We need new strategies to fight malaria, experts say

Moses Wasamu, Kenya
(First published in The Star, Kenya on 15th April 2013): Malaria control strategies must keep up with the rapidly changing patterns of malaria infection in low transmission settings, the authors of a new review published in The Lancet say. Sir Richard Feachem, director of the Global Health Group at the University of California, San Francisco, USA, and senior author of the study, says the malaria control strategies implemented over the last decade have been highly successful in reducing malaria worldwide. “However, these strategies must evolve to respond effectively to the changing patterns of infection in low transmission areas,” he says.

He reveals that new approaches are being pioneered with great success in countries such as China, Sri Lanka, and Swaziland. The World Health Organisation has been supporting the traditional malaria control methods that focus on home-based interventions such as bed nets and indoor insecticides that protect women and children, coupled with use of artemisinin-based combination therapies (ACTs) for those already affected by the disease.

The review says that with an 85 per cent reduction in malaria cases between 2000 and 2010, malaria-prone countries have made enormous progress towards their elimination goals. Nonetheless, strategies that address the changing epidemiology - the increasing proportions of infections from non-falciparum species, in adult men, from imported transmission and migration, and in hard-to-reach populations - need to be developed, validated, and adopted.

The authors suggest that one solution to this problem is to rethink the typical malaria control methods used to control infection, tailoring and targeting new strategies to the groups most likely to contract malaria. The authors suggest that different, occupation-based control methods—such as insecticide treated clothing, or hammocks—could be used to protect these populations.

And it is not just the demographics of malaria infection that are changing. Traditionally, the Plasmodium falciparum parasite has been considered responsible for the majority of the global malaria burden, and has therefore been the focus of control efforts.

However, successful control of P-falciparum in many countries has resulted in an increasing proportion of infections from another malarial parasite, Plasmodium vivax. While P-vivax is less likely to lead to death than P-falciparum, it is also harder to detect and treat, and therefore more difficult to control and eliminate.

Allocation of funding for malaria control in future years will play a critical role in addressing these challenges, the authors say. They add that a major cause of concern is that despite the growing importance of imported malaria, the largest international funder for malaria control—the Global Fund to Fight Aids, Tuberculosis and Malaria— allocates only a small proportion of its malaria funding to multi-country proposals.

The authors recommend that regional and multi-country funding mechanisms need to be launched to support malaria elimination and encourage national investment in elimination efforts. In the current climate, these mechanisms are more likely to come from regional than global leadership, they say.

Last year, WHO announced that malaria transmission still occurs in 99 countries around the world, and the malaria burden continues to cripple health systems in many African countries. In 2010, malaria caused an estimated 655,000 deaths worldwide. About 560,000 of the victims were children under five, which means malaria killed one child every minute.

At the time, WHO said an assessment of Kenya's progress in fighting malaria cannot be made due to incomplete or inconsistently reported data. WHO includes Kenya among seven countries in East and Southern Africa with high transmission rates of malaria.

WHO says that the number of long-lasting insecticidal nets delivered to malaria-endemic countries in sub-Saharan Africa increased from 5.6 million in 2004 to 145 million in 2010. The availability of rapid diagnostic tests has made it possible to improve and expand diagnostic testing for malaria. WHO says that the rate of testing - in the public sector in Africa - rose from less than 5 per cent in 2000 to 45 per cent in 2010.

WHO revealed that the number of ACTs procured worldwide by government health departments also increased exponentially, from 11 million in 2005 to 181 million in 2010. Dr Thomas Teuscher, executive director of Roll Back Malaria Partnership, said that sustaining recent gains in Africa will require continued political commitment and funding.

He added that an estimated three million lives can be saved by 2015, if governments in endemic countries redoubled their efforts to provide people with essential health services. These findings are coming at a time when the US Congress just passed a Bill to maintain full support for the Global Fund, which supports health programmes in 151 countries, providing 310 million insecticide-treated nets for the prevention of malaria since 2002.

The Bill, which now awaits President Barack Obama’s signature, recognises the critical needs met by the Global Fund and its partners, providing $1.65 billion (Sh140.25 billion) for the fight against these deadly diseases – TB, HIV/Aids and malaria - and moving the US one step closer to meeting its three-year, $4 billion (Sh340 billion) pledge to the organisation.

The Global Fund’s executive director Mark Dybul applauded the decision. “This vote provides continued hope for millions of people who depend on treatment and care financed by the Global Fund and provided by its partners,” he said.

Moses Wasamu, Kenya
Citizen News Service - CNS
(First published in The Star, Kenya on 15th April 2013)