|A past celebration of theWorld Malaria Day|
The day has been set aside on the calendar as an opportunity for malaria-free countries to learn about this age-old disease that has plagued mankind for centuries. A day for malaria afflicted countries to learn from each other’s efforts about how to control the disease.
Despite all efforts, malaria continues to be a serious public health concern throughout the world. It affects over 100 countries and approximately 40 per cent of the world's population. It causes between 300 and 500 million infections and approximately 1 million deaths each year, most of which occur in the poorest region of the world, sub-Saharan Africa. It is estimated that malaria claims a child’s life every thirty seconds and the ones who survive an episode of severe malaria are likely to suffer from learning impairment or brain damage. Pregnant women and their unborn children are also particularly vulnerable to malaria, which is a major cause of stillbirths, low birth weight and maternal anaemia.
The majority of people in this world will never experience the debilitating effects of malaria, thanks mainly to the eradication campaign adopted at the eighth annual World Health Assembly meeting in 1955. Despite the fact that the campaign was eventually abandoned and considered a failure, it registered resounding successes in wiping out malaria from large regions of the globe. Successful application of DDT as part of indoor residual spraying (IRS) programmes, coupled with the effectiveness of antimalarial treatments such as chloroquine formed cornerstones of the programme. Africa however, was largely overlooked in the global eradication effort because the continent lacked the necessary infrastructure to conduct a successful campaign.
African nations now have the tools to control the disease. Communities have effective insecticides for the targeted application on the inside of their household walls, insecticide treated bed nets, and drugs to clear the parasites from their bodies. But the obstacles to a successful control programme today are similar to those that existed during the eradication campaign — weak infrastructure, bureaucratic hurdles and the stark reality of millions of poor individuals who can barely sustain themselves, let alone spend money on personal measures to control and treat the disease.
Over the past few years, a number of large multilateral organisations have taken an interest in malaria and eradication efforts are now benefiting from more funding and more political interest. The US President’s Malaria Initiative (PMI) is set to devote $1.2 billion to malaria control in 15 African countries over 5 years, eventually benefiting an estimated 175 million people. The Global Fund for AIDS, TB and Malaria (GFATM) provides hundreds of millions of dollars to malaria prevention and treatment programmes. The US Congress is currently negotiating and authorising a bill that will seek to devote up to $9 billion for malaria control over 5 years. This interest in raising the profile of malaria must be applauded but simply pouring more money into the problem may not be sufficient to control the disease.
Without the necessary checks and balances in place this additional funding will be wasted. If the required economic development does not take place in targeted countries and a domestic commitment made to a sustainable control programme, it’s difficult to envision how the problem will be solved. There is a long, hard road to travel and, if history is anything to go by, the successful implementation of an eradication programme will have more to do with African politics and economics than with specific technologies.
In the short run, countries must continue to strive towards implementing a comprehensive malaria control programme. This implies an acute understanding of the nature of the vectors as well as the measures needed to control the parasite most effectively within each unique setting. Baseline studies in malaria affected areas need to be conducted before any interventions are initiated. Ultimately, the success of the programme should be measured in terms of reductions in morbidity and mortality, as opposed to the simplistic notion of the amount of resources expended.
Research into new and essential tools to fight malaria in Africa must continue. Desperate attention must be given to the development of a new insecticide that can be used in those areas where resistance is building up or has already built up. Furthermore, we need to remain vigilant of the quality of drugs being used to treat malaria and this involves a clamp down on the production of fake and sub-standard drugs.
World Malaria Day once again provides the opportunity to raise the profile of the disease and provide answers to the question of what works in malaria control on the ground. Additional funding is necessary but is by no means sufficient to control malaria. The necessary checks and balances must be put into place or else funding will be wasted, and World Malaria Day will be just another public relations event.