Malaria News |
Changes in the burden of malaria in sub-Saharan Africa 
The burden of malaria in countries in sub-Saharan Africa has declined with scaling up of prevention, diagnosis, and treatment. To assess the contribution of specific malaria interventions and other general factors in bringing about these changes, we reviewed studies that have reported recent changes in the incidence or prevalence of malaria in sub-Saharan Africa. Malaria control in southern Africa (South Africa, Mozambique, and Swaziland) began in the 1980s and has shown substantial, lasting declines linked to scale-up of specific interventions. In The Horn of Africa, Ethiopia and Eritrea have also experienced substantial decreases in the burden of malaria linked to the introduction of malaria control measures. Substantial increases in funding for malaria control and the procurement and distribution of effective means for prevention and treatment are associated with falls in malaria burden. In central Africa, little progress has been documented, possibly because of publication bias. In some countries a decline in malaria incidence began several years before scale-up of malaria control. In other countries, the change from a failing drug (chloroquine) to a more effective drug (sulphadoxine plus pyrimethamine or an artemisinin combination) led to immediate improvements; in others malaria reduction seemed to be associated with the scale-up of insecticide-treated bednets and indoor residual spraying.
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Malaria in Africa: progress and prospects in the decade since the Abuja Declaration
Malaria is a global health problem but more than 70% of the total morbidity is in Africa. 10 years ago, heads of state from across Africa signed a declaration in Abuja, Nigeria, to "halve the malaria mortality for Africa's people by 2010". This Viewpoint discusses how far we have come in this effort, what we can expect for the future, and what our priorities should be.
Not long after the launch of the Global Malaria Eradication Programme in 1955, it became apparent that elimination was not yet achievable in sub-Saharan Africa. In 1969, global malaria eradication changed from a time-limited campaign to a long-term goal. The strategy started to focus on control, but in practice this approach relied on treatment of febrile illness and during the 1970s and 1980s, malaria-specific mortality began to rise frighteningly as resistance to chloroquine spread.
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Global, regional, and national causes of child mortality in 2008: a systematic analysis
Up-to-date information on the causes of child deaths is crucial to guide global efforts to improve child survival. We report new estimates for 2008 of the major causes of death in children younger than 5 years. Of the estimated 8.795 million deaths in children younger than 5 years worldwide in 2008, infectious diseases caused 68% (5.970 million), with the largest percentages due to pneumonia (18%, 1.575 million, uncertainty range [UR] 1.046 million-1.874 million), diarrhoea (15%, 1.336 million, 0.822 million-2.004 million), and malaria (8%, 0.732 million, 0.601 million-0.851 million).
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Scale-up of services and research priorities for diagnosis, management, and control of tuberculosis: a call to action
The Millennium Development Goal target for tuberculosis control is to halt the spread of tuberculosis by 2015, and begin to reverse the worldwide incidence. After the introduction of standard control practices in 1995, 36 million people were cured and about 6 million deaths were averted. However, substantial scientific advances and innovative solutions are urgently needed together with creative new strategies. Strong international and national political commitment is essential. Urgent action is needed by national governments to fund their own programmes, and for the G8 countries and other donor governments and organisations to support governmental and non-governmental efforts. To foster the global need for urgent action to control the tuberculosis epidemic, The Lancet, in collaboration with the Stop TB Partnership, WHO, Global Fund to Fight AIDS, Tuberculosis and Malaria, and the experts participating in this Series, is launching The Lancet TB Observatory, which will assess and monitor progress in tuberculosis control and research, assess domestic and global financing, regularly disseminate information, and advocate for intensified efforts with stakeholders at all levels.
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Artemisinin combination therapy for vivax malaria
Early parasitological diagnosis and treatment with artemisinin-based combination therapies (ACTs) are key components of worldwide malaria elimination programmes. In general, use of ACTs has been limited to patients with falciparum malaria whereas blood-stage infections with Plasmodium vivax are mostly still treated with chloroquine. We review the evidence for the relative benefits and disadvantages of the existing separate treatment approach versus a unified ACT-based strategy for treating Plasmodium falciparum and P vivax infections in regions where both species are endemic (co-endemic). The separate treatment scenario is justifiable if P vivax remains sensitive to chloroquine and diagnostic tests reliably distinguish P vivax from P falciparum. However, with the high number of misdiagnoses in routine practice and the rise and spread of chloroquine-resistant P vivax, there might be a compelling rationale for a unified ACT-based strategy for vivax and falciparum malaria in all co-endemic regions. Analyses of the cost-effectiveness of ACTs for both Plasmodium species are needed to assess the role of these drugs in the control and elimination of vivax malaria.
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Malaria elimination in Asia-Pacific: an under-told story
An oft-cited story describes how Sri Lanka reduced its incidence of malaria from 2.8 million cases in 1946 to a mere 17 in 1963, only to see the rate resurge in subsequent years. Yet, in the past decade, Sri Lanka has brought its annual caseload down from more than 200 000 confirmed cases in 2000 to just 670 cases in 2008, with no deaths due to malaria in more than 2 years. Similarly, in the Philippines, the past decade has seen nine provinces become malaria free, bringing the total to 22 of 81. Eight of 20 malaria-endemic countries in WHO's Western Pacific and Southeast Asia regions achieved declines in annual cases of more than 50% from 2000 to 2008. Success stories such as these reverberate throughout Asia-'Pacific: in this era of renewed commitment to elimination participants gathered in Kandy, Sri Lanka (Feb 16-'19, 2010), for the second annual meeting of the Asia Pacific Malaria Elimination Network (APMEN).
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Global, regional, and national causes of child mortality in 2008: a systematic analysis
Up-to-date information on the causes of child deaths is crucial to guide global efforts to improve child survival. We report new estimates for 2008 of the major causes of death in children younger than 5 years. Country-specific estimates of the major causes of child deaths should help to focus national programmes and donor assistance. Achievement of Millennium Development Goal 4, to reduce child mortality by two-thirds, is only possible if the high numbers of deaths are addressed by maternal, newborn, and child health interventions.
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Malaria elimination on Hispaniola
Recently there was a call for malaria elimination on the island of Hispaniola, the last island in the Caribbean with endemic transmission of Plasmodium falciparum, the most lethal species of the parasite. We strongly support this bold call to action and suggest that recent studies in Haiti be considered in developing an elimination strategy.
Elimination of malaria on Hispaniola is timely and important for two reasons: it would provide proof of principle that malaria elimination can be achieved in complex environments, and there is now in-vitro molecular evidence for chloroquine resistance in Haiti. Therefore, a rigorous malaria elimination effort is desperately needed before the island is forced to switch from chloroquine to a more costly combination therapy. An additional rationale for elimination is the protection of immunologically naive individuals internally displaced as a result of the recent earthquake in Haiti, many of whom are either moving into malarious areas to seek shelter or are sleeping in poorly constructed shelters with minimum protection from mosquitoes.
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