Malaria Control Improves in Sub-Sahara Africa

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More children and pregnant women in sub-Saharan Africa now have greater access to effective malaria control measures, according to World Health Organisation

By Anayo Ezugwu  |  Dec 26, 2016 @ 01:00 GMT  |

THE World Health Organisation, WHO, has said that children and pregnant women in sub-Saharan Africa have greater access to effective malaria control measures. The WHO’s World Malaria Report 2016, published on Tuesday, December 13, revealed that across the region, a steep increase in diagnostic testing for children and preventive treatment for pregnant women has been reported over the last five years.

It stated that among all populations at risk of malaria, the use of insecticide-treated nets has expanded rapidly, but in many countries in the region, substantial gaps in programme coverage remain. According to WHO, funding shortfalls and fragile health systems are undermining overall progress, jeopardising the attainment of global targets.

“Sub-Saharan Africa carries a disproportionately high share of the global malaria burden. In 2015, the region was home to 90 percent of malaria cases and 92 percent of malaria deaths. Children under five years of age are particularly vulnerable, accounting for an estimated 70 percent of all malaria deaths.

“Diagnostic testing enables health providers to rapidly detect malaria and prescribe life-saving treatment. New findings presented in the report show that, in 2015, approximately half (51 percent) of children with a fever seeking care at a public health facility in 22 African countries received a diagnostic test for malaria, compared to 29 percent in 2010.”

To protect women in areas of moderate and high malaria transmission in Africa, WHO recommends that ‘Intermittent Preventive Treatment in Pregnancy’ IPTP, with sulfadoxine-pyrimethamine. The treatment, it noted administered at each scheduled antenatal care visit after the first trimester, can prevent maternal and infant mortality, anaemia, and the other adverse effects of malaria in pregnancy.

According to available data, WHO said there was a five-fold increase in the percentage of women receiving the recommended three or more doses of this preventive treatment in 20 African countries. The organisation said the coverage reached 31 percent in 2015, up from six percent in 2010. “Insecticide-treated nets are the cornerstone of malaria prevention efforts in Africa. The report found that more than half (53 percent) of the population at risk in sub-Saharan Africa slept under a treated net in 2015, compared to 30 percent in 2010.”

Last month, WHO released the findings of a major five-year evaluation in five countries, the study showed that people who slept under long-lasting insecticidal nets, LLINs, had significantly lower rates of malaria infection than those who did not use a net, even though mosquitoes showed resistance to pyrethroids (the only insecticide class used in LLINs) in all of these areas.

Malaria remains an acute public health problem, particularly in sub-Saharan Africa, according to the report, there were 212 million new cases of malaria and 429 000 deaths worldwide in 2015. “There are still substantial gaps in the coverage of core malaria control tools. In 2015, an estimated 43 percent of the population in sub-Saharan Africa was not protected by treated nets or indoor spraying with insecticides, the primary methods of malaria vector control. In many countries, health systems are under-resourced and poorly accessible to those most at risk of malaria.

“In 2015, a large proportion (36 percent) of children with a fever was not taken to a health facility for care in 23 African countries. We are definitely seeing progress. But the world is still struggling to achieve the high levels of programme coverage that are needed to beat this disease.”

Pedro Alonso, director, WHO Global Malaria Programme, said at the 2015 World Health Assembly, that member states adopted the Global Technical Strategy for Malaria 2016-2030. The strategy, he said set ambitious targets for 2030 with milestones every five years to track progress.

“Eliminating malaria in at least 10 countries is a milestone for 2020. The report shows that prospects for reaching this target are bright: In 2015, 10 countries and territories reported fewer than 150 indigenous cases of malaria and a further nine countries reported between 150 and 1000 cases.

“Countries that have achieved at least three consecutive years of zero indigenous cases of malaria are eligible to apply for the WHO certification of malaria elimination. In recent months, the WHO director-general certified that Kyrgyzstan and Sri Lanka had eliminated malaria. But progress towards other key targets must be accelerated. The strategy calls for a 40 percent reduction in malaria case incidence by the year 2020, compared to a 2015 baseline.”

According to him, less than half (40) of the 91 countries and territories with malaria are on track to achieve this milestone. Alonso said progress has been particularly slow in countries with a high malaria burden. “Sustained and sufficient funding for malaria control is a serious challenge. Despite a steep increase in global investment for malaria between 2000 and 2010, funding has since flat-lined. In 2015, malaria funding totalled US$ 2.9 billion, representing only 45 percent of the funding milestone for 2020 (US$ 6.4 billion).

“Governments of malaria-endemic countries provided about 31 percent of total malaria funding in 2015. The United States of America is the largest international malaria funder, accounting for about 35 percent of total funding in 2015, followed by the United Kingdom of Great Britain and Northern Ireland (16 percent). If global targets are to be met, funding from both domestic and international sources must increase substantially,” he said.

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