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Africa: Progress on Malaria

AfricaFocus Bulletin
Apr 27, 2009 (090427)
(Reposted from sources cited below)

Editor's Note

"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 ... [there are] substantial increases in coverage of insecticide-treated 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." - UNICEF

For the first time, there seems to be growing optimism that the campaign against malaria may scale up quickly enough to made world-wide eradication feasible. That might appear to be wishful thinking, but the new Global Malaria Action Plan takes on the goal of reducing preventable deaths from their current level of some one million a year to near zero by the year 2015. Is it doable? If the current momentum continues, it may just be possible, say a growing number of those engaged in this effort.

This AfricaFocus Bulletins contains excerpts from two World Malaria Day articles on recent initiatives against malaria, one by Sue Mbaya, Africa Advocacy Coordinator for World Vision, based in Nairobi and one by UNICEF on Children & Malaria. And, from http://allafrica.com, an article about the UN Foundation's "Nothing but Nets" initiative to mobilize individual contributors for supplying bednets.

For previous AfricaFocus Bulletins on health issues, visit http://www.africafocus.org/healthexp.php On malaria in particular, see http://www.africafocus.org/docs08/mal0809.php and http://www.africafocus.org/docs08/mal0802.php

For current news coverage on malaria, see
http://allafrica.com/malaria

Other sites with a wealth of additional background information include

WHO World Malaria Program
http://www.who.int/malaria

Global Malaria Action Plan
http://www.rbm.who.int/gmap

World Malaria Day 2009
http://www.rbm.who.int/worldmalariaday

World Vision's End Malaria Campaign
http://www.endmalaria.org

Center for Interfaith Action on Global Poverty
"One World against Malaria" Summit, Washington, DC http://www.centerforinterfaithaction.org
including keynote address by Susan Rice, U.S. Ambassador to the UN http://www.state.gov/p/io/rls/rm/2009/122183.htm

++++++++++++++++++++++end editor's note+++++++++++++++++++++++

World Malaria Day: Here in Africa Mosquitoes Still Kill

By Sue Mbaya, World Vision, April 24, 2009

The Huffington Post
http://www.huffingtonpost.com

Sue Mbaya is World Vision's Advocacy Director for Africa

[Excerpts only. For full story, visit http://tinyurl.com/dnynwn]

Today is World Malaria Day. and more than sixty years ago some Americans might have marked the day by being sick -- perhaps very sick. Malaria causes high fevers, sweating and chills, and even brain damage and death. But malaria was eradicated in North America by 1950. So instead, U.S. communities are welcoming warmer weather now with little more than bottles of bug spray and a vague annoyance at the buzzing sounds of mosquitoes that come out at dusk.

Here in Africa, it's quite a different story. Our mosquitoes still kill.

More than nine out of ten malaria-related deaths happen in the region of the world where I live, sub-Saharan Africa. Malaria takes nearly one million lives a year, 85 percent of which are children. Mosquitoes and their deadly bites deliver a steady blow to millions of already struggling families, sapping their productivity and income, and snuffing out the next generation.

Even as many African countries continue to make hard-earned economic progress, the financial toll of malaria remains a roadblock to these economies reaching their full potential. And with the global economic crisis already threatening to cut into Africa's gains, the effects of malaria should serve as a wake-up call to the international community.

All told, malaria costs Africa an estimated $12 billion in lost economic productivity each year, while consuming some 40 percent of government health expenditures in countries where it is endemic, according to UN and World Health Organization assessments.

The exhausting, debilitating symptoms of malaria keep hundreds of millions of adults from completing a full day's work, sometimes for weeks on end. Infected children often miss school and too many are burdened with long-lasting complications of anemia or brain damage, diminishing physical and mental productivity for years. For many, death is the ultimate outcome.

...

Yet there's still good news on this World Malaria Day. This killer disease is preventable and treatable for a fraction of the $12 billion it robs from Africa's economic potential. A new report from World Vision this week confirms that the solution is simple--yet also shows that the solution must be rooted in the affected communities themselves.

Here is what it takes, according to experts: First, the all-important bed nets, combined with indoor spraying of insecticides, anti-malaria drugs and preventive medicine for pregnant women. The world community is making commendable progress on this front, with bold commitments to provide universal access to these items in endemic African countries by the end of 2010.

The second key to ending malaria is less dramatic, but no less important: In vulnerable areas, the local community has to be equipped to train and reinforce prevention practices and proper bed net use at the household level, as well as ensure availability of nets to the entire community. In fact, research has shown that bed nets need to cover everyone in a vulnerable community, not just the most vulnerable to malaria--children and pregnant women, for example. It's 80 percent or more coverage of everyone in one village that stops the deadly cycle of malaria.

...

For more information on how you can get involved in the fight to help end malaria around the world, go to http://www.endmalaria.org.


Malaria & children

Progress in intervention coverage

Summary update 2009

United Nations Children's Fund

[Excerpts only. For full text, including figures and footnotes, see http://www.unicef.org/media/files/WMD_optimized_reprint.pdf]

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. 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.

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. Malaria in pregnancy can also lead to stillbirth and maternal deaths.

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. 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.

...

Since 2007, and building on the recent momentum in the fight against malaria, the UN Secretary-General, the African Union and others have called for a bolder, long-term goal of eliminating malaria as a global public health problem. To realize this vision, the Roll Back Malaria Partnership revised its goals and targets, as set out in its 2008 Global Malaria Action Plan.

Roll Back Malaria Partnership goals and targets [now include]:

  • Achieve universal coverage for all populations at risk using locally appropriate interventions for prevention and case management by 2010 and sustain universal coverage until local field research suggests that coverage can gradually be targeted to high-risk areas and seasons only, without the threat of a generalized resurgence.
  • Halve the malaria burden between 2000 and .... 2010 and reduce by 2015 the number of cases by three-quarters and the number of preventable deaths to near zero.

...

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. 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. 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 insecticide-treated 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 and many countries have shown little or no efforts to scale up programs.

Insecticide-treated mosquito nets are one of the most effective ways to prevent malaria transmission. Studies show that high coverage and regular use can reduce all-cause mortality rates in children under age five by nearly 20 per cent in malaria-endemic areas. Since 2004 the number of insecticide-treated nets produced worldwide has more than tripled--from 30 million to 100 million in 2008--leading to a rapid rise in the number of nets procured and distributed. The number of nets procured by UNICEF--the largest global net procurer--is 20 times greater today than in 2000. Programs supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria distributed 70 million nets by the end of 2008. Most nets are distributed through integrated maternal and child health services, such as in Madagascar (box 4). Many countries are now working to develop monthly distribution plans to help ensure distribution by the 31 December 2010 deadline to achieve universal coverage.

...

Together with regular use of insecticide-treated nets, intermittent preventive treatment during pregnancy is critical for preventing malaria among pregnant women in stable malarious areas. The treatment consists of at least two doses of an effective antimalarial drug during the second and third trimesters of pregnancy. This intervention is highly effective in reducing the proportion of women with anemia and placental malaria infection at delivery. Sulfadoxinepyrimethamine is a safe and appropriate drug for intermittent preventive treatment for pregnant women.

Most countries have only recently adopted intermittent preventive treatment as a recommended regimen for pregnant women. The next round of surveys is expected to show higher coverage. Some countries have already achieved relatively high levels, including Zambia (60 per cent in 2008) and Senegal (49 per cent in 2006; figure 11). The higher coverage is due largely to early adoption and implementation of intermittent preventive treatment as a key part of national reproductive health and malaria control activities. Indeed, many countries with more recent data show higher values, and better coverage is expected in the next round of surveys.


Africa: How a Sports Writer Unleashed a New Wave of Philanthropy

Elizabeth Gore

24 April 2009

http://allafrica.com/malaria

Opinion

Elizabeth McKee Gore is director of Nothing But Nets, one of the most successful campaigns to distribute insecticide-treated bed nets to malaria-endemic countries. The global Roll Back Malaria Partnership estimates that 700 million insecticide-treated bed nets will have to be distributed by 2010 to remain on target for the goal of nearly eliminating malaria by 2015. More than half of those nets must be distributed in Africa, where most malaria deaths occur.

Nothing But Nets, based in the United States, uses an integrated approach to distribution, relying on existing networks, such as inoculation campaigns, non-governmental organizations, faith-based communities, health workers and others to ensure nets are delivered to even the most remote villages and that they are consistently and properly used. So far, Nothing But Nets has distributed nearly 2.5 million bed nets. Gore recently talked to AllAfrica about how Nothing But Nets came about.

About five years ago what we really needed was larger U.S. government funding for malaria and we needed the rest of the world to start paying attention. The Aids community in the United States is amazing in terms of advocacy and ensuring proper funding but there's no malaria community.

So we started thinking at the United Nations Foundation that we've got to build a public campaign for malaria so people will start supporting it. Nets seemed like a really interesting entry point and a hook for the public to get behind. And it's such a small price for an American - to think of a 10-dollar donation as literally saving someone's life.

So we decided to start fundraising for the nets publicly and we were hoping to leverage that into bigger U.S. dollars and start building this constituency. It was going along okay, not great, but then we got a phone call from Rick Reilly, a writer for Sports Illustrated magazine, who has a huge following. He called and said, "I just saw this documentary on malaria and I am blown away by it. In sports we have nothing but nets - even a sports fan can figure it out." So, we asked him to write a column about it.

He had not been to Africa. He just really liked the solution around the net. So he wrote a column called "Nothing But Nets." Nothing but net is a basketball term when you swish a basketball. It was also used in a McDonald's commercial. [With the column] he did what the entire UN probably couldn't have done and pulled a huge issue down to a 30-second sound bite, down to 800 words in a column.

He said, if you've ever scored a goal in soccer, if you've ever dunked in a basketball net, if you like cheerleaders in fishnets, donate 10 dollars, do it now. And 1.2 million dollars were raised in four weeks from that article. It almost crashed our server. We had to hire temps to man the phones. The amount of mail that came in was just unbelievable. And the bigger thing was 18,000 people responded, which in a community, on an issue where you don't have a following, is pretty huge.

It evolved into the Nothing But Nets campaign and Rick said why not get the sports groups involved. NBA [National Basketball Association] Cares were immediately in. They just loved it. But then we really needed an organizational partner.

We had already been talking to the Methodists a little bit about malaria and so I approached them again. They came on board, which was huge for us because if you think there are 12 million Methodists worldwide and they agreed to communicate this, suddenly we have this enormous audience.

So those were the pinnacle partners that got us kicked off. We had the public launch in January 2007 and we took Rick to Nigeria to see where his nets had gone. And instead of asking the public again we thanked the public. So he published this article "Nothing But Thanks," which garnered double the amount of donations and that's how we broadened out the campaign.

We boiled this whole issue down to Malaria Kills, Send a Net, Save a Life. Donate 10 dollars. The UN Foundation pays the cost of the campaign so that 10 dollars is the full contribution. There's no overhead taken out, which is important to people at that price point. Then we just kept bringing in new partners. Major League Soccer came on board, the WNBA [Women's National Basketball Association] Cares came on board, the Lutherans, the Union for Reform Judaism.

These partnerships are what created the now 100,000 registered people involved in malaria. Who would have thought? We couldn't get three people in a room to talk about malaria and now we have 100,000 registered people. We think that through all of our partners that Nothing But Nets touches about 25 million people.

We take the marketing very seriously but we also take the distribution very seriously. We continue to follow this money all the way to the ground. We go as often as we can to communicate back to the donors: this is how your money is being used, this is what's happening, this is how the mortality rates have dropped. So half of our job is reporting back, which I think people love because you're not just contributing to malaria, you're learning about Africa, you're learning about the UN, you're learning about these awesome kids that we're working with.

The youth have become the power of this campaign, which was not the original goal. We have an eight-year-old in Pennsylvania who just hit 100 thousand dollars. They're just amazing, they're our celebrities and they surprise us every day. These kids are educating us on the new wave of philanthropy and a new way of getting involved. It's not just raising money. While that's important, it's the whole awareness around this issue.

We need everybody and most of all we need our peers in Africa to lead this and they are. We are supporting them and they are leading the way. These nets only go where they say they should go and I think this has been incredibly effective because they're our partners.

We are encouraging everyone to go out and do their own Nothing But Nets campaign, whether they're hosting a bake sale or a basketball tournament, or just educating the public through their own press release in their local town or at their school to get involved. They can actually populate our Google map on http://nothingbutnets.net and show the rest of the world what they're doing in honor of World Malaria Day.


AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

AfricaFocus Bulletin can be reached at africafocus@igc.org. Please write to this address to subscribe or unsubscribe to the bulletin, or to suggest material for inclusion. For more information about reposted material, please contact directly the original source mentioned. For a full archive and other resources, see http://www.africafocus.org


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