MALARIA: Redrawing Roadmaps - can we get there from here?

Bill Brieger : 15 May 2011
The Roll Back Malaria Partnership guided countries to develop 2010 roadmaps for major malaria commodity and support service availability and gaps. The aim was to aid planning to reach universal coverage by the end of 2010. Forty-seven countries/locations on the African Continent and surrounding islands completed the analysis and started moving down the road to success.
In the case of 36 countries the road became a little longer than anticipated. Part of the challenge was international - there are only a few manufacturers of long lasting insecticide-treated nets, for example. Some of the barriers were internal, inadequate estimates of the logistical costs to distribute commodities, even if they were in hand. Now we have 2011 roadmaps in an effort to meet up with the original 2010 goals of 80% coverage with essential malaria commodities.

At least one-quarter of countries that actually targeted a specific intervention in 2010, did not meet the 80% goals. Of particular concern is the fact that Rapid Diagnostic test use is both off target and not keeping up with ACTs.
Meeting procurement and distribution targets is one step, but getting people to use malaria control interventions is another challenge. As the director of a prominent Nigerian NGO recently said, “… ‘though about 35.6 million nets have been distributed across the country, it is highly under utilized,’ which according to him is responsible for the high death rate associated with malaria.”

Nigeria provides an instructive case. The roadmap for 2010 called for 62.9m LLINs of which 4.4m were already in place and pledges were set for 49.4m. This left a gap of 9.2m. While the RBM 2010 roadmap analysis shows that Nigeria met its LLIN target, the implication is that the target did not include the gap. Now the 2011 roadmap for Nigeria now shows that resources are in hand for both the 9.2m gap from the 2010 campaign plus an additional 8.2 m for routine distribution in clinics as a keep-up measure.
The gross figures do not fully reflect the fact that of the 36 states (plus one capital territory), campaign distribution of LLINs continued from 2010 into 2011 in 17 states. So far 9 or the 17 have completed distribution, but by carrying the campaign into 2011 additional delays were met in the remainder due to national elections, delayed local funding for the effort, and distribution logistics. So again while the roadmaps help identify commodity gaps, they do not always identify the challenges at the level of distribution and use.
The roadmap process is an important planning tool. It needs to be supplemented with plans for logistical support and health education to encourage use of the malaria commodities and services that are eventually distributed. For example, Nigeria estimates that it needs close to $17m for Monitoring and Evaluation and Information. Education and Communication. We can see from the Nigerian roadmaps that this planning needs to be a continuous process - not only is annual resupply of ACTs, RDTs and SP for IPTp needed, but also continuous stocks of nets for routine, keep-up services.
http://www.malariafreefuture.org/blog/?p=1201

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: 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: Universal Coverage - if not now, when?

Bill Brieger : 30 Dec 2010
As of October 2010 Nigeria had distributed long lasting insecticide-treated nets (LLINs) 14 of the 36 states and the Federal Capital Territory and about 40% of the targeted 60 million plus nets. A key challenge was, “The lack of operational funds to support campaigns in 22 states significantly resulting in undue delays in the delivery of LLINs.” More progress was made during the remaining months of the year.
Where are we on 31st December 2010? The Roll Back Malaria Partnership’s most recent report on progress toward targets (the country road maps) is seen in the chart. Intervention coverage progress is based on the number of countries that are actually implementing nets, medicines and spraying.
As can be seen the best progress comes with treatment and preventive medicines (ACTs and IPTp respectively). Only 64% of countries have distributed at nets to at least 80% of the targets. The biggest gap in in the area of rapid diagnostic testing.
Distribution of an intervention does not mean actual coverage has been achieved. A recently reported study from Nigeria shows the challenges once nets reach the household.
Oyeyemi and colleagues found that 95.2% of households has received a net after a campaign. Unfortunately progress went downhill from there: “87.3% of the LLINs received were present in the households during the survey and 52.1% of households hung their LLINs … (and) utilization rate of a LLIN among the sampled population was 59% the previous night before the survey.”
Recent Demographic and Health and Malaria Indicator Surveys from places like Liberia, Senegal and Nigeria show that possession of a net by a household is not a guarantee that it will be used.


From the chart we can see that efforts to attain universal coverage - or more accurately universal distribution - will have to proceed into 2011. Distribution goals require health systems strengthening. The coverage goals will require more intensive community outreach and education to ensure these interventions are actually used.



We are achieving outputs - commodities distributed; we are struggling with outcomes - commodities used. What will we see in terms of impact by 2015 - the latest on the list of public health targets where we started this posting?
http://www.malariafreefuture.org/blog/?p=1141

MALARIA: Roll back Malaria

PROGRESS & IMPACT SERIES Number 3 . September 2010
Saving Lives with Malaria Control:
Counting Down to the Millennium Development Goals
New Report shows investment in malaria prevention paying off: hundreds of thousands of children’s lives saved
Model predicts more good news: with increased funding, another 3 million deaths can be prevented

A new report confirms that the current global investment in malaria control is saving lives and that further increases in funding will contribute significantly to achieving the Millennium Development Goals (MDGs) for health. Saving Lives with Malaria Control: Counting Down to the Millennium Development Goals – authored by Tulane University, Johns Hopkins University, WHO and PATH and published today by the Roll Back Malaria Partnership (RBM)– reveals that the lives of almost three quarters of a million children in 34 African countries are estimated to have been saved in the past 10 years, through the use of insecticide treated mosquito nets, indoor residual spraying, and preventive treatment of malaria during pregnancy.
The report estimates that an additional 3 million lives could be saved by 2015 if the world continues to increase investment in tackling the disease.
Malaria causes over 850,000 deaths per year worldwide, the majority of deaths in Africa where the disease accounts for almost 20% of all child deaths. Malaria also threatens the health of pregnant women. In sub-Saharan Africa , as many as 10,000 pregnant women die each year of malaria-related causes, mainly anaemia.
Massive increases in the availability of insecticide treated nets have been recorded in the last few years. However, directly measuring the impact of insecticide nets, treatments and other malaria control efforts is difficult as health information systems remain weak, and the majority of malaria deaths are not properly recorded.
The Lives Saved Tool (LiST) - developed to be used across major childhood diseases - is being applied to malaria prevention across Africa . The report provides the first assessment of lives saved based on the level of coverage achieved with currently available malaria prevention tools. Although this does not include data on lives saved from diagnosis and treatment, and is likely to be an underestimate, the results show just how much progress has been made.
"The findings from this report clearly show the efficacy of our efforts to save lives, especially among children in Africa ," says Professor Awa Coll Seck, RBM Partnership Executive Director. "This is a vital tool which can help strengthen country planning and guide us all as we focus on 2015." Findings from the report also show that the number of rural households protected by either insecticide-treated nets or indoor residual spraying has increased significantly, especially in the latter half of this decade. The report estimates that malaria funding in 2010 could result in 500 more children alive every day.
"This report demonstrates the critical importance of malaria control efforts to reaching the healthrelated Millennium Development Goals by 2015" states Dr Robert Newman, director of the Global Malaria Programme at WHO. "Without continued investment in malaria, reaching the MDG for child survival is unlikely to be reached in Africa ."
"While we've made great progress, much work remains", said Rear Admiral (Ret.) Tim Ziemer, U.S. Global Malaria Coordinator. "To reach the Millennium Development Goals, we must accelerate our efforts to expand not only malaria prevention and treatment, but also a broad range of communitybased health services. The Administration's Global Health Initiative is helping partner countries achieve major advances through innovation, integration and improved health service delivery in countries."
Progress made in controlling malaria is still very fragile. The Global Fund to Fight AIDS, Tuberculosis and Malaria, the largest funder of malaria control programmes worldwide, will hold its third replenishment meeting in November 2010, where governments will make financial pledges which may well determine if the malaria-related MDGs can be achieved.
http://www.rollbackmalaria.org/ProgressImpactSeries/docs/report3-en.pdf

MALARIA: Can Malaria Be Beaten?

Jeremy Laurance 05 Aug 2010 The Independent
When I see a packet of malaria pills I think of that famous Clint Eastwood line from Dirty Harry, delivered as he pointed his .44 magnum at a bank robber and neither of them could remember how many shots he had fired, or whether there was still one left in the chamber. "The question you have got to ask yourself is: do I feel lucky? Well, do ya, punk?"Actually, I do. Lucky enough not to have to take the nasty, expensive little things on my periodic visits to Africa and other malarial parts of the world. Now I find myself being asked to reconsider after X Factor star Cheryl Cole's unpleasant encounter with a mosquito in Tanzania. Such is the power of celebrity.I based my view on a Lancet paper published in the 1990s by London's Hospital for Tropical Diseases which assessed the chances of contracting malaria, for those not taking prophylactic drugs, at 0.6 per cent for an average two-week holiday in East Africa. The authors described this as "high" and in public health terms I suppose it is - the Health Protection Agency points out that more than 1,500 people are diagnosed with malaria in the UK each year having acquired it abroad.But it didn't seem high to me - and I disliked the way commercial travel clinics pushed expensive injections and other protective measures at frightened travellers without quantifying the risks. So for the last 15 years I have followed a rough rule of thumb: if I am slumming it or travelling into the bush, I take the pills; if I am staying in four-star hotels in town, I don't bother. My impression is that many regular visitors to Africa do the same. Public health doctors may demur - and Ms Cole's story undoubtedly strengthens their case. She had spent only six days in Tanzania and had, reportedly, taken anti-malarial drugs that provide 90 per cent protection. How unlucky is that?Doubly unlucky because - and this is the real story about malaria - in many parts of the world it is declining, rapidly. About 2.5 billion people live in malarial areas around the globe, and the disease kills almost a million of them every year, mostly children. Changes in the incidence of the disease may go unnoticed by tourists but have huge significance for the local population. Now Cheryl Cole, who first visited Tanzania last year on a charity expedition to Mount Kilimanjaro, has helped focus attention on their plight in a way she could hardly have anticipated.In coastal Kenya, not far from where she was holidaying, cases of severe malaria in children have fallen 90 per cent in the last five years. Similar falls have been reported from other locations across Africa and the world.In certain islands in the Philippines malaria has been eliminated. Mexico is said to be close to eradication, and some countries in Central and South America are moving in the same direction. Morocco was recently declared malaria-free by the World Health Organisation, helping boost the tourist trade there.Sub-Saharan Africa, which bears 70 per cent of the disease burden, presents a much tougher challenge. Yet even here there have been spectacular advances, as in coastal Kenya. Last week, the African Leaders Malaria Alliance announced that malaria cases and deaths had been cut by up to 80 per cent in 10 African countries since 2000, including Ethiopia, Ghana, Rwanda, Zambia and Zanzibar.Among malaria specialists, where gloom prevailed a decade ago, the buzzword now is "elimination": no more malaria deaths by 2015 and no more malaria a decade or two after that. As the Lancet noted last month, "previously cautious malariologists, released from a 40-year collective depression... have been invigorated."How has this change of heart come about? Some call it the Bill Gates effect. Almost three years ago, the world's biggest philanthropist threw down a challenge to the global health community to eliminate malaria in his lifetime. Sceptics responded that his dream would only be realised if he were cryo-preserved. Yet his call had a galvanising effect.The Foundation that he leads with his wife, Melinda, has not only given grants of dizzying size to the search for a malaria vaccine, the distribution of bed nets and other measures, it has also brought a new vigour to the entire aid industry. Its speed and flexibility leaves larger bureaucracies like the UN standing, and where it goes others follow. It has been described as a new type of multilateral organisation, introducing entrepreneurial flair to a sector submerged in red tape.Some complain that Gates is seeking to replicate the world domination he achieved with Microsoft in another, albeit altruistic, sphere. These critics say the new entrepreneurial aid business he has spawned is undemocratic, overly powerful, and is leading to empire- building, wasteful competition, fragmentation and duplication. Why should Bill Gates decide which sorts of vaccines get developed? they ask.There is no denying, however, the impact of Gates's interest on the bottom line. Today's funding for malaria, from all sources, exceeds $10bn (£6.3bn) - a hundredfold increase in little more than a decade. Celebrities from Senegalese musician Youssou N'Dour to David Beckham have joined the cause. Politicians Bill Clinton and Tony Blair have become involved through their respective aid foundations, followed by a growing queue of corporate donors and public figures who bring clout, profile and funding. This week, Andrew Mitchell, the International Development Secretary, published the UK's business plan for malaria, opening a consultation on the best ways of supporting the fight against the disease.Malaria - for so long the poor relation to Aids in terms of global attention, despite claiming more lives in many countries - is suddenly glamorous.The tools for elimination are to hand. More than 200m insecticide-treated bed nets have been distributed since 2000, and are estimated to have saved 1m lives, according to the Roll Back Malaria Partnership. Ban ki-Moon, the UN Secretary General, said that with the delivery of a further 150m bed nets by the end of this year "universal coverage of malaria prevention can be achieved". Vast funds have been invested in indoor spraying against mosquitoes, in distributing more effective artemesinin-based drugs against the disease, and in developing a vaccine, with one candidate, made by the UK-based pharmaceutical manufacturer GlaxoSmithKline, in final (phase III) human trials.But meeting Gates's challenge will be a tough task. Optimists, such as Sir Richard Feachem of the Malaria Elimination Group, point to the "shrinking map" of malaria, which included the US and the UK in 1900 (when malaria was endemic in the Kent marshes). Today, 108 countries in the world are malaria-free. One hundred countries have continuing malaria transmission, and of these, 39 are embarked upon malaria elimination. The remaining 61 are striving to control malaria, but it is Feachem's hope that they too can be persuaded to switch to a policy of elimination.The task is immense. In 2008, malaria killed 863,000 people. Almost 90 per cent of those who died were in Africa, and of those, almost 90 per cent were children under five, according to the WHO. Children are especially vulnerable because they have undeveloped immune systems; the WHO estimates the disease kills 3,000 children a day.The world has been striving to eliminate malaria for more than half a century - with faint success. The Global Malaria Eradication Programme was launched in 1955 but it quickly became apparent that its ambition was not achievable in sub-Saharan Africa. In the late Sixties the strategy switched from eradication to long-term control; people with fever caused by the disease were treated with the then standard drug, chloroquine. But as resistance to the drug grew, malaria deaths rose through the 1970s and 1980s. By the early 1990s the strategy was recognised as a disaster.Throughout the 1990s, as nations wrung their hands over Aids, efforts were made to refocus attention on malaria. The world's health ministers launched a global declaration in Amsterdam in 1992 to control the disease, with a focus on Africa. The latest drive against the disease began 10 years ago, when leaders of countries across Africa signed a declaration in Abuja, Nigeria to "halve the malaria mortality for Africa's people by 2010". Initially progress was slow; there were reports that instead of declining, malaria was rising, by up to half in some areas. Accurate figures were hard to come by, and estimates were distrusted. What is not in dispute, however, is that over the last three years things have moved much more quickly, and more consistently in the right direction. The huge rise in the importation of bed nets and artemesinin drugs has saved millions of lives.Controlling malaria has come to be seen as good business, not just good charity. The disease is estimated to cost Africa $12bn a year - 1.3 per cent of its economic growth. If that sum could be saved, it would constitute the biggest boost to health and development in the continent's history. Eradicating disease boosts productivity, creates markets and stabilises governments.The future, however, is anything but certain. Though the 90 per cent fall in children with severe malaria on the Kenyan coast is impressive, the reasons are not obvious. Malaria has been in decline in this area for at least 15 years and some have suggested climate change is a factor. Meanwhile it is rising in upland areas around Mount Kenya, where incidence was previously low. Professor Robert Snow, who reported the Kenyan figures in The Lancet, said malaria had changed "from a major cause of childhood illness and death to a relatively minor problem" on Kenya's coast. But it was simplistic to attribute it to more bed nets and better drugs. "The truth is probably much more complex," he wrote.Critics also question the notion of "universal coverage" with bed nets - expected in Ethiopia and southern Sudan this year and everywhere in early 2011. How many nets can you hang in a small hut occupied by a large family? Some older children are always likely to go without. There have been distribution problems too: the rush to freight in bed nets has left thousands of them sitting in warehouses because there was no means of transporting them over the final miles.Malaria is concentrated around the equator, the "middle, wet bit" of Africa, with just seven countries accounting for two thirds of all cases: the Democratic Republic of Congo, Ethiopia, Kenya, Nigeria, southern Sudan, Tanzania and Uganda. While there have been gains in some, others such as Nigeria have done less well. With a population of 120 million, Nigeria contributes heavily to the global malaria burden.Even where success has been achieved, there is no guarantee it will be permanent. Zanzibar, the island off Tanzania that has become a luxury tourist destination, has eliminated malaria twice before but each time it has been re-imported from the mainland. Kenya has also slipped back, and in Congo the uncertainties multiply.Constant vigilance is essential. That requires stable, committed government. It is not always available. In Uganda, grants worth over $350m were suspended by the Global Fund over allegations of corruption (which are currently before the courts). In Tanzania a grant worth over $100m from the Global Fund was discovered unclaimed last year because it lacked a single signature.Countries worst affected by the disease have been reluctant to buy the new artemesinin-based drugs because of their cost. At $1 to $2 a dose, they are 10 times more expensive than chloroquine. Though funded by aid programmes today, governments wonder for how long that funding will last. There are fears about resistance too, signs of which have emerged on the Thai-Cambodian border. If the artemesinin drugs lose their potency, there is nothing else immediately in the pharmaceutical locker.Eradication may be the only way to combat resistance. The most taxing question, however, and one which divides the malaria community, is what penalties may follow success? Chris Drakeley, director of the Malaria Centre at the London School of Hygiene and Tropical Medicine, points out that enormous funds are required to eliminate the last few cases of a disease - witness polio, still defying efforts to wipe it from the planet."If malaria drops down the Top 10 list of worst diseases, what justification is there for putting in vast resources to eliminate it? In a situation where malaria had been controlled to a low level for a decade, you would have a large group of children with no immunity to the disease. The impact of an outbreak could then be devastating. There is an argument that some level of malaria is quite good - it maintains a level of immunity in the population."The best hope for the future is a vaccine. No disease has ever been eliminated without a vaccine. But malaria is not caused by a simple virus - it is an organism (a parasite) with a nucleus that is more complex than a virus.The front runner is GlaxoSmithKline's RTSS vaccine, currently being tested in 14,000 children in 11 African countries, with results due in 2012. Early trials suggested that it provided 30-50 per cent protection - far from perfect, but a lot better than nothing.Scientists are optimistic that it will provide a useful further weapon against malaria. But there will be many years yet of fighting before the war can be declared won.
http://www.independent.co.uk/life-style/health-and-families/features/can-malaria-be-beaten-2043383.html

MALARIA: place for volunteers

After walking for over three hours in the Mozambique heat, Emilia Primeiro reached the health centre. She was seven months' pregnant but she needed a mosquito net. "It's my first check up," says the 27-year-old. "I heard on the radio that because I'm pregnant, I would be given a net. I'm hoping that the nurse will give me one. I'm frightened of malaria."
Emilia lives in rural Inhambane province in the south-east of the country and 20 kilometres from her nearest health centre in Jangamo, but it was worth the walk for an insecticide-treated net (ITN) to protect her against mosquitoes. Only recently, Emilia's two-year-old son, Filipe, died of malaria. "He had fevers and then the next day he got fits. It was too late to carry him here. He died at home."
Children under the age of five, pregnant women and people with HIV are the most vulnerable to malaria, which is transmitted by female mosquitoes carrying one of five species of the plasmodium parasite. In Africa, one in five child deaths is caused by malaria and the World Health Organization (WHO) estimates that 243 million cases led to 863,000 deaths worldwide in 2008.
The disease is treatable, preventable, and although there is no human vaccine, its science is well understood. The weapons to defeat it, including ITNs and the more durable Long Lasting Insecticide Nets (LLINs), are all available today. Nets have proved to be a simple and effective solution for preventing mosquitoes from biting from dusk till dawn.
"When you put the LLINs into villages, every net acts as a mosquito trap," says Paul Emerson of the Carter Center, a US-based charity. "If they touch the net they are dead. So you can get coverage in a village of only about 70-80 percent and everybody gets protected from malaria because you shift the age of the mosquitoes and you don't get those mosquitoes growing old and becoming infectious."
In recent years, the global community has accelerated its fight against malaria and millions of free nets have been distributed across Africa by international aid agencies working in coordination with national health ministries. Nets have been deployed in large-scale programmes or handed to pregnant women like Emilia at antenatal clinics. The strategy has been to give nets to the most vulnerable to meet the UN's Millennium Development Goal 6 of reversing the incidence of malaria by 2015, and the Abuja Declaration – signed by 44 African leaders in Nigeria in 2000 – to reduce the burden of malaria by the end of 2010.
But nets alone won't cure the sick or eradicate the disease. A three-pronged attack with indoor residual spraying (IRS) of buildings to kill mosquitoes, and by prescribing artemisinin combination therapy (ACT) is widely accepted as the best solution. Governments must act fast – there are growing fears that mosquitoes around the Thailand-Cambodia border are building up resistance to insecticides.
So far the strategy seems to be working. A WHO assessment of children of all ages in four regions of Ethiopia in 2007 revealed a 67% drop in confirmed malaria cases, a 54% decline in malaria admissions, and a 55% decrease in malaria deaths thanks to this approach. And according to UNICEF, handing out nets to each family door to door in Tete Province in Mozambique helped to reduce malaria cases and deaths by nearly 70% and 90% respectively in the past year.
Statistics, however, may mask fundamental problems in malaria-endemic regions. The International Federation of Red Cross and Red Crescent Societies (IFRC) believes that local volunteers are essential to saving lives. In the district of Diébougou in Burkina Faso, the IFRC piloted universal coverage to give nets to all 110,000 citizens in 2009. Local volunteers were trained to raise awareness, to encourage people to collect the nets, and to show people how to hang them up. Advising people house to house about the cause of malaria, where to get treatment and how to replace a damaged net helped the most vulnerable and the most remote people. The pilot increased net usage rates and significantly reduced the incidence of malaria.
Living with his family of 17, Ihiri Justin Sonda received nine nets during the campaign for all the sleeping spaces in his home. "Recently, I spent two days in the hospital because of malaria," he says. "During my convalescence, our seven-month old baby was treated in intensive care, also for malaria. And two years ago, we lost a one-month-old baby girl because of malaria so I hope these nets will improve health in our family."
Volunteers also help to diagnose the disease which is especially important for young children who can die within 24 hours of showing the first symptoms. By speaking the language, and knowing the community's customs and habits, locals can make a huge contribution, but challenges remain. "Sometimes it is hard to convince people who have symptoms of malaria to go to the health centre," says volunteer Jefferson Sié Kam. "People have strong habits of using medicinal plants and traditional healers and some of them don't believe in modern medicine. Fortunately, mosquito nets are widely accepted and people understand the importance to sleep under them."
By educating and empowering local people, and by providing the funding and support, net distribution programmes are showing positive results. Not only is this good for the health of individuals, but it also means people can use their energy to work, and their money to buy food and take care of their families instead of paying for expensive medicines. People and the economy benefit from the fight against malaria, which costs Africa $12 billion annually in losses and economic growth according to the Roll Back Malaria Partnership.
When Emilia left the health centre under Mozambique's midday sun with her new net, she was happy and optimistic. "The mosquitoes are not going to bother me tonight," she says. "And when my baby is born, he or she will sleep with me under this net."
http://www.guardian.co.uk/journalismcompetition/local-volunteers-vital-to-winning-global-fight-against-malaria

Malaria Kills: Distributing 63 Million Bednets in Nigeria with RapidSMS

The human and economic cost of malaria in Nigeria is staggering. There are currently 110 million clinically diagnosed cases in a population of 151 million. Malaria kills 250,000 children under five years old in Nigeria every year, and is the cause of 11% of maternal deaths. 60% of out-patient visits and 30% of hospitalizations in the country are malaria-related.
In addition to the enormous toll malaria takes on public health, it is also expensive. 132 billion Naira (USD $870 million) is lost every year in the form of malaria prevention and treatment costs and from the loss of overall economic productivity.

 And yet in spite of the risk malaria poses to the Nigerian people, health surveys from 2006 to 2008 indicated that only 8% of households in the country owned at least one insecticide-treated net (So-called ITNs).
Needless to say, there is an urgent need for ramped-up malaria prevention efforts in Nigeria. 

The Nigerian government has been collaborating with a variety of international organizations, including the World Bank, World Health Organization, UNDP and UNICEF on a campaign to “Roll Back Malaria.” This effort has led to the creation of the National Malaria Control Program (NMCP) that seeks to unify all of the disparate pieces of the Nigerian malaria control strategy at the national, regional and local levels.
In its 2006-2010 strategic plan, the NMCP sets out the goals of “a reduction of [the] malaria burden by half (50%) by the year 2010 compared to the year 2000.” UNICEF is a key partner in the Nigerian anti-malaria campaign, supplying “safe, effective and affordable anti-malaria interventions.” NMCP and UNICEF have called for the distribution 63 million insecticide-treated bednets to Nigerian households by the end of 2010. According to Naawa Sipilanyambe, UNICEF Nigeria's Chief of Health and Nutrition, by February 2010, 80% of households in 10 states had received ITNs through the initiative. As of March 2010, 16.5 million ITNs have been distributed in 11 states.
No Data Means Decision Making in the Dark
“Often, we feel we’re making decisions in the dark.” According to Tim Akinbo, a local software developer who works with UNICEF in Nigeria, this is the feedback UNICEF field staff would offer when asked about the challenges they encountered in doing their work. Indeed, when rolling out a logistically complex initiative like the large-scale distribution of bednets, implementation teams constantly need to find ways to work around the constraints in large-scale aid delivery. Poor infrastructure, issues related to transportation and communication, difficulties of accessing and working in remote locations all test the supply chain management of aid organizations.UNICEF Innovation, working with its country offices, launched a mobile technology initiative in 2008 to address the challenges in on-the-ground data collection and supply chain management in aid delivery. RapidSMS, on of the products that orginitated with the Innovation team, is a free, open-source framework for dynamic data collection, logistics coordination, and communication. The software was introduced as a tool to resolve a common problem in the delivery of aid projects: How can relevant be collected and accessed data faster?
RapidSMS in Supply Chain Management
RapidSMS was developed by UNICEF Innovation in partnership with the technology company Dimagi, along with members of the Open Mobile Consortium. RapidSMS implementations across Africa capitalize on the growing prevalence of mobile phones on the continent, and the ease and cost-effectiveness of text messaging to allow for better and more timely coordination of aid delivery projects. Following a famine in Ethiopia in 2008, UNICEF carried out a large-scale food distribution program with the help of mobile phones targeting malnourished children at more than 1,800 feeding centers. RapidSMS was first used to track the real-time availability and delivery of food aid in remote locations, helping to eliminate the kind of delays a paper-based data collection system creates.
http://mobileactive.org/malaria-kills-getting-63-million-bednets-nigerians-rapidsms

Potential Disparity between money spent and benefit achieved

LONDON — Health groups have spent more than a billion dollars and bought millions of bednets to fight malaria, and 20 African countries have increased their bednet coverage at least fivefold, new research says.
In a report on the status of malaria in Africa issued on Monday by UNICEF and Roll Back Malaria, a U.N.-led partnership, the authors said $1.8 billion was spent last year, a 10-fold jump since 2004. More than 150 million insecticide-treated bednets to protect against the mosquito-borne disease have been produced and donors have purchased 160 million drug treatments.
If the bednets are indeed getting to people at risk, that number puts some countries on target to reach a U.N. goal of providing a bednet to all 350 million people at risk of malaria by the end of this year, officials said.
But other experts said the figures are an artificial symbol of success against the disease.
"These are meaningless input measures that tell us only (the UN) is effective at spending other people's money," said Philip Stevens, a health-policy expert at the London think tank International Policy Network.
Richard Tren, director of Africa Fighting Malaria, an Africa and US-based advocacy group, said measuring malaria spending and the numbers of drugs bought did not always mean more Africans had access to them.
Tren said he had once been in Uganda when the central warehouse had plenty of malaria drugs but clinics throughout the country had none. "They had no trucks to deliver anything," he said.
http://www.google.com/hostednews/ap/article/ALeqM5gJ7WJQPxbm4WliunMZ3BQO0umNigD9F68J302

Malaria & G8

OTTAWA – An international group of malaria experts is calling on G8 leaders to make the disease part of its plan to boost maternal and child health.
Astrid, Princess of Belgium, told a meeting of Canadian parliamentarians and anti-malaria organizations it's critical to get the message across that malaria is completely preventable.
“Malaria control is central to improving the health and well-being of populations in endemic countries,” she said Friday in Ottawa.
Malaria kills one million African children every year. Pregnant women are four times more likely to catch malaria, which leads to severe maternal anemia, premature births and low birth weight. But it's easy to prevent malaria with insecticide-treated bed nets, and handing out free nets is a way to get women into clinics for prenatal care, said Debra Lefebvre of Buy-A-Net, a Canadian organization that raises money to distribute free nets.
Awa Marie Coll-Seck, executive director of Roll Back Malaria, says she's worried the priorities of the G8 change every year, but malaria should be a consistent target.
“Malaria is on the development agenda and I am happy to see you all raising the issue at the G8,” Coll-Seck said. “Every priority, malaria is there.”
http://www.torontosun.com/news/canada/2010/04/16/13615346.html