MALARIA: Ghana: AngloGold Ashanti investment in a malaria control programme

May 10, 2011 : Anso Thom


A multi-million rand AngloGold Ashanti investment in a malaria control programme in Ghana has led to massive reductions in productivity losses, school absenteeism, infant mortality and treatment costs, a report released at the World Economic Forum has shown.
Malaria is a completely preventable and treatable disease that kills almost 800 000 adults and children worldwide, 90% of them in Africa – where it accounts for almost 20% of all child deaths.
According to the World Health Organisation’s Roll Back Malaria (RBM) programme Malaria is costing Africa U$12-billion annually in lost productivity.
Steve Knowles, Director for Malaria Control at AngloGold Ashanti presented details on their flagship programme at one of their mines in Obuasi, Ghana were their intervention reduced the burden of malaria in the entire community, increased school attendance, reduced absenteeism at the mine, increased productivity and reduced the cost of malaria treatment.
“There was no doubt that malaria was the biggest threat to us as a company,” said Knowles, who has been spearheading the programme’s expansion to their mines in Ghana, Mali, Guinea and Tanzania as well as other industries and mines in these countries.
In 2005 the Obuasi Mine Hospital was seeing a staggering average of 6 800 malaria patients per month, of a workforce of 8 000.
Of these 2 500 were mine employees with an average of three days off per patient which equates to 7 500 man shifts lost per month.
“This coupled with a slow work rate during recuperation, resulted in a major loss of production,” said Knowles. The cost of medication for treatment was in excess of U$55 500 per month.
The Obuasi Malaria Control Programme essentially consisted of killing the mosquitoes through indoor residual spraying, preventing the mosquitoes from biting with nets, screening and repellants, controlling breeding via environmental management and anti-malarial drugs.
The combined interventions has led to an average decline of over 5 800 cases per month (75%) since 2005. School attendance has increased by 70% and according to Knowles the infant mortality in now zero.
The average monthly cost of treatment has also declined from U$55 000 to just over U$6 000 and the lost man-days due to malaria has been reduced from almost 7 000 per month to just over 160.
The Programme has now teamed up with the Ghana government which was recently awarded U$133-million over five years by the Global Fund to Fight AIDS, Tuberculosis and Malaria. The money has been earmarked to scale up the “Obuasi Model” to 40 districts.
Knowles said they were assisted by the “very robust health system and infrastructure” in Ghana as well as the country’s health insurance scheme.
“There were nurses and clinics and most of our professional training was really targeted at the laboratory personnel, training them in the diagnosis of the disease,” he said.
He said the picture was very different in Guinea and Mali.
“The brain drain in West Africa is horrendous,” she said.
Knowles said the insecticides they used were “100% safe” although they did not use DDT as the mosquitoes in Obuasi were resistant to it.
“There are no side-effects whatsoever and I would be quite happy to have my children live in any of the houses we spray,” he said.
Knowles grinned: “I remember a time when you could not sit outside in Obuasi without having hundreds of mozzies zooming around your head. There are now no mozzies in Obuasi.”
http://www.theghanaianjournal.com/2011/05/10/malaria-investment-pays-off/

MALARIA: Nigeria: Pregnant women and battle against malaria

Oluwole Ige : 30 May 2011



Pregnant women at an ante-natal clinic

Malaria, from the medical point of view, is caused by female mosquito known as anopheles, which drops its Plasmodium into the system of individuals after biting. It is no respecter of status, gender and age. Besides, it is one of the highest killer-diseases in Africa. Some experts even claim that malaria kills more than the dreaded HIV/AIDS, especially in Sub-Saharan Africa. The new dimension to the scourge of the disease is its ravaging effects on the population of pregnant women in Nigeria.

Recently, the Ogun State Commissioner for Health, Dr Isiaq Salako, hinted that about 4, 500 pregnant women die of malaria in the country annually.
Though, the figure appears insignificant, considering the over 150 million population of Nigeria, it is an established fact that the disease remains a great threat to the population particularly expectant mothers.
According to Dr Adelakin Makanjuola, a consultant gynaecologist, malaria is a parasitic infection transmitted to humans through the bites of infected female anopheles mosquitoes. About 60 species of the anopheles mosquito are major transmitters of the disease. There are four different types of malaria parasites, plasmodium falciparum, P. malariae, P. ovale, and P. vivax. Within each species there are many variant strains. Worldwide, P. falciparum and vivax cause the vast majority of clinical cases and nearly all of the deaths and serious morbidity.
In Africa, P. falciparum, the most dangerous of the parasites, causes over 90 per cent of all malaria infections. So far, entomologists have identified over 2000 species of mosquito, but only the anopheles mosquito actually transmits malaria. In Africa, the major vector of malaria is An. gambiae, and there are many members of this group of mosquito. The parasite after spreading rapidly through the bloodstream to the liver, emerges again into the blood stream, finally to settle in the red blood cells, where it multiplies and emerges in bursts of new organisms.
These parasites, because of their large numbers, can cause particular damage to the nervous system, liver, and kidney. The resulting disease in humans can be devastating, especially in young children and adults including, pregnant mothers and their unborn babies as well as Nigerians in diaspora who have been away from Nigeria or other malarious zones for more than two years and have either not developed natural immunity or have lost it.
This group is also very vulnerable to cerebral malaria which can result in death within hours. Others die later from the infection either from overwhelming anaemia, liver or kidney failure. Generally speaking, with untreated malaria, up to 20 per cent of persons infected with falciparum malaria will die. The stark reality of this scourge in Nigeria is as follows: In Nigeria, there is an estimated 25 per cent -30 per cent of mortality in children under five, or an estimated 300,000 deaths each year due to malaria.
The campaign slogans aimed at battling the endemic disease are endless and their messages catchy to drive home the need to avoid environmental and sanitary conditions are, capable of fuelling the spread of the malaria. Such slogans include: “Roll back malaria; Counting malaria out; Effective malaria treatment, and Free Africa from malaria now, among others. The improper disposal of refuse, stagnant water, gross inadequate access to right medication and inability of many families to access preventive facilities like bed nets have been identified as factors aiding malaria infections.
Despite the aggressive campaigns against the disease and the huge financial and manpower commitments by the Federal Government, donor agencies, including the World Health Organisation (WHO), Global Fund and other stakeholders in the health sector, malaria continues to constitute a serious health challenge, with the 110 million clinically diagnosed cases in Nigeria annually.
From its debilitating effects, investigations by the United Nations Children Fund (UNICEF) revealed that the disease imposes a heavy social and economic burden, which resulted into a loss of about N132 billion annually in prevention, cost treatment and productivity loss in Nigeria. Such loss came in form of hours lost due to illness, deaths of members of the working population; impaired child development and absenteeism from work as a result of the disease.
Worst hit by the malaria endemic are the children and pregnant women. It adversely affects children under the age of five and pregnant women in Sub-Saharan Africa, leading to the death of nearly 3, 000 every day.
Apart from little children and infants, pregnant women are found to be highly susceptible to malaria attacks. Generally, expectant mothers have been medically proven to be four times more prone to malaria parasites than those not pregnant. Reports by medical experts indicate that when women become pregnant, their immunity and disease resistance level become low, therefore, they will be more or less helpless when malaria parasites strike.
It is not uncommon for some pregnant women, having frequent bouts of malaria fever and this has made it mandatory for them to seek medical treatment immediately, with a view to avoiding its negative consequences. Experts and consultant gynaecologists hold the view that malaria attack on pregnant women could lead to low blood pressure, premature labour, abortion, stillbirth, low weight babies, anaemia and possibly preventable death, if timely action is taken to reverse its trend.
The United Nations (UN) has done a lot in its quest to totally eradicate malaria. The Roll Back Malaria (RBM) and the Global Malaria Action Plan (GMAP) are some of the intervention strategies made by organisations and individuals to help deliver the world, including Nigeria from the shackles of malaria.
Despite the clear evidence that many pregnant women could be saved from the complications of malaria through the use of insecticide-treated nets (ITNs) and intermittent preventive treatment, many still succumb to death occasioned by malaria parasites. Towards this end, concerned health care practitioners have raised alarm, cautioning that if the situation is not checked on time, the target to checkmate the incidence of malaria in pregnancy will not be met and the gloomy pictures of the endemic disease will continue to wreck havoc on Nigerian women and their unborn babies.
The most pathetic development is that most times, the victims do not show any symptom of illness. Clinical records show that the malaria parasites attack the placenta even at low infection rates and this invasion of the placenta leads to ill health for the mother, which may precipitate abortion of the foetus as well as premature labour.
More frightening is the recent world malaria report, which indicated that Nigeria accounts for a quarter of all malaria cases in the 45 malaria-endemic countries in Africa. This revelation obviously brings to the front burner the daunting challenges of malaria in the country. Thus, pregnant women, who are identified as one of the groups at high risk of the effects of malaria infection, need special protective measures to ensure their survival and improve birth outcomes.
Therefore, sleeping under insecticide treated nets remains one of the key strategies for protecting expectant mothers and their newborns from malaria-carrying mosquitoes and seeking medical care after suspecting symptoms of malaria would also go a long way in combating the disease.
In an interview with the Nigerian Tribune, Dr Bukola Adesina, a gynaecologist, at the University College Hospital (UCH), Ibadan said malaria as a disease affects pregnant women in Nigeria, just like any other person. She described Nigeria as an endemic country as far as malaria infection is concerned.
“It is endemic in Nigeria. It is important to make a demarcation. It depends on what part of the world you are living because this determines to a large extent how you will react or respond to malaria,” she stated.
According to her, people get infected all year round, “though individuals, who live in endemic area or zone, have some level of immunity” but they still get infected after being bitten by mosquitoes that transmit malaria parasites into their body systems.
“When a woman becomes pregnant, her immunity mechanism will reduce. The malaria will live in the placenta of the woman. The placenta provides a safer abode for the malaria parasites and it is the supply link between the baby and the mother. After occupying the placenta region, malaria parasite will disturb the supply of nutrients to the baby; hence, the baby is starved and this negatively affects the weight of the baby,” Dr Adesina remarked.
While observing that Nigeria’s prenatal mortality ranked among one of the highest in the world, the gynaecologist maintained that malaria, which makes pregnant women to develop anaemia contributes to maternal mortality rate.
“It is observed that when the malaria parasite load is so much in the system of an expectant mother, the baby dies before delivery. There is no robust data capturing system in Nigeria. Worldwide, 10 per cent of maternal mortality is related to anaemia, which is a fallout of malaria,” Dr Adesina hinted.
She further listed reasons pregnant women die as a result of haemorrhage-bleeding, hypertension with seizures-convulsion, obstructed labour, abortion and infection, adding that part of the measures put in place by the federal government to combat maternal mortality include the provision of access to effective health care, Intermittent Preventive Therapy (IPT), Insecticide Treated Nets (ITNs) and prompt treatment of malaria with Artemisin Combination Therapy (ACT).
Dr Adesina, who canvassed for the effective education of the people, particularly pregnant women about the myths of malaria on the part of the government, said some people still believed erroneously that exposure to the sun could cause malaria infection, stressing the need for all to seek information about the disease.
According to her, poverty also contributed largely to the spread of malaria infection in Nigeria, advising that government should address poverty squarely as a veritable means of combating the scourge, saying that some people could not even seek medical services because of their inability to pay for the medicare.
Part of the short term measures that can be adopted by the government, Dr Adesina said, involve active collaboration with the mission homes and Traditional Birth Attendants (TBAs) because some pregnant women in Nigeria still patronise them for delivery services.
Said she, “the government should liaise with these mission homes and TBAs on the need to educate pregnant women to make use of Insecticide Treated Nets (ITNs) and create awareness about the danger that malaria poses to the health and survival of pregnant women in Nigeria”.
Continuing, Dr Adesina contended that “opinion leaders, religious groups, market women associations, civil society organisations, Non Governmental Organisations (NGOs) and health institutions are major stakeholders that government should work in synergy with to really have headway in the fight against malaria.
Some pregnant women who spoke to the Nigerian Tribune expressed concerns and fears over the debilitating effects of malaria parasites on their present status, lamenting that the infection had done irreversible damage to them in the past.
Mrs Sakirat Adebimpe regretted that she lost four months old pregnancy to malaria in 2009. She said “I do not treat malaria with kid’s gloves any longer because of the bitter experience I had in June 2009. I was attacked by malaria fever, though, I went to the hospital to treat it, I eventually had a miscarriage due to the extent of damage it had wrecked on my pregnancy then. The doctor observed that if I had reported at the hospital earlier, the malaria could not have affected the pregnancy.”
The 36 year-old woman, who is already carrying a six month pregnancy added that “nowadays, I attend ante-natal clinic regularly and if I feel or suspects any symptom of malaria, I hurriedly visit hospital to access appropriate medical services, with a view to warding off any advance from malaria parasites.”
In her own submission, Mrs Ijeoma Nwachukwu had this to say, “I have always adopted preventive measures to combat malaria. I am quite aware of the dangers that malaria poses to pregnant women and this has made it mandatory for me and my children to sleep inside Insecticide Treated Net [ITN] so as to avoid mosquitoes’ bites that cause malaria. Besides, I attend antenatal clinic and also go for medical checks regularly to avoid any untoward development”.
Several factors have been postulated as accounting for limited successes in eradicating malaria, which include lack of political will and commitment of successive Nigerian governments in tackling it, poor awareness and appreciation of the magnitude of the malaria burden right across the board, poor health facilities and practices by individuals and in communities and resistance to drugs and insecticides by malaria parasites.
http://tribune.com.ng/index.php/features/22651-pregnant-women-and-battle-against-malaria-scourge

MALARIA: Private Sector: Many Roles, Many Benefits

Bill Brieger : 13 May 2011

The latest edition in the Roll Back Malaria Progress and Impact Series is “Business investing in malaria control: economic returns and a healthy workforce for Africa. “The report provides an overview of the direct and indirect economic costs of malaria and looks closely at activities by three businesses in Zambia to tackle the malaria problem.
These companies were “able to scale up malaria control quickly and have seen a rapid return on investment. Malaria-related spending at three company clinics in Zambia decreased by more than 75%, and a very conservative estimate showed that the companies gained an annualized rate of return of 28%.” These experiences provided “Strong models … for businesses to take leadership roles in controlling malaria, protecting their workers and their families, strengthening their businesses, and extending programmes into communities.”
In fact there are several different and complimentary business roles for participation in rolling back malaria as seen below …
Manufacturers of preventive and treatment commodities
Wholesalers and retailers of malaria prevention and treatment commodities
Private health service providers: Formal orthodox, Informal, Indigenous
Private companies and industries based in endemic areas that aim to prevent and treat malaria among their employees and surrounding communities
Private companies and industries that provide donations to or organize malaria programs whether they are based in endemic areas or not
Sales of non-malaria products with a proportion/donation to malaria programming, like PRODUCT RED
Private companies that donate to malaria programming through their Foundations
The RBM website that features the Progress and Impact Series on Business involvement provides 16 downloadable case studies on the different models outlined above. Several diverse examples follow:
The Azalaï Hotels Group in West Africa, an active participant in the United Against Malaria (UAM) campaign, implements programmes to protect its employees with nets and hotel guests against malaria.
The ExxonMobil Malaria Initiative protects employees, supports malaria research and enables NGOs to carry out innovative community malaria control efforts
The MTN telecommunications group uses its technology and communication platforms to educate communities through radio, television, SMS, billboards and fliers.
The Sumitomo Chemical Company not only produces long lasting insecticide-treated nets but has provided technical assistance toward the establishment of the A to Z Textile Mills, based in Arusha and Kisongo, Tanzania, to ensure locally produced net supplies.
Although not featured by RBM, AngloGold Ashanti in Ghana has maintained an indoor residual spraying from for all structures in Obuasi District for five years now. Cases of malaria illness have steadily reduced at the district hospital. This protects employees, their families and the wider community.
The impact of individual business efforts may affect a community or a region and vary widely from place to place. In order for greater impact to be felt, national malaria control programs need to identify all potential and actual business partners and bring them into national partnership forums so that collectively the private sector impact on malaria will be most strongly felt.
http://www.malariafreefuture.org/blog/?p=1198

MALARIA: Africa: Cheap Malaria Drugs to Flood Africa Soon

Yinka Shokunbi : 30 April 2011
With the renewed determination of the international community to sweep out malaria out of Africa, a new initiative to put affordable and effective anti-malaria drugs within the reach of people in often remote communities in Africa is making rapid progress.
In four implementing countries - Ghana, Kenya, Madagascar and Nigeria - life-saving malaria treatment can now be bought in private stores and pharmacies for as little as 50 U.S. cents as against previous cost which was up to 20 times as much.
The Affordable Medicines Facility - malaria (AMFm) gets key financial support from UNITAD, the United Kingdom and the Bill & Melinda Gates Foundation, technical support from members of the Roll Back Malaria (RBM) Partnership and it is hosted by the Global Fund.
The initiative, which began last year, is being piloted in eight countries - Ghana, Kenya, Madagascar, Niger, Nigeria, Tanzania (including Zanzibar), Uganda and Cambodia - to enable lessons to be learnt before a potential global rollout.
AMFm aims to make anti-malarial drugs, known as artemisinin-based combination therapies (ACTs), available as widely and cheaply as possible. About 225 million people fall ill with malaria every year and 780,000 die from the disease.
Although the World Health Organisation (WHO) specifically recommends ACTs as first-line treatment for Plasmodium falciparum malaria, the most deadly form of the disease, the drug accounts for only about one in five of all treatments taken for malaria and until recently, it has only been available for free or at low cost in public health facilities.
Most people buy anti-malaria treatments in private shops and pharmacies where ACTs were not available at an affordable price before the launch of AMFm. These shops sell older, cheap medicines such as chloroquine and sulfadoxine-pyrimethamine, which are no longer effective because the Plasmodium falciparum is increasingly resistant to them.
The objective of the AMFm programme is to drive out these ineffective therapies by bringing down ACT treatment costs drastically and making the drugs more accessible to millions of people.
According to the executive director of the Global Fund, Prof. Michel Kazatchkine, "We are making further progress in fighting malaria in Africa by providing affordable treatment to millions of people through the Affordable Medicines Facility for malaria," said executive director of the Global Fund.
"The Affordable Medicines Facility - malaria is a major step forward. It uses innovative financing methods to save lives by providing affordable and effective medicines to more people in need through the public, NGO and private sectors."
For the innovation to work, the Global Fund first negotiates a discounted price for ACTs with drug manufacturers and then pays most of the reduced price on behalf of importers from the private, NGO and public sectors, leading to an average sales price of less than 10 cents.
The reduced prices allow private wholesalers to sell the ACTs to retailers at a profit. Pharmacies and stores in turn sell the drugs to patients and caregivers with an additional mark-up, while keeping the retail price affordable.
The AMFm was introduced in the country in March 2011, ACTs that are not co-paid by the AMFm cost about 1,000 - 1,500 Naira (US$ 6.70 - 9.50) per adult treatment.
The Society for Family Health (SFH), a not-for-profit NGO started distribution of AMFm co-paid ACTs in Nigeria in March 2011.
Under AMFm, SFH will sell a full course of treatment for children aged under-five years in private health facilities and outlets at US$ 0.20. The adult course of treatment is expected to sell for US$ 0.80.
In the eight countries where the AMFm is being implemented, governments are supporting the initiative with public awareness campaigns and training for ACT providers.
http://allafrica.com/stories/201105021732.html

MALARIA: Malaria in Pregnancy & Procurement Supply Management

 Bill Brieger : 14 Dec 2010
Michelle Wallon from Jhpiego’s Zambia office discusses the challenges of maintaining stocks of sulphadoxine-pyrimethamine (SP) for use in Intermittent Preventive Treatment for pregnant women (IPTp) that arose during recent Roll Back Malaria meetings in Livingstone and Lusaka:



The effects of malaria in pregnancy are many and the interventions, simple. Intermittent Preventive Treatment (IPTp), insecticide-treated bed nets, and timely case management can reduce effects including maternal anemia, low birth weight, and maternal and fetal mortality. Yet, when speaking to clinicians and public health experts across Africa about prevention and control of malaria in pregnancy (MIP), there is a common theme – stock-outs of SP, the drug used for IPTp, commonly inhibit the effectiveness of MIP interventions.
IPTp is relatively straight-forward and SP, is an inexpensive drug. Furthermore, at the time that the IPTp recommendations were adopted via the Abuja Declaration in 2000, many countries were still procuring SP as the first-line treatment for the general population (For example, Nigeria did not officially switch to ACTs as firstline malaria drugs until 2005).
SP supplies were abundant when it was still recommended as treatment. What then is the problem now?
Although SP stock-outs are formally documented in only a few African countries, including Zambia, Tanzania, and Malawi, the problem can be inferred by most of the recent Demographic and Health Survey and Malaria Indicator Survey reports (e.g. Liberia, Nigeria, Uganda, Senegal) showing low coverage of the recommended two doses of IPTp. MIP experts readily and repeatedly identify a handful of culprits for the SP stock-out phenomenon.
One set of problems surrounds continued and irrational use of SP for treatment in RDT-negative cases in the general population that siphon off SP supplies from MIP services. These stem from …
Provider mistrust of RDTs coupled with policies that ACTs be provided only after positive diagnosis via RDT or microscopy
Real or perceived high incidences of malaria
Strong correlation in the community between fever and malaria with high expectations for malaria treatment
Weak clinical skills in the appropriate diagnosis and management of fever
Lack of skilled providers and high client loads
Inaccurate SP quantification based on population rather than consumption data and/or quantification failing to account for irrational use also create stock problems. Weak logistics systems with bottlenecks between central-level drug stores and receiving facilities result in stock-outs of both SP and ACTs.
These problems are not new and neither are the solutions. MIP has a potential advantage in that it falls under both reproductive health and national malaria control programs, and yet the persistence of SP stock-outs indicates that this is often used less as an opportunity for collaboration than as an excuse to pass the buck.
As the public health community moves towards more integrated programming, we must seize the opportunity to bridge the programmatic gap.
http://www.malariafreefuture.org/blog/?p=1116

MALARIA: Uganda Malaria Indicator Survey shows progress - is it enough?

 Bill Brieger : 14 Dec 2010

The Uganda Malaria Indicator Survey for 2009 is now available for reading. The report helpfully provides charts that distinguish levels of key indicators from the 2006 Uganda Demographic and Health Survey with the current data. While there has been clear progress, most indicators fall below the 80% targets set by the Roll Back Malaria Partnership for 2010.



The chart of the right shows that sleeping under any insecticide treated bed net the night prior to interview tripled for children under five years of age and quadrupled for pregnant women, the 2009 levels do not achieve RBM goals. Even when one looks only at households that actually possess these treated nets, one finds that use is less than ideal.



The report provides some reasons for low net usage…
The most common reason cited for non-usage was that the net was not hung (58 percent of households), especially in North East region (99 percent). Sixteen percent reported that the net was not used because it was too hot, and 11 percent said the net had too many holes or was too old.
There were also wide variations in ownership and use across different parts of the country, meaning that program managers need to look more indepth at possible regional factors that discourage access to and use of nets.
The East African countries were among the pioneers to introduce intermittent preventive treatment with sulphadoxine-pyrimethamine for pregnant women. Again we see that RBM targets are far from being met in Uganda, although progress over 2006 is evident.

16% of pregnant women got two doses in 2006
45% got one dose in 2009
32% got two doses in 2009
95% of pregnant women attended ANC with a skilled provider at least once in 2009

Clearly problems of procurement, supply and stock keeping and missed opportunities are preventing achievement of this goal.
The malaria case management picture was not cheering. Among children under five years of age with a reported fever in the two weeks before the survey …
60% took any antimalarial drug
23% of took an ACT
14% took ACT same or next day
Chloroquine and SP were still being used
Uganda is not in a unique situation. Even countries benefiting from the Global Fund, the US President’s Malaria Initiative and other major partners like Unicef, DfID and the WOld Bank are having a challenging time with managing commodities, improving service quality and attracting clients to avail themselves of malaria services.

2010 ends in 17 days. How many places will have achieved the RBM 80% targets? More importantly, what can the international partnership do to meet the needs?
http://www.malariafreefuture.org/blog/?p=1115

MALARIA: There is a 60% global shortfall in funds for malaria control

Researchers found only 21 out of 93 countries where malaria is common have received enough money to implement effective control measures.
African countries have seen the biggest funding increases but billions are still needed elsewhere, the experts say in the Lancet medical journal.
The Roll Back Malaria Campaign warned $4.9bn (£3.1bn) was needed this year.The researchers, led by Professor Bob Snow of Oxford University and Kenya's Kenyatta National Hospital, found that annual international funding had increased by 166% - from $730m to $1.94bn - since 2007.
They said: "Any decline in malaria-funding commitments will run the risk of a resurgence of malaria in countries that have enjoyed the benefits of this funding to provide protection from malaria since 2002.
Poor countries with inadequate donor assistance and large sectors of their population at risk of malaria must remain the focus of attention”
Professor Bob Snow
"Susained funding in these countries is crucial or $9.9bn invested since 2002 will have been in vain."
While financing for malaria control has increased as part of international efforts to reach the Millennium Development Goals, the amount received from domestic sources varies greatly.
Twenty-one countries, 12 of them in Africa, now receive adequate donor money, according to the research.
But a further 50, including Niger and Sierra Leone, as detailed in the Lancet paper, do not get enough from the international community.
Professor Snow said: "Poor countries with inadequate donor assistance and large sectors of their population at risk of malaria must remain the focus of attention if global ambitions for malaria control are to be realised.
"The challenge will now be on finding more money, making sure funding is linked to performance and putting pressure on malaria-endemic countries with large domestic incomes to do more for themselves.
"A failure to maintain the momentum will mean money spent so far will have been for nothing."
The authors also argue that some countries like China and India, which have their own space programmes, could perhaps contribute funds to help other countries rather than being recipients, thereby increasing the financial support available.
But the work only assesses external funding.
Commenting on the study, Professor Anne Mills, from the London School of Hygiene and Tropical Medicine in the UK, said that external funding may be low because a country may be funding its own malaria programmes.
 http://www.bbc.co.uk/news/health-11453519

MALARIA: Bed nets go unused

But even as donations roll in and millions of bed nets pile up in warehouses across Africa, aid agencies and non-governmental organizations are quietly grappling with a problem: Data suggest that, at least in some places, nearly half of Africans who have access to the nets refuse to sleep under them.
Why that is gets to the heart of the trouble with our efforts to dislodge the diseases of the very poor. When scientists first developed the treated nets in the late 1990s, they were hailed by international donors and aid agencies as a magic bullet for malaria. Unlike nearly everything else that combats the disease, including better housing and drainage, anti-malarial drugs and insecticidal spray campaigns, the insecticide-doused nets are cheap and easy to use. Equally important, they require little infrastructure on the ground. A single volunteer on a motorcycle can distribute hundreds of nets a day, in even the most remote locales. There is no need for cold storage to keep drugs and vaccines refrigerated, nor for expert clinicians to oversee proper dosage.
To date, millions of dollars from international agencies, NGOs and USAID have been spent to get treated nets into the hands of impoverished, sub-Saharan Africans. The inter-agency Roll Back Malaria Partnership is calling for 730 million more.
But, as even the staunchest advocate will admit, the treated nets were not designed with the cultural preferences of the rural African villager in mind. Among other design flaws, their tight mesh blocks ventilation, a serious problem in the hot, humid places where malaria roosts. Minor discomfort might be tolerable in rural African communities desperate for anti-malarial prevention. But, as medical anthropologists have consistently found, because malaria is so common in much of sub-Saharan Africa, and because the overwhelming majority of cases go away on their own, most rural Africans consider malaria a minor ailment, the way that Westerners might think of the cold or flu. Many rural people also believe that malaria is caused not just by mosquitoes but also by other factors such as mangoes, or hard work.
As a result, while we see the treated nets as a lifesaving gift, they see them as a discomfort that provides only partial protection against a trivial illness. Is it any wonder that many use their nets to catch fish or as wedding veils or room dividers — all documented uses of insecticide-treated bed nets? If that sounds ungrateful, think about what would happen if public health officials, concerned about the 41,000 lives that Americans lose every year due to flu, blanketed the United States with anti-viral face masks to be worn during the winter flu season. Donning masks would be a simple, safe and effective measure that could save thousands of lives. But would people wear them?
http://www.latimes.com/news/opinion/commentary/la-oe-shah-20100502,0,85181.story

Insecticide treated nets

Major signs of progress across Africa in the fight against malaria, particularly the increase in distribution of insecticide-treated nets (ITNs), is one of the findings of the new ‘Malaria and Children, Progress in Intervention Coverage’ report that was released today.
However the report, a joint effort between UNICEF, the Roll Back Malaria (RBM) Partnership and The Global Fund to Fight AIDS, Tuberculosis and Malaria, also highlights that the disease still causes an estimated 1 million deaths each year, most of these children in Africa.
http://www2.unicef.org/media/media_49446.html