MALARIA: Kenya: Targeted Malaria Control Is the Better Option

Tabitha Mwangi : 29 November 2011
In a Daily Nation article titled 'Vague policies blamed for flop in malaria war', health experts meeting in Mombasa were quoted as suggesting that the government's approach of targeting malaria prophylaxis only at women at the greatest risk was wrong and that all pregnant women in the country should be given malaria prophylaxis.
In this case, the health experts were wrong -- the government had done its homework and its approach was appropriate.
Disease control programmes ought to be evidence-based in order to bring maximum benefit to those most at need, and this is the tenet that the government followed.
In 2009, Dr Abdisalan Noor and his colleagues at KEMRI, in collaboration with the Division of Malaria Control developed a malaria risk map for Kenya.
The map was developed from data collected from a total of 2,600 malaria survey reports, 50 per cent by the Ministry of health.
The malaria infection surveys were conducted among children under 10 years of age in the country since 1975.
"In Kenya, there are about 80 districts with very high malaria transmission, almost all around Lake Victoria. There are a few hot spots at the Coast and in North-western Kenya. Only 21 per cent of the Kenyan population is under intense malaria transmission," said Dr Noor, a senior malaria research scientist, based on their findings.
There are two approaches to preventing malaria in pregnancy; intermittent preventive treatment (IPTp) and use of insecticide treated bed nets.
IPTp involves providing pregnant women with three protective doses of a safe antimalarial drug.
The most commonly used drug is the sulfadoxine-pyrimethamine combination generally known as SP.
"The availability of the risk maps from Dr Noor, make it unnecessary to expose pregnant women with little risk of malaria to IPTp. Efforts should be focused to ensure that 100 per cent of the pregnant women in those high risk areas, get IPTp,' said Prof Bob Snow, a renown malaria expert.
The Division of Malaria Control in Kenya used the map that Dr Noor and his team developed to set priorities and target resources efficiently.
The Division, which was then headed by Dr Elizabeth Juma, had been involved in the research process from the beginning and was therefore swift in using the malaria risk map to target interventions where they were most needed.
"Through antenatal clinics, IPTp is being focused in the three regions with intense malaria transmission. These are Western, Nyanza and Coast province. However insecticide treated bed nets distribution for pregnant women will continue in all regions where it is ongoing,' said Dr Elizabeth Juma.
The logic of giving IPTp to all pregnant women, irrespective of malaria risk, is perhaps based on the fact that the drug is cheap.
But the wastage involved in mass distribution of the drugs is huge. These resources would be better used in ensuring that those pregnant women at high risk of malaria actually receive IPTp on time. This has not been happening.
Kilifi, for example, is within the high risk zone where pregnant women are expected to receive three doses of IPTp during their pregnancy, but the figures are not encouraging.
"When I look at my register, there are very few pregnant women who have taken the three doses and just a few more have received two doses. The majority of the women pay a single visit to the antenatal clinic and therefore receive only one dose," says Gladys Etemesi, the nurse-in-charge at the maternal health clinic at the Kilifi District hospital.
To reap maximum benefits from IPTp, a pregnant woman needs to take a minimum of two doses.
"Women will do anything to bring their child for vaccinations, whether they deliver at home or in hospital. Very few women fail to bring their children for vaccination because most now understand the value of immunizations. If it is emphasised that failure to come for antenatal care also places their babies at risk, they are more likely to come,' says Ms Etemesi.
In this case of Kilifi, and in other high risk areas, funds that would otherwise be spent on buying and distributing the drugs to mothers in low-risk areas who do not need them, they can be used to increase awareness in order to have more mothers and children benefit from the drugs.
At the same time, the funds can be used to ensure that those who fail to show up for repeat IPTp visits at the antenatal clinic are followed up at home and given the medicine and also encouraged to sleep under an insecticide treated bed net.
In March this year, the Ministry of Public Health and Sanitation launched the first community mass net distribution campaign in Kenya that targeted whole populations in the regions identified as carrying the highest burden of malaria on the malaria risk map.
These efforts would be made more cost-effective if linked with efforts to ensure that all the pregnant women in these areas also get their IPTp doses.
http://allafrica.com/stories/201111290016.html

MALARIA: Mosquitoes score in chemical war

Declan Butler : 07 Jul 2011 : Nature
Key weapons in the fight against malaria, pyrethroid insecticides, are losing their edge. Over the past decade, billions of dollars have been spent on distributing long-lasting pyrethroid-treated bed nets and on indoor spraying. Focused in Africa, where most malaria deaths occur, these efforts have greatly reduced the disease's toll. But they have also created intense selection pressure for mosquitoes to develop resistance.
"Data are coming in thick and fast indicating increasing levels of resistance, and also of resistance in new places," says Jo Lines, an entomological epidemiologist and head of vector control at the Global Malaria Programme of the World Health Organization (WHO) in Geneva, Switzerland. The WHO now intends to launch a global strategy to tackle the problem by the end of the year.
Pyrethroids are the mainstay of malaria control because they are safe, cheap, effective and long-lasting. Alternatives such as organophosphates and carbamates are available for indoor spraying, although they cost more and are less effective. But pyrethroids are the only insecticides approved by the WHO for use in bed nets. "We have lots of our eggs in the pyrethroid basket," says Robert Newman, director of the Global Malaria Programme.
The international community has been slow to respond to the threat despite warnings, says Janet Hemingway, director of the Liverpool School of Tropical Medicine, UK, and chief executive of the non-profit Innovative Vector Control Consortium, a public-private venture set up in 2005 to develop new insecticides and monitoring tools. "A number of us had been banging the drums, saying: 'As soon as you scale up you are going to get resistance.'" But Lines says that the malaria-control community felt too many lives were at stake to let the threat of resistance stand in the way of massively scaling up the bed-net and spraying campaigns.
Teasing out the impact of resistance on the success of malaria-control interventions is difficult because so many other factors influence their outcome. More systematic and more sophisticated monitoring of resistance is also vital, says Lines. The best surveillance data (see 'Resistance on the rise'), although useful, do not give a complete picture of where resistance is emerging and how prevalent it is, he says. Malaria-control programmes often lack insect-resistance monitoring, and detection of all forms of resistance is not easy. Quick, cheap tests can pick out gene mutations that help the mosquitoes' nerve cells withstand pyrethroid attack. But other forms of resistance, which depend on increased levels of mosquito enzymes that can destroy pyrethroids before they reach their target, require more complex tests to detect (H. Ranson et al. Trends Parasitol. 27, 91-98; 2011).
But uncertainties about the extent of resistance or its impact are "no excuse for inaction", says Newman, arguing that the proposed WHO strategy needs to be urgently implemented, and also rolled out preemptively in places where resistance has yet to be detected. The WHO's plan will recommend, for example, that control programmes rotate insecticides sprayed indoors, using pyrethroids one year and a different class the next. This would be more costly and less effective than relying only on pyrethroids, however, so control programmes may be reluctant to adopt this measure.
Lines says that new combinations of insecticides also need to be developed, so that mosquitoes resistant to one would be killed by the other. In areas where pyrethroid bed nets are used, a different class of insecticides should be used for wall spraying, he adds.
Ultimately, entirely new classes of insecticides — particularly those that can be applied to bed nets — are needed to alleviate the dependence of malaria-control efforts on pyrethroids. For indoor spraying, some longer-lasting and more cost-effective non-pyrethroid insecticides should be available by next year, Hemingway says, although developing wholly new classes will take five to seven years. Repurposed agricultural insecticides might also act as a stopgap were resistance to pyrethroids to develop rapidly. Research targeting mosquito control is "grossly underfunded" compared with that on malaria drugs and vaccines, she adds, which is why control efforts have had so few options to call on.
http://www.nature.com/news/2011/050711/full/475019a.html

MALARIA: African Countries Debate Using DDT in Anti-Malaria Efforts

July 12, 2011 : Sanday Chongo Kabange : Lusaka, Zambia

African Countries Debate Using DDT in Anti-Malaria Efforts : Some propose using pesticide in tightly controlled conditions

Photo: VOA - A. Fortier

African children watch a play on malaria prevention at the Mbosse health clinic.

The chemical pesticide DDT has been banned by most countries for use in agriculture, but some continue to use it indoors to kill insects that carry malaria.
In Zambia, it’s an important part of the government’s malaria control program, and the controlled use of DDT spray has led to a reduction in malaria cases over the years.
Other African countries are facing a rise in the number of cases and several African governments are considering the carefully monitored use of DDT as part of their strategy against the disease.
In Malawi, for example, the Department of Health may undertake a DDT spray program in malaria prone-areas.
There is no doubt that DDT is very effective in killing mosquitoes. The problem lies in what other effects DDT may have on human health, wildlife, environment, horticulture and crops.
Malawi’s secretary of health, Chris Kang’ombe, was part of a delegation that visited Zambia to learn how the use of DDT has helped reduce malaria there.
Kang’ombe is convinced that DDT can help reduce the spread of malaria in Africa -- if handled under controlled conditions by trained personnel and monitored by government agencies.
He says, “DDT is used for indoor spraying. It is used to only spray within, inside the house, dwelling houses. What we have learnt (from Zambia) and we know from our experience here (in Malawi), the other chemicals [are active for] up to about two or three months, whereas with DDT you are talking of six months plus. So in terms of “residue effect,” it (DDT) is better, and also eventually the cost of indoor spraying…will be much cheaper, more cost effective than using other chemicals. “
While authorities in Malawi are still considering using DDT in malaria control, a thorny issue has arisen.
The Tobacco Control Commission is against the idea of using the pesticide. Tobacco is the mainstay of Malawi’s economy, and there’s fear that Western consumers will not buy it if there are any traces of DDT on the crops. So the commission will likely require careful monitoring if Malawi is to start using DDT in malaria control.
Similar views are shared by Uganda’s Network on Toxic Free Malaria Control. The network is against the use of DDT as a malaria control strategy.
“We have no law specifically for DDT,” says Network Secretary General Ellady Muyambi . “ We have no trained manpower. We do not have equipment in terms of transportation facilities, in terms of storage facilities, in terms of disposal facilities, in terms of laboratories for chromatography. We do not have the capacity. We are still relaying on donor funding and we are saying why can’t our country use its own resources to deal with its own problems, especially these ones like malaria.,” says Muyambi.
Also involved in the DDT debate is Kenya, another country debating whether to use the pesticide.
Shrikant Bhatt professor of medicine at the University of Nairobi in Kenya explains why the controlled use of DDT should be reintroduced. “We are almost getting defeated by the pandemic that is occurring due to malaria. [Anti-malarial] drugs are gaining resistance [to the parasite]. You know we have very few drugs which we can use as effective means of controlling malaria. So, I think we do not have any option but to reintroduce DDT in a limited way, [like] spraying DDT indoors or using it in endemic areas we should be able to contain the malaria pandemic,” he explains.
The International Centre for Insect Physiology and Ecology (ICIPE), also based in Kenya, is taking different approach.
John Githure a researcher at the centre says “ICIPE is largely concentrating on how we can come up with innovative ways or even using available products to kill the mosquitoes at larval stage. “
One such product uses soil-dwelling bacteria called bacillus thuringiensis, or BTi.
Githure says ,”we are trying to introduce that in Africa and ICIPE have of course gone ahead to construct a demonstration factory that will be able to at least make the product BTi available, affordable and accessible to the community to use for mosquito control.”
Meanwhile, the government and various organizations including Melinda and Bill Gates Foundation are encouraging free distribution of insecticide-treated mosquito nets and sleeping under bed-nets as short term measure for malaria control.
http://www.voanews.com/english/news/africa/pan/African-Countries-Debate-Using-DDT-in-Anti-Malaria-Efforts--125426193.html

MALARIA: Uganda: DDT Spraying Costly for Country

Raymond Baguma and Gerald Kawemba : 5 July 2011
Indoor residual spraying as a strategy to control malaria in Uganda is too costly and has affected the programme countrywide.
According to Dr. Seraphine Adibaku, the head of the Malaria Control Programme, this is why other malaria control strategies such as use of insecticide-treated nets and Artemisinin-based combination therapy are considered to be ahead of indoor residual spraying.
The Government is implementing the indoor residual spraying using pyrethrum-based and carbon-based insecticides in 10 malaria-endemic districts in the northern and eastern regions.
They include Amolatar, Apac, Kitgum, Kumi and Bukedea.
"About three million people in the 10 districts have been covered. We have reached over 90% of the population," Adibaku said.
She added that under the Presidential Malaria Initiative, the budget for indoor residual spraying is sh4.5b per district each year.
Adibaku said it would be much cheaper if the ministry distributed insecticide-treated mosquito nets.
She, however, said indoor spraying has an advantage of delivering immediate impact compared to treated nets.
Adibaku disclosed that the health ministry is re-evaluating the effectiveness of using DDT for malaria control.
Dr. Joaquim Saweka, the World Health Organisation (WHO) resident representative in Uganda, said indoor residual spraying is highly effective and has been successful in Zanzibar and Rwanda.
He, however, added that it is capital intensive and needs a lot of money for each application done twice a year.
Saweka cited his previous posting in Ghana during which a town of 300,000 inhabitants required $3m for spraying each year.
He said with the high cost of spraying and low financial resources available, Uganda needs to prioritise usage of insecticide-treated mosquito nets.
Saweka added that Uganda is on the right path to eradicating malaria with efforts in prevention, diagnosis and treatment as well as universal coverage of insecticide-treated nets.
Health minister Dr. Richard Nduhura yesterday kicked off a nationwide programme to distribute 11,000 bicycles to health volunteers who will diagnose and treat malaria in homes. The programme is supported by the Global Fund.
It is part of the Government's home-based management of malaria, which is part of a larger national strategy to deliver treatment to children within 24 hours after diagnosis

http://allafrica.com/stories/201107061302.html

MALARIA: Determinants of bed net use in children under five

The following new article has just been published in Malaria Journal


For articles which have only just been published, you will see a 'provisional PDF' corresponding to the accepted manuscript. A fully formatted PDF and full text (HTML) version will be made available soon.

Research
Determinants of bed net use in children under five and household bed net ownership on Bioko Island, Equatorial Guinea
Garcia-Basteiro AL, Schwabe C, Aragon C, Baltazar G, Rehman AM, Matias A, Nseng G, Kleinschmidt I
Malaria Journal 2011, 10:179 (29 June 2011)

[Abstract] [Provisional PDF]
Background
As part of comprehensive malaria control strategies, the Bioko Island Malaria Control Project (BIMCP) distributed 110,000 long-lasting insecticide-treated nets (LLIN) in late 2007 with the aim of providing one net for each sleeping area. Despite attaining initially very high levels of net coverage and net usage, many children under five years of age did not sleep under a net by 2009, according to annual malaria indicator surveys. The aim of this study was to assess the determinants of bed net use in children under five and bed net ownership of the households in which they live.

Methods
Using data from annual cross-sectional household surveys of 2008 and 2009, we investigated factors associated with sleeping under a mosquito net the night prior to the survey, and associated with households owning at least one net, in all households which had at least one child under five years. Amongst others, caregiver's knowledge of malaria and household characteristics including a socio-economic score (SES), based on ownership of household assets, were analysed for their effect on net ownership and use.

Results
There was a decline of around 32% in the proportion of households that owned at least one net between 2008 and 2009. Higher household bed net ownership was associated with knowing how malaria was prevented and transmitted, having the house sprayed in the previous 12 months, having fewer children under five in the household, and children being sick at some point in the previous 14 days. Higher bed net use in children <5 was associated with being sick at some point in the last 14 days prior to the survey, living in an urban area, more years of education of the head of the household, household ownership of at least one ITN (as opposed to an untreated net) and the year in which the survey took place.

Conclusions
The big fall in bed net usage from 2008 to 2009 was attributable to the striking decline in ownership. Although ownership was similar in rural and urban areas, rural households were less likely to protect their children with bed nets. Knowledge about malaria was an important determinant of bed net ownership. Further research is needed to elucidate the decline in bed net ownership between 2008 and 2009.

MALARIA: Rwanda: Country's Textile Factory to Produce Malaria Bed Nets

Bosco Hitimana : 6 June 2011
Rwanda's textile factory Utexrwa announced it is switching to production of insecticide treated malaria bed nets for both local and foreign markets. The factory's Managing Director Mr. Rajendran Ranganathan told East African Business Week that it has an annual potential to produce about 12 million bed nets.
"Malaria bed nets have a huge demand in Africa," said Rajendran.
He said the estimated demand on the continent in 2010 is in the range of around 300 million but less than 30 million nets are produced annually.
For the beginning, the factory has secured over US$400,000 from Heineken to produce 70,000 bed nets for the Rwandan population. Meanwhile Rwanda requires about 4 million bed nets.
"Since this money is given to us at once, we are using it to establish the capacity."
Heineken contracted Utexrwa to produce the bed nets as part of its corporate social responsibility in Rwanda. Rajendran said that the initial tests showed that the factory has the desired quality of the impregnated bed nets and it is now arranging for bigger commercial production.
http://allafrica.com/stories/201106080031.html

MALARIA: COTE D'IVOIRE: Unrest disrupts malaria prevention bid

DAKAR, 7 June 2011 (IRIN)

 Photo: Nancy Palus/IRIN
Malaria preys on children

The post-election violence in Côte d’Ivoire delayed by several months a distribution of mosquito nets - a pillar of the country’s strategy to combat malaria, a leading killer of children.
Some communities must wait even longer as hundreds of thousands of nets were looted during the unrest.
This is just one example of how the recent conflict has disrupted health services, which were already fragile after nine years of a north-south split.
“This sets us back in our malaria prevention efforts. We were supposed to have done this distribution in December,” said San Koffi Moïse, head of the national malaria control programme (PNLP). The project - funded by The Global Fund to Fight AIDS, Tuberculosis and Malaria - aims to cover all households across the country, he told IRIN.
Health workers, along with NGOs Population Services International (PSI) and CARE, on 3 June began handing out insecticide-treated nets in the northwest and in one southern department. A team with The Global Fund is currently in Côte d’Ivoire to meet with PNLP officials and aid workers to discuss how to proceed.
“We are evaluating the situation to see in what regions we can do distributions,” San said.
More than 100 containers of mosquito nets were pre-positioned throughout the country prior to the October 2010 presidential election. In western Côte d’Ivoire - one of the regions hardest hit by post-election violence - entire containers were carted off and scores were broken into and emptied.

In Duékoué IRIN saw several empty containers next to the government health services building; most state health workers abandoned their posts during the violence and hospitals and offices were also looted. Mosquito nets like those destined for free distribution were for sale in the Duékoué market.
“We don’t know the motive for the looting but it appears the thefts were organized, not just simple acts of vandalism,” PSI representative Rambeloson Lalah told IRIN. “In Toulepleu [near the border with Liberia], entire containers were taken away.”
When things began to heat up before the election, NGOs insured the nets against “political violence”, so they expect to replenish stocks so as to cover the entire country as planned.

Vouchers
The rains have started in much of the country, and with that comes malaria. Ivoirians told IRIN they received vouchers for the nets months ago and are still waiting.
“The people really need mosquito nets right now,” said Miagnet Fatou, nutrition expert at the main hospital in the western town of Danané. “It’s mango season and malaria is hitting hard.” Mango season corresponds with the rains so people commonly associate mango season with the disease.
Miagnet said most of the malnutrition she sees in Danané is linked to malaria.
“People received vouchers a long time ago but they are still waiting... Now they’re seeing nets for sale in the market; they’re not sure what to think.” She said nets sell for up to 1,000 CFA francs (US$2.23) in the market - unaffordable for most families.
“I use mosquito nets to protect my children,” said 32-year-old mother of four Affissatou Diakité in the main city Abidjan. “I got a voucher about six months ago… but then the crisis [stopped the process].”


 Photo: Nancy Palus/IRIN
Looters have robbed Ivoirians of mosquito nets

How many needed?
But even as distribution gets under way, there is uncertainty over the number needed in many areas, as tens of thousands of people throughout Côte d’Ivoire have yet to return home after fleeing violence, said Kouyaté Karim, departmental health director in the centre-north city of Bouaké.
“And some people have told me they’ve lost their vouchers. I’m not saying we’ll have to make a new count from scratch, but this is something we have to be aware of as we proceed.”
He added: “The conflict has brought considerable disorder to the health system and it will take time to get back on track.”
While mosquito nets are not a panacea, their use has repeatedly been shown to reduce severe disease and mortality due to malaria in endemic regions, according to the World Health Organization (WHO). Bednet distribution is one part of Côte d’Ivoire’s control strategy, along with prevention measures for pregnant women and ensuring access to malaria drugs.
During 2006-09 PNLP distributed about 2.1 million treated bednets, according to a government report on progress on the millennium development goals. But that is about 10 percent of the number of people at risk, according to WHO’s 2010 World Malaria Report.
http://www.irinnews.org/report.aspx?reportID=92926

MALARIA: Roadmaps are a good tool - but we must stay on the road

Bill Brieger : 16 May 2011

Off-Road in Uganda
Uganda’s 2010 Roll Back Malaria Roadmap seemed reassuring. Apparently 2.7m nets were already in place by late 2009, and supposedly a supply of another 18m long lasting nets (or at least the funding) was ready for achieving universal coverage by December 2010.
Assessment of Uganda’s Roadmap progress credited the country with achieving procurement of these nets. It seems odd therefore that the 2011 Roadmap indicates that 6.4m nets are in place and 10.4m need to be distributed in 2011. What’s going on?
A new study by Carla Proietti and colleagues provides some answers. Not only do they document continued high transmission in the northern part of Uganda (polymerase chain reaction rate of 72% in children below five year of age), a situation that threatens control efforts by neighbors, but they also identify plausible reasons for the lag.
The researchers politely suggest that, “The failure to reduce the burden of malaria could reflect sub-optimal implementation of malaria control measures.” They also explained that, “Malaria control efforts in Apac (sub-county) were not reliably monitored in the last decade and affected by political unrest in preceding years.”
Stockouts of anti-malarial ACTs was also listed as a problem. It should be recalled a few years ago that, “The Global Fund has decided to suspend its five grants to Uganda because there is evidence of serious mismanagement by the Project Management Unit (PMU) for Global Fund grants in Uganda.” Although the programs have resumed, satisfactory settlement of the problem was not achieved.
In light of this study Childsurvival.net warns us not to let successes in recent years blind us to reality. “Those who believe that Africa is within shooting distance of malaria elimination may wish to reconsider their position after reading this article (Proietti et al.). One should qualify this Ugandan article in several ways: 1) Local insurgency in the area under consideration, 2) Hiccoughs with the GF over misappropriation of resources, 3) Autocratic gerontocracy at the national level. Unfortunately, these three factors are not peculiar to Uganda.”
 Roadmaps are a good tool to help us plan for malaria control and elimination - but we must stay on the road for them to work.

http://www.malariafreefuture.org/blog/?p=1203

MALARIA: Equatorial Guinea Dramatically Reduces Malaria in Children

11 May 2011, The Republic of Equatorial Guinea has decreased the prevalence of the malaria parasite in children by 57% in just four years and has increased the number of children protected by bed nets or indoor spraying of insecticides from 4% to 95% in that same period, according to a report by Roll Back Malaria. Research carried out on the Island of Bioko, funded by the government of Equatorial Guinea and a private consortium led by Marathon Oil Corporation, showed a reduction in infant mortality in nearly one third of the population. The program to control malaria is part of a broader effort by the government, through the Ministry of Health and Social Welfare, to improve public health in the West African nation.
The anti-malaria project is currently focused on the island of Bioko, where more than half the population of Equatorial Guinea lives, and has been extended to 2013 to develop local capacity and enable the campaign to reach the mainland. The project has won numerous high-profile awards for social responsibility and good citizenship.
The sixth report on Business Investing in Malaria Control: Economic Returns and a Healthy Workforce for Africa showcases how malaria control investment has significantly improved in Africa. "Companies in Equatorial Guinea, Ghana, Mozambique, and Zambia have worked to prevent malaria among their workers and workers' dependents and have seen an excellent return on investment, with significant reductions in malaria-related illnesses and deaths, worker absenteeism, and malaria related spending."
The Malaria Control Project is a fundamental part of the government-wide effort to meet the goals of the Horizon 2020 development plan set by President Obiang Nguema Mbasogo. Equatorial Guinea has heavily invested in public health. The government has donated $1.5 million and a headquarters facility to the World Health Organization (WHO) to support research for global health. It has also provided technical assistance to the local United Nations Population Fund (UNFPA) to improve the effectiveness of its Assistance Program as well as the implementation of a host of health programs geared towards improving the health of Equatorial Guineans.

About Equatorial Guinea
The Republic of Equatorial Guinea (Republica de Guinea Ecuatorial) is the only Spanish-speaking country in Africa, and one of the smallest nations on the continent. In the late-1990s, American companies helped discover the country's oil and natural gas resources, which only within the last five years began contributing to the global energy supply. Equatorial Guinea is now working to serve as a pillar of stability and security in its region of West Central Africa. The country will host the 2011 Summit of the African Union. For more information, visit http://www.guineaecuatorialpress.com.

This has been distributed by Qorvis Communications, LLC on behalf of the Republic of Equatorial Guinea. More information on this relationship is on file at the United States Department of Justice, Washington, DC.

http://www.redorbit.com/news/health/2045641/equatorial_guinea_dramatically_reduces_malaria_in_children/index.html?source=r_health

MALARIA: Nigeria research provides insights on bednet use—and misuse

Marcy Erskine, International Federation of Red Cross and Red Crescent Societies; Toju Maleghemi, WHO Cross River State; Iyam Ugot, Special Advisor to the Governor of Cross River State, Community Health
Nigeria’s Cross River State Roll Back Malaria team is tasked with “finding” 500,000 previously distributed bednets to determine how many are still being used and why.
In Nigeria, the Cross River State Government has been a leader in public health, providing free primary health care to pregnant women and children under five* and working to improve health indicators and protect its residents from malaria-related illness and death. In 2008, the State Government, with support from the Canadian Red Cross and USAID, distributed over half a million nets—enough for each child under five attending a vaccination site during an integrated measles campaign.
In 2010, Nigeria’s Cross River State Roll Back Malaria (RBM) team was tasked with “finding” these previously distributed long-lasting insecticide-treated nets (LLINs) to determine how many were still “good” and how many new nets were needed in the next distribution cycle. A “good” net was defined by age: a net distributed in 2008 or later was considered good, while older nets were considered non-viable. The physical condition of the LLIN was not taken into account given the subjective nature of assessing hole size and viability of the net. Given that the estimated lifespan of the distributed nets is three years, it was expected that the majority of the nets distributed in 2008 would still be in use. However, the results of the household census undertaken by Nigeria Red Cross volunteers throughout the State to assess household LLIN needs “found” only 52 percent of the LLINs distributed during the campaign. Similar results have been seen in Senegal, where the National Malaria Control Program (NMCP) is leading a rolling distribution of a similar nature with support from NetWorks.
In Cross River State, the results of the household registration led the State project team to question why such a low number of nets was found and, subsequently, the Nigeria evidence-based health information system (NEHSI) staff were contacted. NEHSI, supported by the International Federation of Red Cross and Red Crescent Societies (IFRC) and the World Health Organization (WHO), conducted a qualitative study to find out what had happened to the previously distributed nets.
The results of the study were of immediate relevance to the net distribution and hanging program currently being rolled out. It was assumed that some people would not be honest about receiving or owning nets from the previous distribution, including ones not yet hung and used, and the survey found that this was actually the case in a number of surveyed households. Another interesting discovery was that more than two-thirds of people surveyed would only sleep under the bednets for about 6–12 months, at which point the nets were considered to be expired or no longer “good” and were either burned or used for another purpose, such as covering a kiosk or screening a window. About half of the survey respondents also believed that once a net had been washed more than twice, it was no longer effective, and nearly one-third of respondents believed that washing the net in cold water would destroy the insecticide and reduce its effectiveness.
This study was relatively inexpensive and easy to implement, and it provided new critical information that is already being used to inform Cross River State’s next phase of mosquito net distributions. It will also be useful to other countries trying to account for nets that are still “good” in households. The study raised concerns about not only the validity of planning net replenishment campaigns based on the age of the net alone, but also the potential difficulties with quantifying net needs when moving from low or moderate to high LLIN coverage based on assumptions of “existing” nets.
In Cross River State, targeted messaging is being developed to encourage residents to use their mosquito nets for the full three years (or longer) and to repair them when they are torn or damaged. A net awareness campaign is being considered to improve knowledge and practice regarding LLIN use, maintenance, and repair. An end process monitoring exercise is currently taking place to ensure that universal coverage has actually been achieved where distribution has taken place. The campaign used a house-to-house distribution and hanging method, with volunteers equipped with hammers, nails, and string in addition to LLINs. The effectiveness of this approach for ensuring LLIN utilization will be assessed later in the year.
In Nigeria as a whole, the progress to date is staggering. The country bears approximately 25 percent of the malaria burden in Africa among its population of 153 million. Under the leadership of the Government and the Federal Ministry of Health, and with support from partners, the country has distributed close to 30 million LLINs and plans to distribute another 28 million this year. Nigeria’s success is reflective of strong leadership, effective partnership, and an excellent coordinating mechanism. In addition to the strong role of the NMCP, State ownership is crucial. Cross River State’s Government has played a key role in the coordination of the current campaign to move from targeted to universal coverage. This qualitative study to “find” previously distributed nets was one of the first of its kind, and provides critical information for Nigeria and other countries seeking to undertake similar activities. The study also demonstrates the importance of regular quantitative and qualitative data collection and analysis to modify project planning.

* This is the overall health policy in Nigeria, but is not yet implemented by all states.
http://www.macepalearningcommunity.org/newsletter_nigeriabednet.htm

MALARIA: Zambia: Door-to-door bednet distribution

Cecilia Katebe, Zambia National Malaria Control Centre Zambia uses community volunteers to help hang millions of bednets in homes to improve utilization rates.
Zambia’s National Malaria Control Programme (NMCP) is expected to distribute over 5 million nets in 2011, of which approximately three-quarters shall be distributed using the door-to-door distribution strategy in an effort to increase the usage of the nets being distributed. The remaining quarter will be distributed to pregnant women and children under five years of age through antenatal clinics. A high percentage of people in Zambia own bednets because of the government’s ongoing efforts to scale up the distribution of malaria control interventions, which, in addition to bednets, include indoor residual spraying and effective medicines. Though 64.3 percent of households own at least one bednet, the 2010 Malaria Indicator Survey (MIS) determined that only 42 percent of people were actually using the nets. The NMCC conducted a survey and found that there were a number of reasons for the low utilization rates. Many people said that they weren’t using the nets because they didn’t know how to hang them or they didn’t have the accessories to hang them; others said that they only use the bednets in the rainy season when mosquitoes are very visible.
The door-to-door campaign was launched in 2009 as a means of increasing utilization rates. During the campaign, Community Health Workers, Neighborhood Health Committee members, and other trained volunteers take the nets right up to individual houses and ensure the nets are hung properly before leaving the household. This also provides an opportunity to share important messages on malaria prevention and control.
In November 2009, a door-to-door distribution pilot was conducted in Chongwe District of Lusaka Province and a follow-up survey found that about 93 percent of households that had received nets during the pilot were using those nets. Based on these excellent results, it was decided that the door-to-door distribution strategy would be used to distribute the all the nets received in 2011.
During this year’s mass distribution, one volunteer will be responsible for 20 households in a village and, whenever possible, a volunteer will be chosen that also lives in the village and is a member of the community. This is really useful for several different reasons: the family will already know and trust the volunteer, they will be more likely to be honest about how many nets they need, and they will be more likely to allow them into their bedroom to help hang their nets. There is a high demand for bednets, but the challenge is being allowed into a bedroom to help hang a net. To address this issue, we’ve engaged traditional leaders to help people understand why this is important. The volunteers will then collect the data and bring it to the health center, where it is consolidated and used to determine how many nets a district needs. When the nets arrive, the volunteers will go back to the houses and distribute the nets, helping to hang them in each sleeping space in a household. To do this sort of distribution requires a massive effort with many people participating, so training is key.
Each volunteer visits the same house several times throughout the year. During their first visit, they note the number of sleeping spaces, how many people live in each house, and how many existing nets they have. An ITN database at the central level details all the nets that have been delivered to every district, the type of nets, the program under which the nets were distributed, and the month when the nets were received. This information is used for planning purposes and can produce a forecast that reveals areas of critical need.
Trainings for the upcoming distribution are started when it’s known that a shipment of nets is coming. Districts in need are then identified and a meeting with local stakeholders—including malaria task force committees, ministries, nongovernmental organizations, churches, and local leaders—is arranged. It is important to make sure the district office, with the support of the local partners, is able to handle the storage, distribution, and information-sharing once the nets are received. Health center staff, neighborhood health committees, relevant trainers, and door-to-door distribution volunteers are then trained. Through a strong partnership, coordinating body, and dedicated volunteers, millions of nets will be distributed this year and the work to protect Zambians from malaria will continue.
Door-to-door mass distribution is just one of the ways nets are distributed in Zambia. They are also distributed under the Malaria in Pregnancy Programme through antenatal clinics to pregnant women and children under age five, the Equity Programme to vulnerable populations like the elderly and the chronically ill by NGOs through the MOH, and through the World Bank-supported Community Malaria Booster Response programme.
http://www.macepalearningcommunity.org/newsletter_bednets.htm

MALARIA: Contribution of Integrated Campaign Distribution of Long-Lasting Insecticidal Nets to Coverage of Target Groups and Total Populations in Malaria-Endemic Areas in Madagascar

Manisha A. Kulkarni et al

In October 2007, Madagascar conducted a nationwide integrated campaign to deliver measles vaccination, mebendazole, and vitamin A to children six months to five years of age. In 59 of the 111 districts, long-lasting insecticidal nets (LLINs) were delivered to children less than five years of age in combination with the other interventions. A community-based, cross-sectional survey assessed LLIN ownership and use six months post-campaign during the rainy season. LLIN ownership was analyzed by wealth quintile to assess equity. In the 59 districts, 76.8% of households possessed at least one LLIN from any source and 56.4% of households possessed a campaign net. Equity of campaign net ownership was evident. Post-campaign, the LLIN use target of 80% by children less than five years of age and a high level of LLIN use (69%) by pregnant women were attained. Targeted LLIN distribution further contributed to total population coverage (60%) through use of campaign nets by all age groups.

Am. J. Trop. Med. Hyg., 82(3), 2010, pp. 420-425

http://www.ajtmh.org/cgi/content/full/82/3/420

MALARIA: Claims about the Misuse of Insecticide-Treated Mosquito Nets: Are These Evidence-Based?

Eisele TP, Thwing J, Keating J (2011) April 12, 2011

There are a number of potentially damaging misconceptions about insecticide-treated mosquito nets (ITNs) in Africa that have been propagated in media reports, almost all of which are based on anecdotal accounts.

While it is clear there is room for improving the level of ITN use among those who have them, and that misuse of nets occasionally occurs, we found very little evidence to support claims of widespread misuse across Africa.
We identified only one peer-reviewed study that reported misuse of ITNs; this study was a non-probability survey of seven beaches on Lake Victoria in western Kenya, making the conclusions non-generalizable.
Inaccurate news stories of widespread ITN misuse should be rebuked directly through the dissemination of empirical data contradicting anecdotal reports and in rebuttal editorials in newspapers and journals.
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001019

MALARIA: Battling Africa’s Number One Killer

April 22nd, 2011
Jennifer Weiss – health advisor for Concern Worldwide, an international humanitarian organization. She currently manages Concern’s Child Survival programs in Rwanda, Burundi, and Niger. A former Peace Corps volunteer in Honduras, she holds a Masters in Public Health from Tulane University.





Mukarurangwa Cecile, a community health worker in Marebe, Rwanda visits the home of Valentine, 3, to examine the cause of his fever. Photo: Esther Havens, Rwanda.

According to estimates from the United Nations and the World Health Organization (WHO), nearly one million children do not reach their fifth birthday because they die from malaria each year. Ninety percent of these deaths occur in Africa, where malaria remains the number one killer of young children. An additional 30 million pregnant women and their newborns are also at risk of malaria infection, which may lead to stillbirth, spontaneous abortion, low weight, and neonatal death.
Pregnant women and children die from malaria because they lack access to low-cost, effective solutions to both prevent and treat the disease. Concern is working to change this through our USAID-funded Child Survival programs in Rwanda, Burundi, and Niger, which provide life-saving malaria prevention and control to a total of 1.2 million women and children.


 Josepine Mukahirwa, a community health worker of 3 years, visits the home of Tuyishime Sylvie, 26, in Gasambu to educate on the importance of using a bed net. Photo: Esther Havens, Rwanda

The most obvious way to control malaria is to protect people from being bitten by malaria-carrying mosquitoes in the first place. People are at the highest risk of being bitten at night, while they are sleeping. Therefore, sleeping under a mosquito net, which is treated with a long-lasting insecticide, is a simple solution with dramatic results: at an average cost of about $10, long-lasting insecticide treated bed nets have been shown to reduce malaria transmission by 90 percent.
Concern works with local partner and governments to provide long-lasting insecticide treated nets to the people that need them the most: pregnant women and children under 5 years of age. Concern’s cadre of Community Health Workers then provides one-on-one counseling during household visits to further encourage parents to have their young children sleep under the bed net, and answer any questions or address any challenges the family may be facing in their use.
In Rwanda, Concern’s Child Survival Program is on target to ensure that 85 percent of all households own at least one bed net, and that pregnant women and children under the age of five are sleeping under them each night.
Another life-saving prevention technology recommended by WHO is to provide all pregnant women with at least two preventive treatment doses of an effective anti-malarial drug during routine antenatal clinic visits. Intermittent preventive treatment (IPT), as it is called, has been shown to dramatically reduce maternal anemia and low birth weight, and other adverse effects of malaria during pregnancy. However, many country governments are struggling to provide this service to all pregnant women during their antenatal care visits.
In Niger, Concern’s Community Health Workers are educating mothers about the importance of IPT, and the program is training health facility staff to provide IPT, in order to ensure that 70 percent of all mothers received the recommended two doses of IPT during their last pregnancy.

 Early diagnosis of malaria is critical to ensure prompt access to life-saving treatment. Photo: Esther Havens, Rwanda

However, in 2009, only 35 percent of malaria cases were confirmed with a diagnostic test, which requires a skilled laboratory technician and appropriate equipment. Therefore, the majority of malaria diagnoses in sub-Saharan Africa are based on symptoms alone—many of which (fever, difficulty breathing, reduced appetite) are also symptoms of pneumonia. Treatment of pneumonia alone may result in death from malaria, while the unnecessary, ‘presumptive’ treatment of malaria may result in malarial drug resistance.
However, in 2010, the World Health Organization, approved the use of a a new technology, called Rapid Diagnostic Tests (RDTs), which health facility staff may use to make malaria diagnosis without the use of sophisticated laboratory technologies.
In Rwanda, Concern is partnering with the Ministry of Health to conduct the initial roll-out of this ground-breaking tool, and is already seeing improved results: from December 2010-February 2011, Community Health Workers saw a total of 2,944 cases of fever. With the help of RDT, 33 percent were confirmed as cases of malaria and treated accordingly.
For many people, even if a child has been diagnosed with malaria, the nearest health facility is a several hours’ walk away, and parents may not seek treatment until it is too late. Concern’s Child Survival programs bring malaria treatment directly to people who are most vulnerable through an approach called “Community Case Management.” Concern trains Community Health Workers to screen for and treat simple cases of malaria with locally available, effective and safe anti-malarial drugs.
Through the Community Case Management approach in Burundi, Concern is working to increase the percentage of children treated with an effective anti-malaria drug within 24 hours of registering a fever from 26 percent to 60 percent.


 Bahomwana care group meets in Gasambu village, Rwanda where they exchange ideas and discuss ways to overcome challenges to improve their work as Community Health Workers. Photo: Esther Havens, Rwanda

Following treatment, the Community Health Worker monitors sick children, and, if they are not improving, ensures that they seek further treatment from the health facility immediately.
Much work remains to be done if we are to significantly reduce the rate of death from malaria worldwide. Concern is contributing to the fight against malaria through the application of proven solutions, as well as new technologies, to reach those most vulnerable to malaria. Preventing the huge numbers of child deaths from malaria that occur each year is no longer an impossible dream.

http://blogs.concernusa.org/2011/04/22/world-malaria-day/

MALARIA: India: Health workers in Orissa work with rural communities to raise awareness

19 April 2011

Milu Jani and his family under their new bednet. Picture: DFID

Milu Jani lives in Labangi, a small village in a remote area of Western Orissa – one of the poorest states in India. The village is around three hours from the nearest district town of Angul and part of the journey needs to be done on foot. There is no health centre, no electricity and no school in the village. Milu works as a forest guard at the Satakosia wildlife reserve, earning a mere 90 rupees (£1.20) a day.
Like most villagers, Milu has lost a loved one to malaria. His eyes tear up as he recalls his father's death last winter. Milu's father fell ill with a high fever and was tragically diagnosed with malaria only a day before his death, leaving no time for proper treatment. Malaria can be treated effectively with drugs, but treatment is most effective when administered within 24 hours of the onset of fever.
Milu knew mosquito bites can cause malaria but didn't know the deadly mosquitos were breeding in the water pools around the village. After his father passed away, Milu met a local health worker who explained the risks of malaria and how to prevent his family from becoming ill with this deadly disease.

Getting healthcare to rural communities
The DFID supported state health programme in Orissa trains health workers to help raise awareness of malaria prevention and treatment among vulnerable tribal communities like Milu's. Health workers like Suhasini Behera in Milu's village are trained in the use of diagnostic tests and how to administer appropriate medicines. They also distribute bednets and promote the proper use of nets to prevent malaria.
"It was not easy to convince people to use bed nets," Suhasini says. "People feared the nets were poisonous as there had been reports of rashes and itching from the insecticide" – misconceptions that she sought to dispel while visiting their homes.
By working with the community to raise awareness of malaria, Suhasini and her fellow health workers help to prevent people from contracting malaria and help the villagers to understand how to access treatment.

Bednets - a simple prevention tool
DFID's support to the Orissa state health programme has helped Milu and his family purchase bednets that will prevent them from contracting malaria in the future. By subsidising the cost of the nets, DFID enables poor families like Milu's to purchase two bednets for only 20 rupees (25p). The nets are treated with insecticide and last up to five years.
Milu's mother is content with her new net. "I always had disturbed sleep due to the mosquitoes. This new net has brought me a lot of comfort and I also use it for my afternoon nap".
Milu is equally satisfied. "Malaria was a huge problem in our area. Now everyone in the village is using a net. I have lost my father but now I can keep my family safe from malaria".

Key facts
DFID India has committed £100 million over 2007-12 to Orissa's state health programme to tackle malaria, among other health and nutrition initiatives. The programme increases efforts to prevent malaria, improve diagnosis and provide access to treatment for pregnant women and tribal children, who are most vulnerable to the disease.
DFID support has helped provide an extra 300,000 bed nets to young expectant mothers, to prevent anaemia and malaria-related deaths.
Orissa's state health programme has trained 20,000 health workers to use diagnostic tests, administer medicines and distribute bednets.
The state health programme distributed 1.2 million bednets to villages in February and March 2010, supported by the education and awareness activities of health workers.
http://www.dfid.gov.uk/Media-Room/Case-Studies/2011/Battling-malaria-in-India/

MALARIA: Kenya: How scouts are helping in the fight against malaria

Twelve-year-old Aisha Ali really is a well prepared scout. True to the motto of the Scouting movement – 'be prepared' - she is one of more than 21,000 scouts from over 1,000 schools in Kenya who are taking part in a project aimed at preventing the spread of malaria.
"I've always wanted to help others, so joining my school's scouting club gave me great pride." says Aisha.
"When this project was introduced in January 2010, I was very excited at the opportunity to serve my community."
Supported by UK's Department for International Development (DFID) and undertaken in partnership with the Government of Kenya's Division of Malaria Control, the Kenya Scouts Association and Population Services International (PSI) Kenya, the project aims to save the lives of Kenyans living in 36 malaria-prone districts by ensuring people sleep inside well tucked-in, insecticide treated mosquito nets every night, the whole year round.

Members of Kenya Scout clubs in the affected districts 'adopted' some 150,000 homes - equivalent to around 675,000 people - to teach them how to properly hang and use bednets, to avoid being bitten by mosquitoes.

Training
Aisha says 20 scouts from her school were trained about malaria; what causes it, how one can get it and how nets help prevent the spread of the disease. They were also trained on how to hang the mosquito bednets and the importance of sleeping under the nets each night.
"This is where we play an important role in malaria prevention – making sure that everyone in our communities sleeps under a net every night," says Aisha.
Each scout in the scheme is issued with a project booklet containing questions that help them to record how many people live in a home and how many of them sleep under a treated mosquito net.
The scouts are trained to ask to see the sleeping area and ensure the bednets are hung properly. They also show members of each homestead how to hang the nets correctly themselves.
"We were expected to adopt between seven and ten homes and visit them at least once a month to ensure that all the members of the households slept under a net."
One of the homes that Aisha has adopted is that of 'Mama' Hadija Hassan Mwabaha, an elderly widow who lives with four other elderly widows. Aisha recounts how she met Hadija. "I remember the first day I visited Mama Hadija. She is a clever woman and asked me a lot of questions about malaria. I told her about the anopheles mosquito. She was impressed by my knowledge and agreed to be part of our scout's project".
"I showed Mama Hadija how to hang up their nets correctly so that they are not bitten by mosquitoes. I also informed her that pregnant women and children younger than five years are at greatest risk from malaria. I have visited her every month since the first meeting. I like her because not only is she welcoming but she helps me with the project. She is a poor woman but has a very kind heart."
And Mama Hadija has equally good things to say of Aisha. "She has protected us from malaria!" she exclaims.
She goes on to explain that the program has helped to explain the dangers of malaria to the whole community and the importance of everyone using the nets every night.

Serving the community
The whole experience has been very motivating to Aisha: "I am serving my community and that makes me very happy," she says. She also has a certificate of merit from the training, is more enlightened about malaria issues, feels empowered to assist others and is glad that the training has boosted her ranking as a scout.
"When I know that I have helped prevent one more malaria case I feel so proud of my efforts," she concludes with a smile.
Of the ten households that Aisha adopted in January, nine already had the insecticide-treated nets. However not all the homes were using them correctly; over the course of the year, Aisha has assisted her adopted homes to ensure the consistent and proper use of mosquito nets.
http://www.dfid.gov.uk/Media-Room/Case-Studies/2010/Being-prepared-for-Malaria-in-Kenya/

MALARIA: Britain pledges it will help to halve malaria deaths in 10 of the worst affected countries in Africa and Asia over the next four years

Andrew Mitchell 25 April 2011 guardian.co.uk The UK will do all it can to make malaria a thing of the past
To mark World Malaria Day on Monday, Britain pledges it will help to halve malaria deaths in 10 of the worst affected countries in Africa and Asia over the next four years


 A Kenyan child plays under an insecticide treated mosquito net. Photograph: Stephen Morrison/EPA

The facts are stark: every week 15,000 children die from a disease that is not only treatable but preventable.
When I became development secretary I pledged the UK would do all it could to make malaria a thing of the past. When I commissioned reviews of all the UK's aid programmes, I made malaria one of our top priorities.
Those reviews set out our plans – over the next four years we will help to halve malaria deaths in 10 of the worst affected countries in Africa and Asia. We will improve prevention, diagnosis, and treatment, and we will support the development of innovative ways to tackle the disease.
Our approach to aid means making every penny count, and doing what works. We will start with one of the simplest but most effective weapons against this disease: bednets.
It costs less than £4 to deliver a long-lasting insecticide treated bednet. We can save the lives of 3 million children by 2015 if every child at risk of malaria sleeps under a net. The UK will oversee a massive increase in the number of bednets, targeting them especially at women and children. Through the Global Fund to fight Aids, TB and Malaria, we are contributing to the distribution of 110m bednets in the developing world.
The UK will work with partners to scale up access to and use of effective diagnosis and treatment of malaria, to make sure that these are available to those who need it most – particularly women and children – when they need it.
Too many children with malaria are not getting malaria drugs, while at the same time many children with other diseases are being given malaria drugs that they do not need. New rapid diagnostic tests allow doctors in Africa and Asia to improve the diagnosis of fever in children. Malaria is often mistaken for pneumonia, meningitis and other major diseases. These new tests, combined with improved training for people seeing children with fevers, can reduce deaths from malaria and from other common childhood illnesses.
Because the effects of mistreatment are far-reaching. Inappropriately used malarial drugs can build up drug-resistant strains of the disease, which can follow patterns of migration and spread across the globe. This is why the UK is spearheading a drive to tackle malaria in Burma, where drug-resistant strains of the disease have been detected.
Innovative programmes and partnerships are the third prong of our approach. We must continue to outpace this disease, be it though public-private partnerships like the Roll Back Malaria Partnership, which helps to galvanise and co-ordinate malaria efforts; the Medicines for Malaria Venture, which is finding innovative ways of increasing access to medication; or by funding organisations such as Unitaid to secure the supply of arteminisin, a vital component of anti-malarials.
There have been notable successes, especially in Africa. In five years, following rapid improvements in control efforts, deaths from malaria fell by nearly 70% in Rwanda and 62% in Ethiopia. In Zanzibar, in east Africa, overall deaths from malaria have fallen 90% since 2003.
These success stories should give us hope. While eliminating malaria completely will always be our ultimate goal, there is no reason why anyone should die from it. Every life lost is needless. With common resolve and a united front we can beat malaria
http://www.guardian.co.uk/global-development/poverty-matters/2011/apr/25/uk-help-halve-malaria-deaths

MALARIA: NetsforLife®: Achieving Progress and Impact

21 April 2011
With over 247 million cases of malaria occurring annually, NetsforLife® continues to be an innovative global player in the fight against this deadly disease. In commemoration of World Malaria Day 2011: Achieving Progress and Impact, the NetsforLife® program partnership is working to ensure that sustainable gains on both the national and community levels of its malaria prevention approach are maintained and bolstered.
For World Malaria Day 2011, NetsforLife(®) will join with the United Methodist Committee on Relief (UMCOR) in Mozambique to hang 100,000 malaria nets in homes in the Homoine and Panda Districts of Inhambane Province. Over the course of five days, 180 volunteers will be trained to help families learn how to use nets to prevent malaria, and an additional 400 volunteers will be mobilized for the distribution of nets.
"We are excited about partnering with agencies like UMCOR, a sister faith organization, to amplify the reach of the NetsforLife(®) malaria prevention initiative," said Meg L. DeRonghe, Acting Executive Director of NetsforLife(®). "Our local and global partnerships are critical to the sustainability of the program and the positive changes it is making in so many communities."
Through community engagement, education, and monitoring and evaluation, NetsforLife(®) works in 17 malaria-endemic African countries and collaborates with international agencies, national programs and local malaria stakeholders to combat malaria by instilling a 'net culture': a community-wide understanding of the protective value of nets and the right way to use and care for them. In countries where NetsforLife(®) has been active for a number of years, there is now renewed focus on maintaining people's working knowledge of how malaria is transmitted and how it can be prevented. [Watch a video interview with Samuel Asiedu Agyei, Monitoring & Evaluation Manager for NetsforLife(®), discussing the importance of net culture in motivating families to take malaria seriously.]
Churches are often the only functioning institutions in communities located "at the end of the road," and utilizing this long-standing, trusted delivery system to empower and unite people to bring about lasting results is essential to success. This strategy has led to widespread change in attitudes and behavior around malaria nets, and also helped NetsforLife(®) gain a reputation for effective community outreach. These outcomes have made the program a valued partner that is routinely solicited to participate in formal country-wide strategic planning, and often tasked with technical leadership of these key components to ensure better overall results. In the Democratic Republic of Congo, which has one of the highest rates of malaria cases and deaths in Africa, the initial baseline survey showed net use by children under five - the most vulnerable group - to be 9.2%. Currently, monitoring and evaluation analysis points to an impressive net use rate of 82.5%, which exceeds the World Health Organization target.
"The success of NetsforLife(®) is a result of our monitoring and evaluation program, which includes training people to collect data and assess the impact of the programs on communities that are often underserved by health facilities," reflected Dr. Stephen Dzisi, NetsforLife(®)'s Technical Director. "Capacity building of local communities, and follow up to ensure malaria prevention knowledge is sustained, are built into the NetsforLife(®) system." [Hear more from Dr. Dzisi in this hour-long NetsforLife(®) conference call, recorded on April 12.]
The goal for the current phase (2008-2013) of the NetsforLife(®) program partnership is to distribute 7 million nets in sub-Saharan Africa. So far, the program has distributed over 4.8 million nets, trained nearly 43,000 malaria control agents, and directly reached almost 9 million community members. From net use to symptom recognition and treatment-seeking behavior, all NetsforLife(®) metrics show significant progress in malaria prevention in program areas. Nevertheless, challenges in malaria control continue as the world races to achieve universal coverage (defined as one net for every two people) and the Millennium Development Goal (MDG) target of reducing malaria-related deaths by 75%.
http://www.redorbit.com/news/health/2034273/netsforlife_achieving_progress_and_impact/index.html?source=r_health

MALARIA: Ghana: Deputy Health Minister counsels change towards malaria treatment

14 March 2011
 Deputy Health Minister, Rojo Mettle-Nunoo

Deputy Health Minister Rojo Mettle Nunoo says malaria patients’ failure to complete the full course of their medication is seriously stalling efforts to eradicate the disease.
He is also worried about the influx of fake malaria drugs on the market.
Rojo Mettle Nunoo who was addressing the launch of an anti-malaria campaign by the Hyundai Motor Company said apart from governments, citizens also have a key responsibility in malaria prevention.
He said while people “gladly receive the mosquito net, they will pack it under their bed or in their suit case. That is not they way to stop malaria”.
The Deputy Minister said he was particularly concerned that pregnant women “who go to hospital and are given mosquito nets to take home do not use the mosquito net”.
Prevention is better than cure, he stated.
The Hyundai Motor Company intends to set aside funds each year for the anti-malaria campaign.
Jihad Hijazi, the Chief Executive, said the programme was intended to last between 3-5 years.
He said this year Hyundai distributors, Auto Plaza Limited, has planned to contribute $150,000 to the fight against Malaria.
http://news.myjoyonline.com/health/201103/62667.asp

MALARIA: Leading Bed Net Manufacturers Commit to an Industry Code of Conduct

In a major push for transparent and efficient bed net procurement practices, the industry's dominant manufacturers have recently committed to company Codes of Conduct. By addressing bottlenecks in the delivery and disbursement of insecticide-treated bed nets, a more streamlined delivery approach will help prevent malaria cases across the globe.
Formulated through GBC's Bed Net Industry Dialogue, company codes of conduct are complimented by Industry Action Commitments, to ensure heightened transparency and good governance for bed net procurement. These Industry Action Commitments are designed to serve as the cornerstone for future engagements with key government, multilateral and donor stakeholders. Participants in the Bed Net Dialogue have committed to:
General principals of transparency and good governance, through Codes of Conduct
Prioritizing focus on complying with competition and trade law, business practices against corruption, conflict of interest policies, documentation standards and financial reporting

Strengthening compliance mechanisms
"We've seen this in other industries, but this is the first time a group of bed net manufacturers have collectively agreed on a set of business principles and practices to ensure transparency and improved governance of procurement practices," said Anna Thompson-Quaye, Director at GBC . "The bed net Industry is committed to this effort through a certification process, one which shows proactive leadership and a commitment to doing the right thing. I am thrilled that GBC was able to play a key role in organizing commitments to action by the industry."

Commending the dialogue is Michael Santoro, Business Ethics Advisor, GBC/ Professor of Management and Global Business, Rutgers Business School. "An innovative feature of the Bed Net Dialogue is its openness and engagement with different global stakeholders. Under the skillful and experienced guidance of the GBC, the bed net manufacturers have taken a practical, problem-solving approach to working with governments, NGOs, and the funding community. This kind of multi-sectoral cooperation is essential to achieving the urgent public health goal of eradicating malaria, and it is good business too."

Vestergaard Frandsen CEO Mikkel Vestergaard commented on the GBC-led conversation as well: "As the largest manufacturer of bed nets, my company is keenly aware of the ongoing challenges that must be consistently overcome to protect people from malaria. By facilitating strategic collaborations and shared best practices through the Bed Net Dialogue, the GBC and Industry are playing a vital role in identifying and overcoming the many obstacles in procurement and transparency involved in the fight against malaria."

The following companies have affirmed their commitments to the Industry Commitments with the following certification statements: A to Z Textile Mills; Bayer Environmental Science; Clarke Mosquito Control; BASF; Sumitomo Chemicals; Syngenta; Tana Netting; Vestergaard Frandsen
http://www.gbcimpact.org/node/2940