Despite recent significant declines, in 2010 malaria remained one of the biggest killers of young children in Eastern and Southern Africa, accounting for more than 40 million probable confirmed cases, 100,000 inpatients and 35,000 recorded deaths. Malaria also contributes to high levels of anaemia in children and pregnant women, and to low birth weights – one of the key underlying causes of infant mortality and an impediment to children’s ability to grow healthy and reach their full potential.
Malaria is a disease of poverty. It affects mainly the poor living in malaria-prone rural or urban areas that offer few, if any, barriers against mosquitoes. It has serious economic impacts, slowing economic growth and perpetuating the vicious cycle of poverty.
One of the most effective ways of reducing malaria and saving lives is by correctly diagnosing people infected and then quickly eliminating malaria parasites using anti-malaria drugs. Recent malaria control innovations have improved the quality and expanded access of malaria case management to millions of children down to their villages and even homes.
Rapid Diagnostic Tests (RDTs) are now used by community health workers (CHWs) to correctly diagnose malaria. Confirmed cases can then be fully cured by treatment with highly effective Artemisinin Combination Therapy (ACT) drugs, thus reducing malaria and potentially saving thousands of lives. In most endemic countries millions of pregnant women are now also provided with prophylactic anti-malaria drugs as part of the Interruptive Preventive Treatment (IPT), during their second and third trimesters to prevent infections.
Use of Long Lasting Insecticide Nets (LLINs) and implementation of Indoor Residual Spraying (IRS) prevents mosquitoes transmitting malaria parasites between people and reduces re-infection of people that have been recently cured. Sleeping under LLINs can reduce overall child mortality by 20 percent. There is evidence that LLINs, when consistently and correctly used, can save six child lives per year for every 1,000 children sleeping under them. In Eastern and Southern Africa, the proportion of children under five years in malaria-affected areas sleeping under LLINs has increased rapidly since 2005, with the more highly endemic countries achieving more than 40 percent net use. However, more effort is needed to further increase this to reach the globally agreed target of 80.Malaria - Percentage of children under-five sleeping under insecticide-treated nets
The graph below is from the Rollback Malaria Partnership, Progress and Impact Series, Number 7 – September 2011. It illustrates the increasing number of children’s lives saved by malaria prevention.
UNICEF in action
UNICEF in actionIn 1998, the Roll Back Malaria Partnership was launched by WHO, UNICEF, UNDP and the World Bank, in an effort to provide a coordinated global response to the disease. Later in 2003, The Global Fund against AIDS, Tuberculosis and Malaria (GFATM) started providing substantial funding for the first time, totalling billions of dollars per annum. And in 2005 USAID introduced the Presidents Malaria Initiative (PMI), which is now also a significant major contributor to national malaria control programmes in several countries in Eastern and Southern Africa. All these efforts and financial support have provided unprecedented opportunities to significantly reduce malaria-related child mortality in Africa.
Together with these partners, UNICEF supports Indoor Residual Spraying and distributes Long Lasting Insecticide Nets as part of routine health services and campaigns. UNICEF works with Ministries of Health, WHO, the GFATM, PMI, non-governmental organizations (NGOs), as well as community health workers to strengthen local health systems to provide quality malaria services as close to affected families as possible. UNICEF has helped countries to leverage additional funds, and procured and distributed tens of millions of LLINs to countries in the region.
Waiting even six hours for treatment can mean life or death for a child sick with malaria. To help further reduce these child deaths, UNICEF has increasingly supported national governments and partners to expand and strengthen integrated rural health systems to start using new Rapid Diagnostic Tests (RDTs) and roll-out the highly effective Artemisinin Combination Therapy (ACT). For the first time children infected with malaria can be accurately diagnosed with RDTs and treated by community health workers correctly in the village and even at home.
Results for children
Data compiled in 2010 has shown that malaria has been reduced by 50 percent between 2000 to 2009 in Botswana, Madagascar, Namibia, South Africa, Swaziland, Eritrea, Rwanda and Zambia . Concurrent reductions in moderate and severe anaemia among children has also been clearly documented, further improving child survival.
These results translate into hundreds of thousands of fewer malaria cases, concurrent declines in anaemia and consequently thousands of lives saved in the last few years. Furthermore provision of Interruptive Preventive Treatment (IPT) prophylaxis to pregnant women has also helped reduce low birth weights and improve the health of pregnant women by reducing anaemia, and preventing pregnancy-related complications.
With the introduction of RDTs and more effective anti-malaria treatments, it is becoming clearer that variations in geographical, seasonal and temporal distribution of malaria are much greater. More countries are now adjusting their malaria reduction responses, taking into account these geographical variations: where malaria is rare, some countries have even embarked on eliminating the parasite in localized areas, but where malaria has actually increased, such as during climate-related epidemics and during emergencies, rapid remedial actions are being implemented.
In the last five years countries in Eastern and Southern Africa has seen an unprecedented large scale expansion of LLIN used to prevent malaria transmission and the implementation of effective new innovative strategies to diagnose and treat malaria cases. By consolidating the last decades’ achievements, further reductions in malaria-related deaths is likely to significantly contribute to MDG 4 with the aim of reducing under-five mortality by two thirds by 2015.
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