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Every year
between 19 and 21 million people fall ill with
malaria in the SADC region, including over 15
million children under five years and close to 4
million pregnant women, the two most vulnerable
groups. Between 200 000 and 300 000 of those
infected in the region die each year
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People across Africa celebrated Africa Malaria
Day on
25 April 2004. The theme was ‘A
Malaria-Free Future’ and the slogan was
‘Children for Children to Roll Back Malaria’.
Malaria is the number-one killer of children in
Africa where
a child dies of malaria every 30
seconds. The aim of
raising awareness is to
increase action against malaria, thus paving the
way for a malaria free future. Malaria kills
approximately 2 million people a year, some 90%
of them in Africa. These numbers come close to
the estimated 3 million people worldwide who die
of AIDS each year. Malaria is second only to
AIDS as a killer disease on the continent.
Southern Africa continues to experience a
chronic emergency as a result of three factors:
the abnormal meteorological conditions that have
occurred in recent years resulting in prolonged
drought, the devastating impact of HIV/AIDS
pandemic, and socio economic decline and
increasing poverty. This has had an adverse
effect on the southern Africa region resulting
in humanitarian crisis, which has put an
estimated 63% of the population at risk.
The relationship between drought and malaria is
frequently misunderstood but has implications
for people living in malaria areas both during
and after droughts. Experience from southern
Africa suggests that malaria can increase in
normally stable malaria areas when they
experience drought. This is because malnutrition
reduces the immunity of the population. Once the
rains return the risk of malaria epidemics
increases significantly in areas of unstable
malaria transmission due to an increase in
breeding sites.
Malaria affects the health and wealth of nations
and individuals alike. The level of poverty in
remote rural areas and peri-urban areas varies
from country to country in southern Africa, but
one common consequence is the serious brain
drain from public health institutions. This
decreases the capacity and sustainability of
national malaria control programmes in affected
countries.
Malaria is both a disease of poverty
and a cause of poverty. Its indirect costs
include lost productivity and income associated
with illness or death. The presence of malaria
in a community or country hampers individual and
national prosperity. Because the high prevalence
of both malaria and HIV increase the poverty and
vulnerability of populations it is important to
consider an integrated community disease control
approach.
Both malaria and HIV/AIDS weaken the immune
system. This has serious implications for people
with HIV who are co-infected with malaria,
particularly for children under five and
pregnant women who are most vulnerable. Evidence
suggests that co-infection increases the rate of
progression of HIV disease, making it essential
to prioritise HIV infected patients for
prevention, early diagnosis and treatment of
malaria. Malnutrition has a negative impact on
the progression of both HIV and malaria.
Action falls far behind promises when it comes
to the treatment of malaria, and debates about
strategy are used as excuses for failure to
provide resources. At stake are both the
availability of resources and willingness to
adopt new, more effective drugs to replace ones
that are now ineffective. More than 600 million
people face the daily threat of death from
malaria because new treatments are unavailable
where they live. About 75% of all malaria deaths
are children and research shows that one out of
five children born on the African continent will
die of malaria. Several million more become
seriously ill. “In many places, they are still
given medicines whose effectiveness is very low
and decreasing," the director general
of the UN World Health Organization (WHO)
stated. The United Nations has called on donor
countries and pharmaceutical firms to provide
the resources necessary to conquer new
drug-resistant strains of the disease.
By 2005, 60% of children across African should
be sleeping under safe mosquito nets, according
to a target set at the Abuja summit in 2000. But
many charities and other groups, including the
WHO’s Roll Back Malaria Campaign, say they do
not believe the targets set at that summit will
be met.
As the rains intensify cases of malaria may
increase. It is essential that national malaria
control programmes and ministries of health put
in place mechanisms and strategies to rapidly
respond to epidemics. The main challenge is that
chloroquine, the least expensive and most widely
used anti-malarial drug, has lost its
effectiveness in much of Africa. Campaigners in
some parts of Africa say that western donors are
ignoring DDT; one of the most effective weapons
against malaria. DDT is a powerful insecticide
that was widely used on crops in Europe and
North America until the 1970s, but it kills
birds and fish and has been banned in the US
since 1972.
Since 2001 the WHO has been advocating a new
plant-based treatment – Artemisinin combination
therapy (ACT) – which it describes as ‘highly
effective’. But at around $2 for an adult dose
ACT costs 10 to 20 times as much as chloroquine.
Most countries in Africa will need external
funding to adopt it. The WHO estimates that
global demand for ACT will soar from about 20
million adult treatments per year at present to
130 to 220 million next year. At the current
price about $1 billion per year will be required
to treat 60% of the affected population. Without
successful implementation of ACT in the next
decade, significant progress in controlling
malaria will be impossible. The WHO has called
on governments and pharmaceutical companies to
place large orders to guarantee supplies of the
treatment. "Increased demand is the main factor
that will drive down prices," says the
director of WHO's Roll Back Malaria campaign.
Medecins sans Frontiers has also stated that
donors must stop wasting their money on drugs
that don't work and help fund efforts by
countries where malaria is endemic to make the
switch to ACT. Endemic countries need to
increase budget allocations to show that they
are serious about improving malaria control.
They need to provide ACT to individuals free of
charge, or at an affordable price. So far, the
Global Fund to Fight AIDS, Tuberculosis and
Malaria has financed programmes to purchase 19
million
ACT treatments in Africa, compared with
10 000-20 000 treatments in 2001. By the end of
2004 it is anticipated that 16 African countries
will have adopted ACT as their first line
malaria treatment.
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