In Niger, 50% deaths among children under five from malaria

In Niger, 50% deaths among children under five from malaria

20 SEPTEMBER 2005 | GENEVA — Seeking to avert a second wave of deaths among Niger’s undernourished children, the World Health Organization (WHO) is dispatching 100 000 antimalarial treatments to the west African country, where peak malaria season has begun in the midst of a humanitarian crisis.

Malaria causes more deaths each year in Niger among children under five years of age than any other single infection.

The current humanitarian crisis in Niger is chiefly a consequence of inadequate rains and a locust invasion in 2004, which resulted in poor harvests. Both farmers and nomadic herders have been struck by hunger.

“Even under ordinary conditions in Niger, 50% of all deaths among children under five are from malaria. Without appropriate measures the toll could rise even higher, because malnutrition makes children more likely to succumb to the disease. It also makes malaria less likely to be diagnosed, because it causes the symptoms of the disease to be less recognizable,” said Dr David Nabarro, Representative of the WHO Director-General for Health Action in Crises.

In the current crisis, some 200 000 children will remain at risk for malnutrition during the peak malaria season, which runs through October, and as many as half of them could contract malaria during that time.

WHO will provide artemisinin-based combination therapy (ACT), the most effective available treatment for falciparum malaria, the deadliest form of the disease and the type found in Niger. The medicines will be divided among the therapeutic feeding centres—each of them associated with a health centre—in the 16 districts that are at high risk of both malnutrition and malaria.

Because Niger only recently made the decision to adopt ACTs for the first-line treatment of uncomplicated malaria, many of its health workers are not fully acquainted with their use. To fill that gap, last week WHO sent a team of malaria experts. They have trained 40 health workers, who are now fanning out across Niger, holding workshops on the correct use of ACTs and refresher courses on the diagnosis and treatment of malaria, especially in malnourished young children. WHO’s nutrition team is providing additional training on how to treat malnutrition and its medical complications.

A malaria prevention initiative is also underway in Niger. The Global Fund to Fight AIDS, Tuberculosis and Malaria has donated 50 000 insecticide-treated mosquito nets to WHO for distribution in Niger to children at risk of malaria. Sleeping under a treated net is a highly effective prevention against this disease.

“For Niger’s children, malaria represents just as big a threat as hunger at present. We hope our efforts will help the country to cross this difficult passage, without losing more young lives to this preventable and curable disease,” said Dr Fatoumata Nafo-Traoré, Director of the WHO Roll Back Malaria Department.

Halting and beginning to reverse the incidence of Malaria by 2015 is one of the Millennium Development Goals.

Technical note: The medicine sent to Niger is artesunate + amodiaquine, one of four artemisinin-based combination therapies (ACTs) recommended by WHO.

Judith Mandelbaum-Schmid – Communications Officer, Roll Back Malaria

WHO/Geneva

Telephone: +41 22 791 2967

Mobile phone: +41 79 254 6835

E-mail: schmidj AT who.int



Marko Kokic – Information Officer

Health Action in Crises

WHO Geneva

Telephone: +41 22 791 24 48

Mobile phone: +41 79 217 34 11

E-mail: kokicm AT who.int

What is Malaria?

Malaria is a life-threatening parasitic disease transmitted by mosquitoes. It was once thought that the disease came from fetid marshes, hence the name mal aria, ((bad air). In 1880, scientists discovered the real cause of malaria a one-cell parasite called plasmodium. Later they discovered that the parasite is transmitted from person to person through the bite of a female Anopheles mosquito, which requires blood to nurture her eggs.

Today approximately 40% of the world’s population mostly those living in the world’s poorest countries is at risk of malaria. The disease was once more widespread but it was successfully eliminated from many countries with temperate climates during the mid 20th century. Today malaria is found throughout the tropical and sub-tropical regions of the world and causes more than 300 million acute illnesses and at least one million deaths annually.

Ninety per cent of deaths due to malaria occur in Africa south of the Sahara mostly among young children. Malaria kills an African child every 30 seconds. Many children who survive an episode of severe malaria may suffer from learning impairments or brain damage. Pregnant women and their unborn children are also particularly vulnerable to malaria, which is a major cause of perinatal mortality, low birth weight and maternal anaemia.

There are four types of human malaria Plasmodium vivax,

P. malariae, P. ovale and P. falciparum. P. vivax and P. falciparum are the most common and falciparum the most deadly type of malaria infection. Plasmodium falciparum malaria is most common in Africa, south of the Sahara, accounting in large part for the extremely high mortality in this region. There are also worrying indications of the spread of P. falciparum malaria into new regions of the world and its reappearance in areas where it had been eliminated.

The malaria parasite enters the human host when an infected Anopheles mosquito takes a blood meal. Inside the human host, the parasite undergoes a series of changes as part of its complex life-cycle. Its various stages allow plasmodia to evade the immune system, infect the liver and red blood cells, and finally develop into a form that is able to infect a mosquito again when it bites an infected person. Inside the mosquito, the parasite matures until it reaches the sexual stage where it can again infect a human host when the mosquito takes her next blood meal, 10 to 14 or more days later.

Malaria symptoms appear about 9 to 14 days after the infectious mosquito bite, although this varies with different plasmodium species. Typically, malaria produces fever, headache, vomiting and other flu-like symptoms. If drugs are not available for treatment or the parasites are resistant to them, the infection can progress rapidly to become life-threatening. Malaria can kill by infecting and destroying red blood cells (anaemia) and by clogging the capillaries that carry blood to the brain (cerebral malaria) or other vital organs.

Malaria, together with HIV/AIDS and TB, is one of the major public health challenges undermining development in the poorest countries in the world.

Malaria parasites are developing unacceptable levels of resistance to one drug after another and many insecticides are no longer useful against mosquitoes transmitting the disease. Years of vaccine research have produced few hopeful candidates and although scientists are redoubling the search, an effective vaccine is at best years away.

Science still has no magic bullet for malaria and many doubt that such a single solution will ever exist. Nevertheless, effective low-cost strategies are available for its treatment, prevention and control and the Roll Back Malaria global partnership is vigorously promoting them in Africa and other malaria-endemic regions of the world. Mosquito nets treated with insecticide reduce malaria transmission and child deaths. Prevention of malaria in pregnant women, through measures such as Intermittent Preventive Treatment and the use of insecticide-treated nets (ITNs), results in improvement in maternal health, infant health and survival. Prompt access to treatment with effective up-to-date medicines, such as artemisinin-based combination therapies (ACTs), saves lives. If countries can apply these and other measures on a wide scale and monitor them, then the burden of malaria will be significantly reduced.

Malaria in Africa

The vast majority of malaria deaths occur in Africa, south of the Sahara, where malaria also presents major obstacles to social and economic development. Malaria has been estimated to cost Africa more than US$ 12 billion every year in lost GDP, even though it could be controlled for a fraction of that sum.

There are at least 300 million acute cases of malaria each year globally, resulting in more than a million deaths. Around 90% of these deaths occur in Africa, mostly in young children. Malaria is Africa’s leading cause of under-five mortality (20%) and constitutes 10% of the continent’s overall disease burden. It accounts for 40% of public health expenditure, 30-50% of inpatient admissions, and up to 50% of outpatient visits in areas with high malaria transmission.

There are several reasons why Africa bears an overwhelming proportion of the malaria burden. Most malaria infections in Africa south of the Sahara are caused by Plasmodium falciparum, the most severe and life-threatening form of the disease. This region is also home to the most efficient, and therefore deadly, species of the mosquitoes which transmit the disease. Moreover, many countries in Africa lacked the infrastructures and resources necessary to mount sustainable campaigns against malaria and as a result few benefited from historical efforts to eradicate malaria.

In Africa today, malaria is understood to be both a disease of poverty and a cause of poverty. Annual economic growth in countries with high malaria transmission has historically been lower than in countries without malaria. Economists believe that malaria is responsible for a growth penalty of up to 1.3%% per year in some African countries. When compounded over the years, this penalty leads to substantial differences in GDP between countries with and without malaria and severely restrains the economic growth of the entire region. Malaria also has a direct impact on Africa’s human resources. Not only does malaria result in lost life and lost productivity due to illness and premature death, but malaria also hampers children’s schooling and social development through both absenteeism and permanent neurological and other damage associated with severe episodes of the disease.

One of the greatest challenges facing Africa in the fight against malaria is drug resistance. Resistance to chloroquine, the cheapest and most widely used antimalarial, is common throughout Africa (particularly in southern and eastern parts of the continent). Resistance to sulfadoxine-pyrimethamine (SP), often seen as the first and least expensive alternative to chloroquine, is also increasing in east and southern Africa. As a result of these trends, many countries are having to change their treatment policies and use drugs which are more expensive, including combinations of drugs, which it is hoped will slow the development of resistance.

Growing political commitment by African leaders for action on malaria was given a boost by the founding of the Roll Back Malaria global partnership in 1998. Less than two years later African Heads of State and their representatives met in Abuja, Nigeria to translate RBM’s goal of halving the malaria burden by 2010 into tangible political action. The Abuja Declaration, signed in April 2000 endorsed a concerted strategy to tackle the problem of malaria across Africa. The Abuja Declaration endorsed RBM’s goal and established a series of interim targets for the number of people having access to treatment, protective measures or, in the case of pregnant women, receiving intermittent preventive treatment to ensure that progress would be made towards the goal and malaria-endemic countries and other RBM partners held responsible.

Considerable progress has been made since Abuja. Almost 20 African countries have reduced or eliminated taxes and tariffs on insecticide-treated nets (ITNs) to make them more affordable. More than half the malaria-endemic African countries, representing almost half the population at risk have established Country Strategic Plans ((CSPs) to achieve the RBM goal and the targets set in Abuja. CSPs are all based on the four technical elements of Roll Back Malaria and the evidence-based interventions associated with them prompt access to effective treatment, promotion of ITNs and improved vector control, prevention and management of malaria in pregnancy and improving the prevention of, and response to, malaria epidemics and malaria in complex emergencies.

Countries are now working through local partnerships to develop the capacity to fully implement their CSPs using ongoing health sector reforms and linkages to other initiatives, such as IMCI (Integrated Management of Childhood Illness) and MPS (Making Pregnancy Safer), to improve access to key interventions. CSPs have been successful in attracting new resources for malaria control. However, given projected resource needs to the year 2010, only 20% of necessary funds will be available locally. African countries, working with their partners and donors, must identify and mobilize resources for the remainder. Countries are looking to a variety of sources to ensure sustainable financing of their efforts to Roll Back Malaria this includes traditional sources of funding, from the national treasury and donor community as well as the exploration of new opportunities through debt relief schemes and the newly formed Global Fund to Fight AIDS, TB and Malaria.

RELATED WHO LINKS

What is malaria?

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Malaria in Africa

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Malaria in pregnancy

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Insecticide-treated mosquito nets

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Children and malaria

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RMB and complex emergencies

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Epidemic prediction and response

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Facts on ACTs (Artemisinin-based Combination Therapies)

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Economic costs of malaria

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Monitoring and evaluation

This article is adapted from an WHO press release and other World Health Organization informational materials.

Article published by Rhett Butler

Green, Health

Africa, West Africa

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