21st April, 2008
Breakthrough in malaria, but more integrated approach is needed
At last, people are beginning to take notice of malaria and funding is coming in from numerous angles, even an American talent TV show, American Idol, featuring Gordon Brown, the British Prime Minister. On the programme, Gordon Brown pledged £100 million in order to buy 20 million mosquito nets for people in Africa.
President Bush pledged $1.2 billion over five years at the G8 summit in 2005 to reduce deaths by malaria by 50% in 15 African countries; the Gates Foundation has so far pledged $860 million to support malaria programmes; and the UN is expected to pledge billions of dollars to expand malaria control efforts significantly in the next few weeks.
Most of this funding is being used for insecticide-treated mosquito nets (ITNs); artemisinin combination therapy (ACT) drugs (currently the most effective anti-malarial); and research for a vaccine. Efforts so far are making a difference.
From 2004-2007 over 35 million ITNs have been delivered, mostly across Africa. In Ethiopia, for example, the mass ITN distribution programme has reduced child deaths by more than half. Between 2004 and 2006 the numbers of ACT doses procured worldwide rose from 4 million to 100 million. But there is still a low uptake on this drug, mainly because of the comparatively high cost.
A vaccine is now moving into the final stage of its clinical trials and should be available for mass trials soon.
More funding is needed to further advances in all of the above interventions. But, it is insufficient to throw money at these interventions alone. A key challenge is to have a better understanding of, and closely involve, the communities you are working with.
Take ITNs for example. Poverty is pervasive in most of the countries where AMREF works and people often sell their ITNs to buy food, as they don’t realise how the nets can prevent malaria and hence save them money in medical bills.
Net distributions have to be accompanied by education sessions that are culturally specific to the respective communities. Click here for an example of a malaria project in Ethiopia - using picture-led materials to educate people about malaria prevention and control.
Gender disparities also have to be addressed. Men often use the nets, as they see themselves as the most important members of the family and don’t realise that women and children are much more biologically vulnerable to malaria.
More investment is needed in strengthening health systems. It’s not enough just to supply effective anti-malarial drugs; there has to be an adequate number of trained health workers to test for malaria, diagnose it and administer the drugs. And laboratories need to be adequately equipped and staffed.
More funding is needed for community health workers and policies should allow them to be able to distribute anti-malaria drugs, especially in remote rural areas, so that people have access to drugs closer to their homes. Too many children die of malaria, as their mothers have to walk for days to get to the nearest health clinic administering anti-malarial drugs. Click here for an example of a malaria project in Tanzania where community health workers are providing anti-malarial drugs closer to people’s homes.
Health systems also need to integrate the management of malaria, HIV/AIDS and TB, as they are all inter-related. It is widely acknowledged that HIV infections result in a greater risk of death from malaria and malaria infection itself leads to an increase in HIV viral load among adults and possible increased mother-to-child transmission of HIV during pregnancy. HIV weakens the cells in the immune system that are needed to prevent TB and TB is the leading cause of death among HIV-positive people.
To effectively tackle any of these diseases, it is important to manage them together, and health staff at all levels need the knowledge, skills and resources to be able to do this. Click here for an example of an integrated HIV, TB and malaria project in Uganda.
In short, malaria cannot be tackled in isolation. A much more integrated approach is needed, and funding opportunities have to take this into account.
For more information about AMREF's work on malaria contact Louise Orton on 0207 269 5526 or 07939 141 764.
Click here to view a photo gallery of AMREF's work preventing malaria in the remote Afar region of Ethiopia.
