Global malaria death toll falling

 
Mosquito Anopheles mosquitoes spread malaria

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We all like reports of dramatic medical and scientific breakthroughs but the reality is that most developments are incremental. As a result, important issues can get overlooked.

Take malaria. Deaths from the parasitic infection - which is spread by the bites of infected mosquitoes - have been falling steadily since around 2004. Only a few years ago it was said that the disease killed one child every 30 seconds. I remember using this figure on a trip to Ghana in 2006. By 2009 the estimate was down to one child dying every 45 seconds.

"It is now more likely that malaria kills a child every sixty seconds," according to Dr Richard Cibulskis, the lead author of the World Malaria Report.

He explained some statistical factors are at work here - in part the fall is due to a downward revision in overall global childhood mortality.

Updates in surveillance numbers in recent years has also led to a fall in the global estimate of cases. Assessing the burden of malaria is not straightforward. Many Africa countries do not have strong disease surveillance systems so cause of death data is not always well recorded. This means that surveys and what are called 'verbal autopsies' - descriptions of symptoms given by parents - are sometimes used.

Progress

Despite difficulties in compiling the statistics, there is a clear, and welcome, downward trend in deaths. It is estimated that malaria killed 655,000 people in 2010, compared to 800,000 in 2004.

Start Quote

When I began working in the malaria field in Africa we were fighting a losing battle. Now all that has changed.”

End Quote Dr Richard Cibulskis World Health Organization

"It is remarkable progress," said Dr Cibulskis. "When I began working in the malaria field in Africa we were fighting a losing battle. Now all that has changed and the risk of dying from malaria has fallen by a third in a decade."

The improvement is down to several factors. A total of 145 million long-lasting insecticide-treated nets were delivered to sub-Saharan Africa last year, a huge increase on 2009. Spraying the walls of homes with insecticide is another effective means of reducing malaria.

Once infected, it is vital that treatment begins quickly. Rapid diagnostic tests are being increasingly used. These detect the presence of malaria parasites in the blood, often via a simple finger-prick test.

The use of artemisinin-based combination therapies has transformed the treatment of the disease in the past decade.

Children who are seriously ill can make a dramatic and rapid recovery after just a couple of days of taking the drug.

Drug-resistance

There continue to be worrying signs of drug resistance, first confirmed on the Cambodia-Thailand border in 2009 and now suspected in Burma and Vietnam.

To reduce the chances of drug resistance spreading it is vital that artemisinin-based treatments are giving in combination, and yet 25 countries - most in Africa - still allow the marketing of monotherapies. The WHO says most of the manufacturers are in India.

There are promising indications from trials of a vaccine against malaria, but this will be only part of the solution to tackling this preventable infection.

There are concerns about the global funding of malaria control which is expected to peak at $2bn this year and fall to $1.5bn in 2015. The UK government is notable among donors in that its support is pledged to increase in the coming years.

Malaria remains a major public health threat. Nine out of 10 deaths are in Africa and the vast majority are children under five.

Four countries - Armenia, the United Arab Emirates, Morocco and Turkmenistan - have been certified free of malaria since 2007. But around more than three billion people in around 100 countries remain at risk. The battle against malaria has a long way to go.

 
Fergus Walsh Article written by Fergus Walsh Fergus Walsh Medical correspondent

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  • rate this
    +1

    Comment number 14.

    9.JFJ - nice idea in theory, but falls down at the stage of practice.

    DDT was & will/would always be the bluntest of tools. It is not possible to use it carefully, mores the pity.

  • rate this
    +2

    Comment number 13.

    Though not mentioned here there's a stage 1 field trial going on in South America at the moment, involving releasing agressive, but sterile, male moscuitos into breeding areas where malaria is present - if all goes according to plan they'll out compete the existing males, but the females they mate with will produce no offspring, hopefully vastly reducing the problem at source.

  • rate this
    0

    Comment number 12.

    As a former aid worker in a small Sub-Saharan African village I question these statistics. When I personally knew of 3 children that died last year in my village alone I find it hard to believe that only 655,000 people died of Malaria last year. It is more likely that with the economic downturn deaths are just being reported less accurately. Less aid money= less money for treatment and research.

  • rate this
    0

    Comment number 11.

    In sub-Saharan Africa (SSA), malaria caused by Plasmodium falciparum has historically been a major contributor to morbidity and mortality. Recent reports indicate a pronounced decline in infection and disease rates which are commonly ascribed to large-scale bed net programmes and improved case management. However, the decline has also occurred in areas with limited or no intervention.

  • rate this
    0

    Comment number 10.

    If 9 out of 10 deaths occur in Africa and a vast amount of deaths are children, then surely we need to act more quickly and provide the drugs required to prevent so many deaths. It is always a question of expense and who would provide it. I sincerely hope the economic recovery will appear sooner rather than later, which could only make the situation worse in Africa and other countries.

  • rate this
    0

    Comment number 9.

    Millions of African children have died since zealous actvists had DDT effectively banned. Judicious use (not overuse as was the case of earlier application) of DDT would have prevented their deaths. Shame on WWF and others who still fail to put the welfare of the vulnerable at the top of their priority list.

  • rate this
    +1

    Comment number 8.

    It is not just drug resistance that needs to be addressed. The mosquitoes are also becoming resistant to the insecticides used so effectively on long lasting insecticide treated nets and indoor wall sprays. Research into, and development of, novel insecticides and ways of controlling the mosquitoes are also urgently required.

  • rate this
    0

    Comment number 7.

    Right now, there is an economic slowdown threatening to curb future progress. WHO's annual global report said international funding rose to about $1.7B in 2010 & $2B in 2011, the highest annual amounts ever.
    But this is still far short of est. $5B - $6B needed to reach zero deaths from malaria by 2015.

  • rate this
    0

    Comment number 6.

    There appear to be difficulties in compiling the statistics: It is estimated that malaria killed 655,000 people in 2010, but 250,000 children in Nigeria alone? At least in Nigeria, the battle is being lost.

  • rate this
    0

    Comment number 5.

    In Nigeria commitment is pathetic. e.g. Last 2 years, population @ 157M, minimum required @ N20 billion. The Fed. Govt committed paltry N200 million. 2011 Appropriation is @ N600 million - not even enough for mosquito-treated nets. Donations are less 7% of requirements.
    Key problems: corruption, lack of political will, resources not properly utilised.

  • rate this
    0

    Comment number 4.

    Malaria kills an average of about 250,000 children yearly in Nigeria; it kills more than HIV/AIDS & tuberculosis put together. It also kills a lot of pregnant women. In fact, 11% of death in these women results from malaria fever & complications. In hospitals, you will see a great number of children suffering from what we call cerebral malaria, parasite entering the brain: It kills.

  • rate this
    +1

    Comment number 3.

    It can only be hoped that the WHO warnings are noted & that steps are taken to address the going resistance. To those who question the value of overseas aid this provides a great example of what can be achieved. Thank you Fergus.

  • rate this
    0

    Comment number 2.

    The drug resistance is a real concern, the climate changes will bring ever more human populus into contact with this terrible disease.

    There is no quick fix for this problem, and in this economy who wants to spend R&D money on it? Only philanthropy on a grand scale may have enough of a chance to make a real difference.

    Bill Gates, the world needs your cash!

  • rate this
    0

    Comment number 1.

    Some data related to the continuing saga of resistance to anti-malarial drugs can be browsed on the WWARN website:

    http://www.wwarn.org/resistance

 

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