Key findings
Global burden
According to the report, half of the world’s population
is at risk of malaria. An estimated 247 million cases of malaria occurred
in 2006, causing an estimated 881,000 deaths, mostly (91%) among African
children. Majority (85%) of the deaths were in children aged less than 5
years of age. A total of 109 countries were endemic for malaria in 2006,
45 within the WHO African region. South-East Asia (especially India)
region accounted for 4% of deaths(2).
Impact of malaria control strategy
Some countries that have implemented aggressive
programs of prevention and treatment, have reported significant reductions
in the malaria burden. Eritrea, Rwanda, Sao Tome and Principe reported
decline in the number of cases and deaths by 50% or more between 2000 and
2006–2007. In addition, 22 countries outside of Africa reported declines
of 50% or more in malaria cases and deaths between 2000 and 2006(2).
Status of preventive interventions
In 2006, the number of LLINs distributed almost tripled
to 36 million since 2004. Of 647 million people at risk in Africa, the
portion covered by insecticide-treated nets (ITNs) rose from 3% in 2001 to
26% in 2006 and an estimated 39% in 2007(2). Despite this progress,
coverage of nets and all other interventions are substantially below the
WHA target of 80% by 2010. Usage was also low with only 23% of children
and 27% of pregnant women sleeping under an ITN. Indoor insecticide
spraying in 2006 protected more than 100 million people, including 70
million in India and 22 million in Africa, where it appeared linked to a
decline in cases in Namibia, South Africa and Swaziland. Although 38% of
African under-five children with fever got some anti-malarial drug in
2006, only 3% sick children were given the more effective ACT despite a
big increase in supply. Only 18% of pregnant women in 16 African countries
received anti-malarial medicine as a preventive treatment to reduce the
risk of babies with low birth weight(2).
Shortcomings
There are several inadequacies in the report as far as
incidence and mortality data are concerned. Reliable data is missing from
many countries and, therefore, different methods have been used to
estimate these figures and these varied by region and even by country. For
example, in most African countries estimates were based on local climate
conditions, which correlate with malaria risk, and the average rate at
which people become ill with the disease in the area(1). The data provided
by National Malaria Control Programs are also inaccurate as in some
countries, reported cases include patients that are diagnosed clinically
but do not have smear positive malaria. The report’s estimate of deaths
and malaria cases are considerably lower than the estimates of 2005 World
Malaria Report but this seems primarily to be due to a refinement of
calculation methods, especially for Asia.
Need of the Hour
As quite clearly reflected in the report, the progress
of global efforts in malaria control is only modest. There are many areas
that call for urgent improvement. Surveillance systems are weak in endemic
countries of Africa. The coverage of preventive and curative interventions
is still substantially below the set targets in most countries. However,
more disturbing is the finding of high incidence of underutilization of
key interventions in many countries. This clearly reflects lack of
political will by governments of many such countries.
After a lapse of almost 40 years, malaria eradication
is back on the global health agenda and key organizations are starting to
debate the pros and cons of redefining eradication as an explicit goal of
malaria control efforts(3). There is more money than ever being pumped
into this initiative to give impetus to every constituent of the program,
be it purchase of medicines or investment in research to develop better
control tools, including a vaccine. These developments encouraged Director
General of WHO to dub the current situation as "the billion-dollar
moment for a centuries old disease!" No doubt, Malaria’s moment has
come, but success in control, let alone eradication, demands a renewed
commitment in every field- from implementation of existing interventions
to proper utilization to basic research related to drug and insecticide
resistance. Although we lack sufficient knowledge, systems and tools to
eradicate malaria today, we do have a window of political will and
financial resources to refocus on the goal of effective control through
universal coverage of appropriate interventions.
