First global report on Roll Back Malaria highlights progress and challenges

Burden of malaria still worst in Africa, but prevention and treatment reaching more people

By Henry Neondo

The first report on the roll back malaria released by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF), today finds that progress has been made in preventing and treating malaria since 2000.

However, the report says, “challenges remain to reduce the burden of the disease which still kills one million people every year, most of those in Africa”.

Proven interventions such as insecticide-treated nets, and the latest artemisinin-based combination therapies only reach a few people”, says Dr Lee Jong- Wook, Director-General WHO.

The report says that due to the difficulties involved in gathering reliable information about malaria in most affected countries—and because those countries have intensified their efforts only in the past few years—it is too soon to measure the impact on illness and death of the recent expansion of malaria control strategies and says that a measurable effect should become apparent about three years after widespread implementation.

While more people are accessing prevention and treatment services for malaria, sparking hope that the number of people who become sick and die from malaria will begin to decline thanks to the introduction of the newest medicines to treat malaria, and increasing use of long-lasting insecticide-treated mosquito nets through innovative new programmes, the report however says that these must be spread to a larger population before “their real impact on malaria”, could be seen.

The report analyzes malaria data collected through 2004 and represents the most comprehensive effort ever made to present the available evidence on malaria worldwide.

“Many countries are moving forward with malaria control programmes, and even those with limited resources and a heavy malaria burden now have a better opportunity to gain ground against this disease," said Dr Jong-wook.

In Africa, all countries reporting on nets collectively had a 10-fold increase in the number of insecticide-treated nets distributed over the last thee years.

After a 2003 campaign to distribute treated nets in five districts of Zambia at least 80 per cent of children under five were sleeping under the nets.

A similar campaign across Togo in December 2004 succeeded in raising the overall percentage of households owning at least one treated net from 8 per cent to 62 per cent.

“At present malaria remains the infectious disease that takes more lives of children in Africa than any other—three times as many as HIV infection,” said Ann M. Veneman, Executive Director of UNICEF.

“If we are going to dramatically reduce child deaths in the next decade, we need to put more focus on combating malaria.”

Countries where the former mainstays of malaria treatment, such as chloroquine, are no longer effective are also moving forward on new therapies.

Since 2001, 42 malaria-endemic countries, 23 of them in Africa, have adopted artemisinin-based combination therapies recommended by WHO.

These are the latest generation of antimalarial medicines and the most effective treatment against falciparum malaria, the deadliest form of the disease.

An additional 14 countries are in the process of changing their malaria treatment policy and 22 have embarked on home-care programmes which enable families and other care-givers to manage malaria.

The recent shortage of artemisinin-based combination therapies has hindered efforts to reduce the impact of the disease, but sufficient supplies to meet demand are expected to be available by the end of 2005, thanks to the combined efforts of UN agencies, other multilateral agencies, non-profit groups and corporations working together under the umbrella of the Roll Back Malaria Partnership.

The report finds that in 2003, some 350 to 500 million people worldwide became ill with malaria—a slight revision of the estimate of 300 to 500 million annual cases that WHO has used since 2000.

Halting and reversing the incidence of malaria by 2015 is a target of the Millennium Development Goals.

The more immediate goal of Roll Back Malaria is to halve the burden of malaria worldwide by 2010.

A major obstacle to achieving that goal, the report explains, is a lack of funds.

The report estimates that US$ 3.2 billion per year is needed to effectively combat malaria in the 82 countries with the highest disease burden.

This year, US$ 600 million was made available for global malaria control.

WHO and UNICEF welcome the recent World Bank announcement of its plan to commit US$ 500 million to US$ 1 billion over the next five years, which will help more people get access to essential malaria prevention and treatment.