Update - Malaria effort brings Africa a rare public-health success story

This weekend The Globe and Mail (Canada's National newspaper) delivered some good news about the fight against malaria so I thought I'd pass it along. You can read the complete article below.

While it's great to know global efforts to eradicate this deadly disease are having a positive impact, we all know there is still A LOT more work to be done, and if anything, this news represents a continued and concerted call to action toward completing the mission and wiping out malaria once and for all.

To date Celtx Users Against Malaria have raised an impressive $1,427.88 (US) towards the purchase of bed nets!!
The Celtx Team extends our thanks and grand applause to all those who have contributed thus far. And while that number is really, really great, we need it to be even greater!!! So we encourage the rest of you, now more than ever, to DONATE a $5.00 bed net today!Sure with Thanksgiving, Christmas and other suckyourpiggybankdry occasions just around the corner,... I can't think of a better gift to offer your family, friends, and colleagues.
So please.....donate one bed net, or donate five, .... and together, let's help keep these kids alive.

Thanks.
Sheila et al

Malaria effort brings Africa a rare public-health success story

Mosquito nets are part of a strategy that could wipe out the disease in some areas, Stephanie Nolen reports

By STEPHANIE NOLEN

Saturday, November 1, 2008

MWEA, KENYA -- Samson Maina and Mary Wanjuku live close to the bone. Their mud house has three rooms partitioned by thin curtains. They work barefoot in the ankle-deep mud of their rice paddies.

Nevertheless, last year they spent 100 shillings - that's about $1.50 (all figures Canadian), on a roughly $8 weekly budget - and bought a pair of soft, billowing, blue mosquito nets, treated with an insecticide that will remain potent for a decade.

And since the day they hung them up, one over their bed and one where their three children sleep, there has been only one case of malaria in their family.

"We used to fall sick so often, it was nearly simultaneous: Someone was sick and before they got well, someone else was sick. It was never more than two months before someone had malaria, especially the children - they would get it for the first time a month after they were born," said Mr. Maina, who at 35 reckons he had suffered the aching, miserable exhaustion of malaria five times a year all his life.

"We had to stay home and tend the sick - you can never leave them to go and work in the fields - and then there was no income and we were hungry. So truly, that 100 shillings was a great investment."

The family heard about the importance of using a bed net to fend off malaria in a sermon at church, and then on the radio. Now, a year later, they would be able to get them for free, as Kenya ramps up its efforts to get every single citizen sleeping under a net.

Already, two-thirds of Kenyan children are sleeping beneath them and, as a result, child malaria deaths have fallen by 40 per cent in the past two years.

This remarkable success story has been repeated across much of Africa: Deaths of children under 5 declined 66 per cent in Rwanda from 2005 to 2007 and by 51 per cent in Ethiopia.

"This really is the one global public-health story that is simply and straightforwardly positive," said Jon Lidén, spokesman for the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has been behind much of the push.

"It's not a gradual change. It's a fundamental change in the fight against malaria."

Yet the decidedly unglamorous innovations responsible for the change - spraying houses, treating standing water to kill larvae, mass distribution of cheap polyester nets and better drugs, and simple public education on the need to treat suspected malaria quickly - receive almost no attention.

"We never make the headlines with this stuff," said Shanaaz Sharif, head of disease control for Kenya's Ministry of Health, which has thus far given out 11 million nets at a cost to the government of $6 each.

It would be difficult to overstate the value of what has been achieved here. There are all the children who did not die, of course, but also a 50-per-cent reduction in hospital admissions, freeing up beds in grossly understaffed hospitals. The percentage of women delivering low-birth-weight babies also has been cut in half, because clinics are presumptively treating for malaria (pregnant women are at much greater risk). Then there are the people who did not suffer a couple of weeks in bed, as Mr. Waina so often did.

Malaria costs Africa at least $14-billion a year in direct losses and much more than that in lost economic growth, according to the World Health Organization. In Kenya before the new interventions, malaria cost the country 170 million working days a year.

"It's drastic," said Elizabeth Juma, who heads Kenya's Division of Malaria Control. "A lot of our economy is agriculture-based, and if an adult gets malaria and can't go to the farm to plant during the season, then he or she has lost the whole year, and it impoverishes him. And [then] if his child falls sick during the year, he can't afford treatment. And if the children are sick, they don't go to school - the whole cycle of poverty and lack of education just continues."

Controlling malaria, Dr. Juma said, could help achieve six of the eight United Nations' millennium goals, including maternal and children's health as well as universal education.

Canada has had a key role in this success: The Canadian International Development Agency is the single largest donor of bed nets to Africa - nearly 6.4 million by the end of last year. In addition to government support, Canadian individuals and charities - notably the Red Cross - have embraced the issue by making donations and fundraising.

"Canadians ... haven't got the credit they deserve," said Prudence Smith, head of advocacy for Roll Back Malaria, a partnership between key global-health agencies and donors such as the Bill and Melinda Gates Foundation.

The nets are one piece of an integrated approach. For those people who do fall sick, clinics are getting better diagnostics and front-line health workers are being taught the importance of quick treatment, because the faster the parasite is eliminated in one person's body, the less of it there is to infect a new mosquito and thus be passed on to others in a community.

There are also new, better treatments based on artemisinin, a highly effective drug derived from a plant that has been used to treat malaria for thousands of years in China.

Plus, there is much more money: International funding for malaria prevention and treatment grew from just $62-million annually in 2003 to an estimated $1.6-billion in 2008. The bulk of that increase went to Africa, home to nearly 90 per cent of cases.

The funds, in turn, spurred renewed interest from long-frustrated health-care staff. "There was complete fatalism about malaria in Africa - no young and inspiring doctor would go into the malaria department, where they had had no tools and no resources and people saw it as an unfortunate byproduct of being born in Africa," Mr. Lidén said.

Today, there is a new sense of energy in health departments that have received large Global Fund grants and seen all the progress. "You can get a total reversal: We can go from people dying in large numbers to zero in five years - which is amazing, but also sad, when you consider how we have had this problem for years," Dr. Juma said.

A greater political commitment has been important too: It's no coincidence that the countries that have seen the biggest gains (Rwanda, Ethiopia, Eritrea) are countries with strong central governments that take an approach that could be characterized as "benign police state" when it comes to public health. Ethiopia, for example, has used the state-controlled media to publicize its plans, and then its huge armed forces to take the bed-net campaign to every corner of the country.

On the other hand, the Democratic Republic of the Congo and Niger, countries where the state presence is often barely felt outside the biggest cities, have made almost no gains and may continue for years to act as reservoirs of the disease.

Malaria is far from vanquished. Even with these gains, only 125 million people in Africa were protected by bed nets in 2007, while 650 million were at risk. Just 3 per cent of children had access to artemisinin-based combination therapy, the treatment recommended by WHO.

And while health agencies are working on getting nets to people who still do not have them, they also need to be thinking of how to replace those that wear out. Malaria is relatively easily eliminated, but also returns very quickly, after one wet season in which vigilance slips.

"We must be constantly on our toes," said Njoroge Muigai, who is in charge of "vector control" in the malaria-endemic, rice-growing region area around Mwea.

There are other huge challenges on the road to eliminating malaria, or at least reducing it to an illness with limited impact. For one, said Ms. Smith of Roll Back Malaria, there is the dreaded question of "capacity." As health ministries receive more and more money, there is a shortage of people with the business skills to manage the handling and distribution of an order of perhaps 10 million nets, she said.

Once nets do go out, people continually need to be reminded to use them - if there is no malaria in a village for a few months, they may decide they do not need the heat and fuss.

But donors are much keener to buy nets than they are to fund community-health workers to spread those messages, Ms. Smith said. "Investing in behavioural change, no one likes that. Donors get nervous ... if they can't count the numbers."

The Global Fund wants to finance a record number of malaria initiatives in its next round - $1.9-billion worth - but has no certainty that First World donors will deliver the cash to maintain the gains against malaria, especially in the context of the global financial crisis.

The Global Malaria Action Plan launched a few weeks ago says that in fact the world must spend nearly $6.5-billion next year to really push back the disease - front-loading the cost now for some rapid gains in the next few years.

The big health agencies are hoping that the "easy win" of malaria - compared with the nightmares of fighting AIDS or tuberculosis - will keep donors engaged.

Here in Mwea, Mr. Muigai hopes so too: His laboratory looks like a Canadian high school in the 1950s, with ancient pipettes and glass slides and a hairdryer to dry malaria smears, but there is nothing old-fashioned about his data.

From 2000 to 2008, tests of suspected malaria in the lab at Kibimbi District Hospital have fallen from 35 per cent positive to 0.1 per cent. There has not been a single positive case this year - his chart shows a row of plump, satisfying zeros.

Even Samson Waina's recent bout, Mr. Muigai suspects, was not actually malaria - it's just that people here have lived with its burden so long that even doctors assume every feverish illness must be malaria, he said.

But at the lab, where they test samples all day long, they are pretty sure malaria is completely gone from this area.

Dr. Juma and her staff in the shiny new malaria-control office talk determinedly of the day they will render themselves unemployed. "Nobody here would mind being out of a job - maybe we'll get huge retirement benefits and go on cruises for the rest of our lives."

She laughed, then added: "Saving these lives, that should be satisfaction enough."

Stephanie Nolen is The Globe and Mail's Africa correspondent.

Going, going, gone
Every year, malaria costs Africa at least $12-billion (U.S.) in direct losses and much more in lost economic growth. The disease affects 109 countries, yet just five {minus} Nigeria, the Democratic Republic of the Congo, Uganda, Ethiopia and Tanzania - account for half of the global death toll.

To address the problem, the Roll Back Malaria Partnership has set some ambitious targets.

By 2010
80 per cent of people at risk will keep mosquitoes at bay by using such measures as insecticidal nets and indoor spraying programs;

80 per cent of those infected will be diagnosed and treated;

In areas of high transmission, all pregnant women will receive preventive treatment;

The global malaria burden will but cut in half from 2000 levels: fewer than 500,000 deaths a year.

By 2015
The mortality will approach zero for all preventable deaths, the 2000 incidence rate will be reduced by 75 per cent;

Eight to 10 countries will have achieved zero incidence of locally transmitted infection.

Beyond 2015
The mortality rate stays near zero for all preventable deaths;

Preventive measures can be targeted to high-risk areas and seasons only, without inviting a resurgence;

And ultimately malaria will be eradicated.

Source: The Global Malaria
Action Plan

Comments

[Rizik K]

Online Museum of the Victims of War in the D.R. Congo

The museum aims at exposing the ongoing invisible unacceptable barbarity of the deadliest conflict since World War II. It's up to 5 1/2 or 6 million people who've died in the last 10 years. And virtually no one has covered it. Tens of thousands of women have been raped, and the majority of them have been gang-raped. http://yoursilenceoncongo.org/default.aspx

[Hoodia Gordonii Plus]

For reducing the victoms of malaria government needs to have awareness among the people, should have better drainage system, better sanitary system if they are living in mud houses and medication for the people who have been suffered from malaria. I think this is good effort

[Ginekologijos Klinika]

I agree with last coment. It's really good effort

[savrab]

Everyone should know this information,coz its very important for all. GJ

[mp3]

Qute difficult problem, world should understand that where is such a countries and hey should help for theis.

[Danny]

Interesting post. As savrab said - "Everyone should know this information"

[Direct Mailing Lists]

Hopefully, malaria will be eradicated. Government on each countries should be alarmed and give immediate solutions. So that travelers will not be frightened to visit other countries.

[jewelry making]

Malaria is perilous to children compared with adults as what I have read from the other article. It also stated there, according to a research from the Nigerian children that vaccines didn't work against malaria. Prayerfully, this dangerous disease will be eradicated.

[Paulius]

Let`s do our best and save those children !

[Pigus drabuziai]

Paulius, I agree with you

[filmai online]

Everyone should know this information!

[Trinkeles]

Isn't there a more effective way to fight it? I mean could we breed mosquitos that resistent to these viruses?

[vestuviu fotografas]

and its only the beginning... will be worse.. we must unite.

[Okeana]

Great to know that! It's time to do something.

[jewelry making]

It's time for action. When we cannot do it today, so when? When we are getting higher rates of this disease?

[Soul Books]

Nice article

[Hoodia Gordinii Plus]

Thanks for the great article..Malaria is perilous to children compared with adults, that's what i really know

[Liaudies medicina]

There are some truth, but with some facts I cant agree

[binary]

I am happy that i'm living in place where can't find such desease

[Paskolos Paskola]

Government on each countries should be alarmed and give immediate solutions. Prayerfully, this dangerous disease will be eradicated.

[Filmai online]

I hope that there wont be so much malaria victims like now.
I think i will buy bed net :)