Monday, December 24, 2007

Why is malaria such a burden?

Dear Colleagues

Malaria is a burden because it is so prevalent in Africa and it is a debilitating disease. It is a killer disease especially for very young children and pregnant women. People cannot work when they are suffering a malaria attack. There have been estimates of the loss of economic output caused by malaria ... and they are significant ... maybe as much as $15 billion a year.

This number is not particularly meaningful, because it does nothing to answer the question of WHY malaria is a burden.

Part of the answer to this question is that national and international leadership has failed to make malaria control a priority and has neither deployed enough money, nor has used the money in the most cost effective way. Though malaria has been brought under control in many places, it remains a serious disease in the malaria endemic areas of Africa.

The international campaign to ban the use of DDT had a serious impact on malaria control programs, and while this was a factor in the failure to control malaria, it was only part of the explanation. Another part was the lack of interest in malaria on the part of the international donor community as a whole, and another part was the lack of leadership on the matter from the governments of Africa.

Over the years, drug therapy to minimize the impact of malaria has become less and less effective, as resistance has built up. Low cost chloroquine is not longer and effective therapy and much more costly drugs have to be used. Few are able to benefit from these drugs unless they are funded by donors.

Since 2000, there has been more interest in malaria control, and a much increased donor funding of programs to address the malaria crisis. But though there has been substantially more money, there are questions about how effective the increased funding has been in reducing the burden of malaria in society.

Clearly there has been some success ... but success has been measured more in the amount of coverage a program has achieved rather than the results that have achieved. Yes ... more people have bednets, and yes ... more people slept under them last night ... but how much less malaria, and how much less prevalence of the parasite. These latter questions are not being answered.

There is significant focus on mortality, especially young children and pregnant women. This results in reduced mortality for these groups ... which has a human value, but not so much an economic value. One without the other is not enough.

There is little or no attention being paid to the morbidity of working age adults. This is the group that is needed to make the economy improve, and make it possible for the society to move forward. Without this, malaria will remain a burden.

There is a lot of work to do to optimise the fund flows in the malaria subsector so that the burden of malaria is reduced as rapidly as possible and in a way that is sustainable. Tr-Ac-Net models suggest that programs that have a clear geographic focus, that consider the whole population, that incorporate all possible control interventions and are optimized based on good data can have a very rapid impact ... but this is not what is being done in most of Africa and by most implementing organizations.

The programs developed by the Integrated Malaria Management Consortium aim to address the malaria problem using a full range of interventions, and using scientific and management data to drive operational activities and the allocation of resources.

It is going to be interesting to see how many programs will demonstrate a reduction in the burden of malaria in 2008.


Peter Burgess

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