a slowdown in the expansion of interventions to control mosquitoes for the second successive year, particularly in providing access to insecticide-treated bed nets. This has been primarily due to lack of funds to procure bed nets in countries that have ongoing malaria transmission.

In sub-Saharan Africa, the proportion of the population with access to an insecticide-treated bed net remained well under 50% in 2013. Only 70 million new bed nets were delivered to malaria-endemic countries in 2012, below the 150 million minimum needed every year to ensure everyone at risk is protected. However, in 2013, about 136 million nets were delivered, and the pipeline for 2014 looks even stronger (approximately 200 million), suggesting that there is real chance for a turnaround.

There was no such setback for malaria diagnostic testing, which has continued to expand in recent years. Between 2010 and 2012, the proportion of people with suspected malaria who received a diagnostic test in the public sector increased from 44% to 64% globally.

Access to WHO-recommended artemisinin-based combination therapies (ACTs) has also increased, with the number of treatment courses delivered to countries rising from 76 million in 2006 to 331 million in 2012.

Despite this progress, millions of people continue to lack access to diagnosis and quality-assured treatment, particularly in countries with weak health systems. The roll-out of preventive therapies – recommended for infants, children under five and pregnant women – has also been slow in recent years.

“To win the fight against malaria we must get the means to prevent and treat the disease to every family who needs it,” says Raymond G Chambers, the United Nations Secretary General’s Special Envoy for Financing the Health MDGs and for Malaria. “Our collective efforts are not only ending the needless suffering of millions, but are helping families thrive and adding billions of dollars to economies that nations can use in other ways.”

International funding for malaria control increased from less than US$ 100 million in 2000 to almost US$ 2 billion in 2012. Domestic funding stood at around US$0.5 billion in the same year, bringing the total international and domestic funding committed to malaria control to US$ 2.5 billion in 2012 – less than half the US$ 5.1 billion needed each year to achieve universal access to interventions.

Without adequate and predictable funding, the progress against malaria is also threatened by emerging parasite resistance to artemisinin, the core component of ACTs, and mosquito resistance to insecticides. Artemisinin resistance has been detected in four countries in south-east Asia, and insecticide resistance has been found in at least 64 countries.

“The remarkable gains against malaria are still fragile,” says Dr Robert Newman, Director of the WHO Global Malaria Programme. “In the next 10-15 years, the world will need innovative tools and technologies, as well as new strategic approaches to sustain and accelerate progress.”

WHO is currently developing a global technical strategy for malaria control and elimination for the 2016-2025 period, as well as a global plan to control and eliminate Plasmodium vivax malaria. Prevalent primarily in Asia and South America, P. vivax malaria is less likely than P. falciparum to result in severe malaria or death, but it generally responds more slowly to control efforts. Globally, about 9% of the estimated malaria cases are due to P. vivax, although the proportion outside the African continent is 50%.

“The vote of confidence shown by donors last week at the replenishment conference for the Global Fund to Fight AIDS, Tuberculosis and Malaria is testimony to the success of global partnership. But we must fill the annual gap of US$ 2.6 billion to achieve universal coverage and prevent malaria deaths,” said Fatoumata Nafo-Traoré, Executive Director of the Roll Back Malaria Partnership. “This is our historic opportunity to defeat malaria.”

[Courtesy AllAfrica News]

DRC: Malaria “Leading Killer of Children”

DRC 21 May 2013

Gaps in the healthcare system in the Democratic Republic of Congo (DRC) are hampering the fight against malaria, a leading killer of children, say experts.

Malaria accounts for about a third of outpatient consultations in DRC clinics, Leonard Kouadio, a UN Children’s Fund (UNICEF) health specialist, told IRIN. He added, “It is the leading cause of death among children under five years and is responsible for a significant proportion of deaths among older children and adults.”

Kouadio continued: “Recent retrospective mortality surveys have revealed that in all regions of the country, the fever is associated with 40 percent of [deaths of] children under five.”

Malaria is also a leading cause of school absenteeism in DRC, and it may have other adverse effects. “In cases of severe malaria, children who survive face serious health problems such as epilepsy, impaired vision or speech,” he said.

According to UN World Health Organization (WHO) estimates, out of about 660,000 malaria deaths globally in 2010, at least 40 percent occurred in DRC and Nigeria.

In DRC, malaria accounts for about half of all hospital consultations and admissions in children younger than five, according to the government’s National Programme for the Fight against Malaria (NMCP).

On average, Congolese children under five years old suffer six to 10 episodes of malaria per year, according to UNICEF’s Kouadio.

Other leading causes of death among under-five Congolese children include acute respiratory infections, diarrhoeal diseases and malnutrition, according to UNICEF’s 2013-2017 DRC Country Programme Document.

“It is apparent that major deficiencies in the health system have contributed to the severity of recurrent outbreaks [of malaria],” Jan Peter Stellema, Médecins Sans Frontières (MSF) operational manager, told IRIN via email.

“Mosquito nets are not being sent to vulnerable areas, and there are shortages of rapid diagnostic test [kits and] drugs and the equipment for carrying out blood transfusions vital for children suffering from anaemia caused by malaria.”

Other problems include costly care and management challenges.

For example, the treatment of an uncomplicated bout of malaria ranges from about US$22 to $35, and treatment for severe cases can cost $75 to $100, according to NMCP. Such costs are prohibitive for a large number of people, many of whom live on about one dollar a day.

“In DRC, the absence of other healthcare providers and overstretched health systems leave people vulnerable to contracting malaria.

Too many health centres lack the supplies necessary for coping with a new outbreak, and as a result children are dying because they did not receive care for malaria,” MSF’s Stellema said.

According to the DRC Country Programme Document, “Governance, management and coordination problems plague the [health] system at the national, provincial and local levels, thereby undermining political commitment, planning, budgetary expenditure, coordination and alignment of partnerships, the accountability and transparency of service providers, and the participation of the population in management of the services.”

It adds, “Combined with extreme poverty, these factors create financial barriers hampering families’ access to nutrition and services, and weaken the social standards that are essential for keeping families together and maintaining a protective environment for children.

“The absence of government investment and the fragmentation of public assistance have eroded the capacity of civil society and of functional public facilities to maintain quality services,” adds the DRC Country Programme Document.

“The re-mergence and expansion of certain epidemics (polio, measles and cholera) are proof of that.

In addition, little has been done to modernize infrastructure. Essential supply systems, such as the cold chain, have not been put in place,” it states.

There is an urgent need to address the struggling health system to fight malaria, experts say.

“The fight against this scourge must remain a top priority of the country, despite the lack of financial resources,” said UNICEF’s Kouadio.

“The government and its partners should increase the funding for the fight against malaria in the DRC, in particular, acquisition and universal distribution of mosquito nets to households, provision of essential drugs and rapid diagnostic test [kits], and dissemination of environmental sanitation measures.”

Malaria occurs almost year-round in DRC due its tropical climate and its river and lake system.

The country has some 30 large rivers totalling at least 20,000km of shoreline, and 15 lakes totalling about 180,000km, which offer environments conducive to the proliferation of diseases and disease vectors, including the Anopheles mosquito, which spreads malaria.

According to MSF’s Stellema, the DRC government and national and international health actors need to take rapid and sustainable measures to prevent and treat malaria in order to avoid unnecessary child deaths.

In 2012, MSF treated half a million Congolese for malaria, many of them children under five.

“MSF’s emergency response is saving lives in the short term. But in the longer term, the organization cannot address the [malaria] crisis alone,” said Stellema.

[Courtesy of IRIN]

HEALTH: Malaria Deaths “Underestimated”

DAA-7 February 2012

A new attempt to quantify malaria deaths over the past 30 years suggests the death toll, especially among adults, has been greatly underestimated. The figures also show the fragility of the gains made in fighting the disease.

Collecting data on malaria deaths is notoriously tricky; the countries where the disease is most prevalent have the weakest statistics. And even where causes of death were recorded, the researchers found many deaths were simply attributed to “fever” – probably malaria, but possibly not. In addition, a malaria infection is often a contributory cause of death along with other health problems.

However, after some complicated number-crunching, researchers, based at the Institute for Health Metrics in Seattle, believe they have produced the best estimates so far of how many people in the world die of malaria.

The figures, published in the London-based medical journal, The Lancet, some surprises, principally because they are significantly higher than those issued last year by the World Health Organization (WHO) – more than eight times higher in the case of older children and adults in Africa, where most of the deaths occurred. The difference was smaller in the case of children under five, but the researchers said they believed malaria was a more important cause of death in under-fives than the 2011 World Malaria Report estimated, causing 24 percent of child deaths in Africa.

Christopher Murray and his colleagues said they believed the fact that almost half a million extra deaths occurred in adults and older children each year had practical implications. “Traditional teaching in most medical schools argues that acquired immunity [in endemic areas] means that adults have clinical malaria, but are not likely to die from it. Inspection of the basic… data, however, clearly shows a substantial percentage of malaria deaths in individuals aged 15 years and over, even in endemic areas such as sub-Saharan Africa.”

In the light of this they suggest a shift of control strategies to pay more attention to all adults, not just women and children, in the distribution of insecticide-treated bed nets.

The research also tracked malaria deaths through time, from 1980 to 2010. Global malaria deaths almost doubled between 1980 and 2004; child deaths in Africa almost tripled over the same period. The researchers suggest the HIV/AIDS epidemic and resistance to chloroquine as probable causes, along with an increase in population in malaria-endemic areas.

After that the number of deaths started to fall, although they are still not down to 1980 levels. The results of hard-fought campaigns, and the resources provided by the Global Fund to fight AIDS, Tuberculosis and Malaria, do show up in the figures. The authors say “the risk of malaria death in several countries that have scaled up control efforts, such as Zambia, Tanzania, Kenya and Ethiopia, has decreased between 2000 and 2010 figures”.

The reverses of the 1980s and 1990s signal the fragility of the gains in the war against malaria, and the researchers say this underscores the danger posed by the world economic crisis, and the slowdown in health funding. They conclude: “The announcement by the Global Fund [in November] that their next round of funding would be cancelled raises enormous doubts as to whether the gains in malaria mortality reduction can be built on or even sustained.”

Sarah Kline, executive director of Malaria No More UK, told IRIN this fragility of funding, especially from the Global Fund, was a big source of discussion and anxiety for the whole malaria community. “The total funding gap for malaria, from all sources, if we are going to meet our 2015 targets, is around US$3 billion a year, although we did have some positive announcements at Davos about extra funding from the Gates Foundation, and the governments of Saudi Arabia and Japan.”

The funding gap was also addressed by the Liberian President Ellen Johnson Sirleaf when she was elected to head the African Leaders’ Malaria Alliance on 2 February, and urged African countries to step up their own funding for control campaigns and find innovative sources of finance to close the gap.
[Courtesy IRIN]

COTE D’IVOIRE: Unrest disrupts malaria programme

DAKAR, 7 June 2011 (IRIN) – The post-election violence in Côte d’Ivoire delayed by several months a distribution of mosquito nets – a pillar of the country’s strategy to combat malaria, a leading killer of children.

Some communities must wait even longer as hundreds of thousands of nets were looted during the unrest.

This is just one example of how the recent conflict has disrupted health services, which were already fragile after nine years of a north-south split.

“This sets us back in our malaria prevention efforts. We were supposed to have done this distribution in December,” said San Koffi Moïse, head of the national malaria control programme (PNLP). The project – funded by The Global Fund to Fight AIDS, Tuberculosis and Malaria – aims to cover all households across the country, he told IRIN.

Health workers, along with NGOs Population Services International (PSI) and CARE, on 3 June began handing out insecticide-treated nets in the northwest and in one southern department. A team with The Global Fund is currently in Côte d’Ivoire to meet with PNLP officials and aid workers to discuss how to proceed.

“We are evaluating the situation to see in what regions we can do distributions,” San said.

More than 100 containers of mosquito nets were pre-positioned throughout the country prior to the October 2010 presidential election. In western Côte d’Ivoire – one of the regions hardest hit by post-election violence – entire containers were carted off and scores were broken into and emptied.

In Duékoué IRIN saw several empty containers next to the government health services building; most state health workers abandoned their posts during the violence and hospitals and offices were also looted. Mosquito nets like those destined for free distribution were for sale in the Duékoué market.

“We don’t know the motive for the looting but it appears the thefts were organized, not just simple acts of vandalism,” PSI representative Rambeloson Lalah told IRIN. “In Toulepleu [near the border with Liberia], entire containers were taken away.”

When things began to heat up before the election, NGOs insured the nets against “political violence”, so they expect to replenish stocks so as to cover the entire country as planned.

Vouchers 

The rains have started in much of the country, and with that comes malaria. Ivoirians told IRIN they received vouchers for the nets months ago and are still waiting.

“The people really need mosquito nets right now,” said Miagnet Fatou, nutrition expert at the main hospital in the western town of Danané. “It’s mango season and malaria is hitting hard.” Mango season corresponds with the rains so people commonly associate mango season with the disease.

Miagnet said most of the malnutrition she sees in Danané is linked to malaria.

“People received vouchers a long time ago but they are still waiting… Now they’re seeing nets for sale in the market; they’re not sure what to think.” She said nets sell for up to 1,000 CFA francs (US$2.23) in the market – unaffordable for most families.

“I use mosquito nets to protect my children,” said 32-year-old mother of four Affissatou Diakité in the main city Abidjan. “I got a voucher about six months ago… but then the crisis stopped the process.”

But even as distribution gets under way, there is uncertainty over the number needed in many areas, as tens of thousands of people throughout Côte d’Ivoire have yet to return home after fleeing violence, said Kouyaté Karim, departmental health director in the centre-north city of Bouaké.

“And some people have told me they’ve lost their vouchers. I’m not saying we’ll have to make a new count from scratch, but this is something we have to be aware of as we proceed.”

He added: “The conflict has brought considerable disorder to the health system and it will take time to get back on track.”

While mosquito nets are not a panacea, their use has repeatedly been shown to reduce severe disease and mortality due to malaria in endemic regions, according to the World Health Organization (WHO). Bednet distribution is one part of Côte d’Ivoire’s control strategy, along with prevention measures for pregnant women and ensuring access to malaria drugs.

During 2006-09 PNLP distributed about 2.1 million treated bednets, according to a government report on progress on the millennium development goals. But that is about 10 percent of the number of people at risk, according to WHO’s 2010 World Malaria Report.

[Courtesy of IRIN]

 


World Malaria Day 2011

World Malaria Day 2011 is a time for examining the progress we have made towards malaria control and elimination and to renew efforts towards achieving the target of zero malaria deaths by 2015.

Malaria is particularly devastating in Africa, where it is a leading killer of children. In fact, there are 10 new cases of malaria every second. Every 45 seconds, a child in Africa dies from a malaria infection.

Malaria does not only kill, it can have long term consequences. Severe malaria often leads to brain damage, holding back a child’s mental development resulting in lifelong impacts.

Yet Malaria is a preventable and curable disease and can be treated effectively with existing drugs and treatment is most effective if administered within 24 hours of the onset of fever.

It costs less than £4 to deliver a long-lasting insecticide treated bednets. The lives of 3 million children by 2015 if every child at risk of malaria sleeps under a net.

Malaria is a disease caused by the blood parasite Plasmodium, which is transmitted by mosquitoes. Malaria, from the Medieval Italian words mala aria or “bad air,” causes 200 million illnesses per year and kills nearly one million people – mostly children under the age of five.

Forty percent of the world’s population lives in malaria endemic countries, and its treatment consumes nearly 40 percent of these countries’ public health resources. In addition to the burden on local healthcare systems, malaria illness and death costs Africa approximately £7 billion per year in lost productivity.

However there have been notable successes, especially in Africa. In five years, following rapid improvements in control efforts, deaths from malaria fell by nearly 70% in Rwanda and 62% in Ethiopia. In Zanzibar, in east Africa, overall deaths from malaria have fallen 90% since 2003.

These success stories should give us hope. While eliminating malaria completely will always be the ultimate goal, there is no reason why anyone should die from it. Every life lost is needless. With common resolve and a united front malaria can be beaten.

References:
RBM http://www.rollbackmalaria.org/keyfacts.html
D
IFID http://ht.ly/4EYuU

MYANMAR: Malarial drug resistance “hotspots” identified

Health experts had barely finished one project to contain anti-malarial drug resistance along the Thai-Cambodia border when their attention was drawn to Myanmar, where early warning signs suggest a waning influence of the anti-malarial drug Artemisinin.
Malaria is a leading cause of morbidity and mortality in Myanmar and a leading cause of deaths in children under five, says the UN World Health Organization (WHO).

Resistance to the previous standard treatment for malaria, chloroquine, was first reported in the 1950s along the Thai-Cambodia border. By the 1980s it had spread to sub-Saharan Africa, which has the world’s highest rate of malaria mortality.

Evidence of resistance emerged from Southeast Asia once again in 2007, this time to Artemisinin, one component of the combination therapies used worldwide to control malaria. Donors, starting with the Bill & Melinda Gates Foundation, pumped US$22 million into the border from 2009.

Charles Delacollette, coordinator of the Bangkok-based Mekong Malaria Programme with WHO, said while those huge multi-country efforts have worked to bring down reports of malaria infections, “what we are seeing along the Thai-Myanmar border seems equally serious … to what we had at the Thai-Cambodian one”.

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