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The fight against malaria
On World Malaria Day in 2009, just over 600 days remain until 31 December 2010, UN Secretary- General Ban Ki-moon's deadline for all endemic countries to achieve universal coverage with essential malaria control interventions.(1) Data presented here highlight major signs of progress across Africa toward this goal.
The World Health Organization (WHO) has estimated that between 190 and 330 million malaria episodes occurred in 2006, resulting in nearly 1 million deaths. About 90 per cent of all malaria deaths occur in sub-Saharan Africa, most among children under age five (figure 1).(2)
Some 50 million pregnant women are exposed to malaria each year, with malaria in pregnancy contributing to nearly 20 per cent of low birthweight babies in endemic areas.3 Malaria in pregnancy can also lead to stillbirth and maternal deaths.(4)
Malaria control is a major development priority. Ambitious new global goals, laid out in The Global Malaria Action Plan (Roll Back Malaria 2008), are challenging countries to implement bold plans for universal coverage (box 1).5 Malaria has also been included among major global development targets, notably the Millennium Development Goals. One of the eight goals relates specifically to malaria, AIDS and other infectious diseases, and many of the other goals, including those for child mortality and maternal health, will be difficult to achieve in malaria-endemic areas without substantially reducing the malaria burden.
Global funding for malaria control has risen significantly in recent years. The Roll Back Malaria Partnership estimates that international funding has grown from $250 million in 2004 to $700 million in 2007, with funding expected to have reached $1.1 billion in 2008 alone, due largely to the Global Fund to Fight AIDS, Tuberculosis and Malaria; the World Bank; the U.S. President's Malaria Initiative and others.6 Many African countries recently achieved unprecedented success in obtaining Global Fund resources in the latest round of malaria grant applications (box 2). And in 2008, world leaders committed billions more towards malaria control.
Indeed, a new phase in the fight against malaria has begun. Data presented here show that the malaria community has accelerated efforts to deliver critical interventions, while also reducing bottlenecks in their production, procurement and distribution. Countries have been quicker to adopt more effective strategies that would have been out of reach with less funding available, such as changing national drug policies to more effective-but more expensive-treatment courses and expanding diagnostics to better target treatment. A focus on behavior change communication programmes is also improving the effective use of malaria interventions. Roll Back Malaria partners, including UNICEF, are supporting efforts to integrate malaria control activities into other maternal and child health services as they accelerate delivery of these essential interventions (box 3). And new actors, such as individual contributors and faith-based organizations, are becoming increasingly involved in the fight against malaria.
We are witnessing substantial increases in coverage of key interventions, notably insecticidetreated nets, with 19 of 22 sub-Saharan African countries with trend data showing at least a threefold increase in insecticide-treated net use among children since around 2000 - 17 of them with at least a fivefold increase. Most of these nets have been distributed through maternal and child health services such as antenatal care and immunization. However, while antimalarial treatment is moderately high across Africa, many children are still using less effective medicines