MALARIA

In Africa, malaria is the single leading cause of death for children under five. Every 30 seconds, malaria claims the life of another African child.[1] Each year, more than a million people succumb to the disease worldwide and more than 80 percent of the deaths occur in sub-Saharan Africa[2]. Malaria preys on the most vulnerable - pregnant women and their unborn children, those infected with HIV/AIDS and children under the age of 5. The disease disproportionally burdens the rural poor, those who lack the resources for bed nets that prevent infection and those who cannot afford treatment once they have contracted the disease.

Malaria perpetuates the cycle of poverty in the world’s poorest countries, as the disease forces children to miss school and fall behind in their education, costs the tourism industry millions and great economic loss on a countrywide scale. In Africa, malaria amounts to an estimated $12 billion in economic loss annually which translates to a $1.3 billion loss in annual GDP in endemic countries. This, in turn, hinders development. Malaria consumes health budgets; USAID noted that malaria accounts for an estimated 40 percent of public health expenditures in Africa. Malaria is costly, both economically and in terms of human lives.

What is Malaria? How does it affect children?

Malaria is a blood-borne disease caused by a parasite that is carried from person to person through mosquito bites. Severe flu-like symptoms are exhibited 9 to 14 days after a bite from infected mosquito. If the infected person does not receive adequate treatment, the infection can lead to comas, life-threatening anemia, and death by infecting red blood cells that clog capillaries that carry blood to the brain and other vital organs. Even when children survive the ravages of the disease, they may suffer long-term brain damage and learning disabilities as a result. When pregnant women contract malaria, both they and their unborn children are at risk as the disease causes mortality, low-birth weight and maternal anemia. Under and malnourished children are at an elevated risk for contracting the disease and the disease is a contributing factor to severe anemia in young children.[3]

What is needed immediately?

A comprehensive, multi-faceted approach is necessary to combat malaria effectively. The President’s Malaria Initiative, announced in 2005, provides $1.2 billion over a five year period with the goal of cutting the number of malaria-related deaths by 50 percent in the 15 target countries.[4] The Global Fund to Fight AIDS, Tuberculosis and Malaria was founded in 2002 and has approved grants worth $2.6 billion over five years and has disbursed $833 million so far.[5] While these commitments have been impressive, increased funding is needed to provide wide coverage of the following proven methodologies:

Insecticide-treated bed nets (ITNs) - Insecticide treated nets provide twice the protection of those that are untreated. Nets are essential for nighttime prevention, as African malaria mosquitoes usually bite between the hours of 10pm and 4am. A net is large enough to protect a few people at a time and can last for 3 to 5 years. Use of ITNs has been proven to reduce mortality in children under 5 by 20 percent and malarial infection of pregnant women and children under five by up to 50 percent.[6] The cost of ITNs range from $4 to $7.
Indoor Residual Spraying (IRS) - Spraying the inside walls of homes with insecticide helps to reduce malaria transmission to others, each spraying lasts 4 to 10 months. This helps prevent and curb epidemics. According to USAID, for IRS to be effective, at least 80 percent of the homes in the targeted area must be sprayed.
Artemisinin-based combination therapies (ACTs) - ACTs are currently the most effective drugs for treating malaria as the combination therapy reduces the risk of drug resistance. A great need exists for cheaper ACTs and a better distribution and access mechanism so that the drugs get to where they are needed most.
Intermittent preventative treatment for pregnant women (IPTp) - Two monthly doses of SP (sulfadoxine-pyrimethamine) during the second and third trimesters of pregnancy help to protect pregnant women from anemia and death and help to protect the baby by preventing malaria-induced low birth weight.[7] This costs only 10 to 12 cents and could prevent between 75,000 to 200,000 infant deaths yearly in Africa.
Better coverage and access to quality antimalarial drugs - It is essential that effective treatment is started within 24 hours of the onset of symptoms, especially for children under the age of 5 to prevent serious illness or death. Barriers exist for those who need treatment though: physical barriers such as distance between village and clinic or prohibitive cost barriers for the drugs. The distribution of home-based care packages containing antimalarial drugs save children’s lives by acting as the first line of defense with the first onset of symptoms.
Quality standards for antimalarial drugs - There has been a rising incidence of substandard or counterfeit drugs. PLoS ONE noted that substandard antimalarial drugs cause an estimated 200,000 preventable deaths per year. Quality testing and inspection by regulatory agencies is necessary and programs, such as PMI, should only buy approved drugs for distribution. According to Africa Fighting Malaria, more than a third of antimalarial drugs sold in Africa have failed quality tests.
Education - Families and communities must be educated about the disease in order to understand methods of prevention and treatment options.

Goals for the future

While commitments such as the President’s Malaria Initiative, PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria have funded life saving prevention and treatment programming, greater progress and a strong political will is needed in order to put an end to needless malaria deaths. The following list contains goals to strive for in the near future:

Malaria Vaccine -According to Malaria No More, while most scientists believe that the vaccine is at least a decade away, it is imperative to continue funding for research while utilizing the current tools we have available to fight and treat malaria in the meantime.
Building capacity of local health systems - Strengthening local capacity is imperative in order to provide sustainable, quality care that can reach the largest possible amount of people.
Better diagnostics - Better, faster and more accurate diagnostic tests are extremely important. Children and adults are given antimalarial drugs at the first sign of a fever and are diagnosed in the clinic, not the laboratory. This panicked approach to diagnosis is expensive, as the medications are pricey and self-defeating, as this will likely lead to an increase in drug-resistant malaria in the future.