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Africa: Ending Malaria in Sight?

AfricaFocus Bulletin
Nov 27, 2009 (091127)
(Reposted from sources cited below)

Editor's Note

On the Comoran island of Moheli, with a population of 36,000, malaria has been eliminated with the aid of a comprehensive Chinese-assisted treatment campaign. And at the 5th Pan-African malaria conference, held in Nairobi in early November, Kenya's minister of public health, Beth Mugo, announced that her country had set the goal of eliminating the disease by 2017.

The conference also featured promising announcements of development of a malaria vaccine. Although that is still uncertain and still some years to come at the most optimistic, scientists and health officials at the conference expressed confidence that current measures, including bednets, indoor insecticide applications, and new combination drugs, held the potential for victory over the disease, if funding and political will could be maintained.

This AfricaFocus Bulletin contains several short reports and article excerpts related to recent developments in the fight against malaria, including reports on the Comoros, Kenya, and Rwanda, on the multilateral initiative to reduce the prices of treatment, on the potential for new medications based on African plants, and the threat of new resistance to the current first-line treatment, Artemesinin-based combination therapies.

For more information on the 5th Pan African MIM Malaria conference, and links to a wide variety of related news and scientific reports, see http://www.mimalaria.org/pamc/

Previous AfricaFocus Bulletins on malaria include:

Africa: Progress on Malaria, Apr 27, 2009
http://www.africafocus.org/docs09/mal0904.php

Africa: Malaria Control Up, Majority Not Covered, Sep 19, 2008
http://www.africafocus.org/docs08/mal0809.php

Africa: Dramatic Anti-Malaria Results Feb 5, 2008
http://www.africafocus.org/docs08/mal0802.php

Africa: Africanizing Malaria Research, Nov 20, 2005
http://www.africafocus.org/docs05/mal0511.php

Africa: Rolling Back Malaria? May 4, 2005
http://www.africafocus.org/docs05/mal0505.php

For additional articles on health issues, see
http://www.africafocus.org/healthexp.php

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Latest in AfricaFocus FYI

http://www.africafocus.org/fyi/recent.php

Nov 25, 2009 - President Barack Obama, " Remarks at Presentation of Human Rights Award ", AllAfrica.com (Published Nov 24, 2009) http://allafrica.com/stories/200911240404.html

The full text of remarks by President Barack Obama at the presentation to Magodonga Mahlangu and Jenni Williams of Women of Zimbabwe Arise (Woza) of the 2009 Robert F. Kennedy Human Rights Award at a ceremony in the East Room of the White House on November 23, 2009. Links to remarks by Mahlangu and Williams as well.

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Kenya: Govt Hopeful It Can Eliminate Malaria

David Njagi, SciDev.Net (London)

9 November 2009

http://allafrica.com/stories/200911091705.html

Nairobi - Kenya hopes to eliminate malaria by 2017, a malaria conference heard last week.

The disease has been in decline in the country in recent years and scientists say they are optimistic that it can be eliminated by then.

The goal was announced by Beth Mugo, minister of public health and sanitation, at the opening of last week's 5th MIM Pan African Malaria conference in Nairobi. Implementation will be steered by a National Malaria Strategy (NMS), which the government launched at a separate event.

"We are at a point of moving towards a malaria-free Kenya in 2017," said Willis Akhwale, head of the country's Department of Disease Control and Prevention.

"Health systems strengthening, the development of effective medicines, human resources capacity building and more will be necessary to achieve this," said Mugo.

"Eliminating malaria in 2017 is possible based on current technologies and adequate funding," said Elizabeth Juma, head of the Division of Malaria Control.

The timeline is based on the findings of a 2007 Malaria Indicator Survey, which demonstrated that transmission is declining in most parts of the country - although seasonal transmission in arid and semi-arid areas is still at worrying levels.

"We plan to change the strategy of intervention in the arid and semi-arid areas and launch a mass drug administration campaign in areas where the disease is endemic," said Akhwale. Experts told the MIM meeting that elimination was not possible without mass drug administration. Elimination occurs when malaria prevalence drops to zero in a region, while eradication achieves the same on a global scale.

Some 13 per cent of pregnant women in Kenya now use insecticide treated nets (ITNs) in all malaria endemic areas, according to the 2007 survey. The number of children aged five and under using ITNs rose from under five per cent in 2003 to more than half in 2006.

Robert Newman, director of the WHO's Global Malaria Programme, said he was confident that Kenya would meet the 2017 target but he added that success depended on improved political will as well as the development of new tools to improve disease surveillance.

It was also essential for communities to realise that they are "not just recipients of drugs but they play an important part in the fight against malaria", he said.

Akhwale said Kenya would need US$100 million if it were to meet the target. NMS plans to decentralise control and to prioritise monitoring and evaluation.


The Affordable Medicines Facility-Malaria to begin delivering subsidized ACTs within two weeks

November 6th, 2009

http://mim.globalhealthstrategies.com/blog/?p=550

http://www.theglobalfund.org/en/amfm/

The Affordable Medicines Facility malaria (AMFm) program, hosted and managed by the Global Fund, will deliver subsidized artemisinin-based combination therapies (ACTs) to select countries within two weeks time. As a result of negotiations and larger, direct payments to manufacturers, malaria drug prices will be reduced from$6 to 40 cents per dose through AMFm. Countries selected to participate in the program, originally announced in April, are: Benin, Cambodia, Ghana, Kenya, Madagascar, Niger, Nigeria, Rwanda, Senegal, Tanzania and Uganda.

The announcement came from the 5th Pan-African MIM Conference in Nairobi on Monday. Experts hailed the drug-delivery decision as key to eradicating malaria in sub-Saharan Africa.


Drug Resistance Threatens Anti-Malaria Drive:
Artemisinin, Malaria "Miracle" Drug, Could Lose Its Potency

by Cathy Sunshine Nov 18, 2009

http://www.suite101.com/profile.cfm/csunshine

Artemisinin compounds are highly effective against malaria, but they're too expensive for most people. Use of cheap substitutes is leading to dangerous drug resistance.

Malaria kills nearly a million people each year, most of them young children in Africa. The vast majority of deaths are due to Plasmodium falciparum, a vicious malaria strain that has become resistant to all but one of the malaria drugs on the market. http://www.who.int/features/factfiles/malaria/en/index.html

That one drug is artemisinin, a derivative of Artemisia annua, the sweet wormwood plant. When taken in combination with another drug, artemisinin can knock out a lethal malaria infection swiftly and completely.

Now, as an indirect result of the drug's high cost, malaria parasites resistant to artemisinin have emerged along the Thai-Cambodian border and are threatening to spread.

Treating Malaria with Artemisinin Combination Therapies

Since 2004, the World Health Organization (WHO) has recommended artemisinin-based combination therapies as the frontline treatment for malaria. The drug cocktails combine fast-acting artemisinin with a longer-acting, older antimalarial, delivering a one-two punch to the parasite.

It is crucial that artemisinin not be administered alone, a method known as monotherapy. Without a companion drug, some parasites linger in the body and can become resistant to artemisinin.

For this reason, the WHO in 2006 called for artemisinin monotherapies to be pulled from the market, except in special cases. But many manufacturers and countries are failing to comply.

Ineffective monotherapies still dominate the private market in large countries such as Nigeria and the Democratic Republic of Congo, which together account for 30 percent of malaria cases in sub-Saharan Africa.

For full article, see http://tinyurl.com/ygkordn

Remaining sections include

"High Cost of Artemisinin Leads to Underuse"

"Malaria Eradication Efforts Threatened"


China adopts "malaria diplomacy" as part of Africa push

Nov. 6, 2009

Reuters Alertnet

[Excerpts. Full article at:
http://www.alertnet.org/thenews/newsdesk/SP503140.htm]

By Tan Ee Lyn

Hong Kong, Nov 6 (Reuters) - In a laboratory in China's southern city of Guangzhou, scientists are trying to enhance the rare sweet wormwood shrub, from which artemisinin -- the best drug to fight malaria -- is derived.

China hopes to improve and use the drug as a uniquely Chinese weapon to fight malaria not on its own soil, where the deadly disease has been sharply pruned back, but in Africa, where it still kills one child every 30 seconds.

Already, a Chinese-backed eradication programme on a small island off Africa has proven a huge success.

...

Successful Trial

Tanzania, Kenya and Nigeria have begun farming hybrids of the sweet wormwood shrub with Chinese and Vietnamese ancestry, said Li Guoqiao at the Tropical Medicine Institute.

"I inspected the plantations and the plants are growing well," Li told Reuters in an interview.

Asked if China would export the high-yielding Artemisia annua to Africa, Li said: "We want to grow them in China and whatever we export depends on bilateral relationships."

Li is spearheading a project on the tiny African island of Moheli, which belongs to the Comoros group of islands at the northern mouth of the Mozambique Channel.

In mid-November 2007, he launched a "mass drug administration" exercise on the island. Its entire population of 36,000 had to take two courses of anti-malarial drugs to flush the parasite from their bodies -- on day one and day 40.

The rationale was that while mosquitoes pass the parasite from person to person, they are merely "vectors" and not hosts. The real reservoir of the disease is people, and many carry the parasite in their bodies without even showing symptoms.

"The key is to eradicate the source, which is in people. Without the source, the vectors are harmless," he said.

The results were startling. While the parasite carrier rate in Moheli ranged from 5 to 94 percent from village to village before the exercise, that fell to 1 percent or less from January 2008 and has stayed around that figure since.

"Before, 70 to 80 percent of hospital patients were there for malaria. After that, you hardly find any," Li said.

Comoros now bars anyone from entering Moheli unless they take a course of antimalarial drugs -- a mix of artemisinin, primaquine and pyrimethamine that China provides for free.

Its government has asked Beijing to roll out the same programme in two of its larger islands, Grande Comore and Anjouan, with a total population of 760,000. Li said Beijing supported the idea in principle and that funding was being worked out.


Kenya: Locally-Growing Moringa Tree Key in Fight Against Malaria

The Nation (Nairobi)

Gatonye Gathura and Isaiah Esipisu

3 November 2009

[Excerpts: full article at:
http://allafrica.com/stories/200911031216.html]

Nairobi A malaria treatment derived from a locally-growing shrub is one of only a few herbal cures being presented at the ongoing international conference in Nairobi.

The tree, moringa oleifera, commonly known as horseradish or mlonge in Kiswahili, is competing alongside malaria medicines developed by some of the world's best scientists with the backing of global pharmaceutical giants.

According to a presentation at the Pan-African Malaria Conference, moringa extract, in combination with other herbs, has been seen to cure even drug-resistant malaria.

Unfortunately for Kenya, this development has been made by Nigerians who say the drug called zogali has been approved by the country's national drug registration agency.

Several herbal malaria cures are being presented at the conference but none from Kenyans despite repeated claims by local herbalists that they can easily treat and even cure the disease.

According to Dr N. Emetu of the National Research Institute for Chemical Technology in Nigeria, the product has been endorsed and accepted after trials by the World Health Organisation.

If this drug wins wider acceptance, it could do for the local tree what another shrub, the sweet wormwood, has done for China. An extract from the Chinese tree has become the drug of choice for treating malaria across the world. As a result, it has become a major cash crop in several countries.

While moringa grows wildly in some parts of the country, several groups of farmers at the Coast, Western, Nyanza and Rift Valley provinces are commercially planting the tree.

The leaves are crushed and sold as food supplements while the seeds are pressed and the extract exported to Europe, China and the US, where it is used in the cosmetics industry.

The main buyer of the seeds is Earth Oil, an export processing zone firm in Athi River.

According to the Nigerian study, the combination herbal remedy not only cures malaria but also boosts the immune system of patients, thereby ensuring complete eradication, sustenance of body resistance and protection from subsequent attack by the parasite.

Evidence presented at the meeting by the University of Ghana and that of Gezira, Sudan, indicated that plant extracts from Africa have the capacity to treat malaria but so far are underutilised.

...


Healthy Lives:
Winning the Battle Against Malaria in Rwanda

http://psi.org

As few as five years ago, malaria was the leading cause of death in Rwanda, with half of those fatalities in children under five. However, this nation of seven million rapidly scaled-up malaria interventions and achieved dramatic reductions in the deadly disease In just over two years of rapid scale-up, deaths due to malaria have dropped to only 7%, a dramatic 60% reduction. Rwanda stands out as one of PSI's platforms that have made dramatic progress in controlling malaria.

A number of factors contributed to the significant gains in reducing the malaria burden in Rwanda. Backed by the strong political will and bold leadership of the Rwandan government, the National Malaria Control Program, together with its partner organizations and donors, assembled a multifaceted approach that currently has malaria on retreat across Rwanda.

Scaled-up Ownership and Usage of Long-Lasting Insecticide-Treated Nets (LLINs)

Prior to 2005, there was a modest 30,000 mosquito nets distributed by the national government to protect its citizens against malaria. In 2005 however, Rwanda received its first grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria 300,000 bednets were supplied. By the next year, as the new resources went to work, 1.4 million LLINs were distributed to the country's most vulnerable populations. In 2006 and 2007, a coordinated national multi-channel distribution of three million nets reached 10 million Rwandans through antenatal clinics, vaccination sites and private sector outlets in 100% of district towns.

Conversion to Artemisinin-Based Combination Therapy (ACT)

LLINs were just one piece of a well-planned, comprehensive malaria control program in Rwanda. While LLIN distribution was being scaled-up, the Rwandan Ministry of Health introduced new guidelines making ACTs the first line treatment of malaria, with both public clinics and private pharmacies stocking the most effective anti-malarial available. Expectant mothers were given intermittent treatment in pregnancy, making them less susceptible to malaria infections during this vulnerable time.

Improved Home-Based Management of Fever

Programs for home-based management of fever ramped up throughout Rwanda, spearheaded by a new cadre of trained community health care workers. With two selected in each village, community health workers put national malaria policies in motion at the local level. Galvanizing community engagement in the fight against malaria, community health workers played a vital role in translating the national strategy into impact by providing information and resources for prompt and effective treatment and malaria prevention. Behavior change communication programs such as mobile cinemas have resulted in additional widespread sensitization about net use and malaria transmission, even in the most rural areas.

Increased Health Facility Utilization

Health center utilization rate is over 70%, with only 10% of patients seeking treatment for malaria, due in part to nationwide government health insurance and improvements in quality of care and availability of services.

Last year, indoor residual spraying (IRS) with pesticide for protection against malaria was provided to more than 190,000 homes in targeted areas.

Even with such significant progress, the battle against malaria in Rwanda is far from over, and the Rwandan National Malaria Control Program is aiming to achieve even more ambitious goals, including universal coverage of LLINs, expanded IRS, subsidized ACTs nationwide, and bolstered monitoring and evaluation to tackle epidemics. Decreased malaria also brings a new set of challenges, including possible drops in net usage as malaria prevalence declines, reductions in natural immunity to the malaria parasite and the need to implement a regional strategy for continued gains against the disease.

This expanding scope of new challenges underscores the need for sustained resources to fully control malaria. Rwandans have achieved remarkable success yet find themselves at a critical turning point in the fight against malaria. If current progress and achievements can be expanded with the support of continued investment, sustained political commitment and diligent management, Rwanda is positioned to become a global model of success. However, if funding recedes and national programs lose momentum, Rwanda could face tremendous and deadly disease resurgence and millions of lives lost.

For more information, visit: http://www.malariafreefuture.org/rwanda/index.php


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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