Coordination Essential in Malaria Battle Laninf

Leading Edge
Coordination essential in malaria battle

April 24 marked World Malaria Day, 2010. A particularly the picture in large countries with huge numbers of people
important year in the fight against the disease, since at risk, such as Nigeria, DR Congo, Kenya, and Brazil,
December is the target date for the ambitious goal set where disease burden has not decreased substantially.
out by the World Health Assembly and Roll Back Malaria Despite enormous success in roll-out of prevention, many
in 2008 to provide universal access to prevention and countries lack sufficient treatment, and drug resistance
treatment, with the aim of halving the number of compounds this problem. Surveillance is another area of
cases of and deaths from the disease relative to 2000. shortfall—but tracking of resistance and monitoring of For more on elimination on
Hispaniola see Reflection and
Furthermore, this year is two-thirds of the way along the transmission are essential not only for control, but also Reaction page 291
path to the target date for the Millennium Development for elimination. With multiple institutions, organisations, For World Malaria Day 2010 see
Goals (MDGs), several of which are intrinsically linked to and funding bodies involved, duplication of work is http://www.rollbackmalaria.org/
worldmalariaday/
malaria, and dependent on successes in its control. common, sometimes the same populations are surveyed
For WHO’s World Malaria Report
According to the WHO World Malaria Report 2009, several times for the sake of progress reports to different see http://www.who.int/malaria/
world_malaria_report_2009/en/
published in December, and the Roll Back Malaria organisations. Along with slow declines or even increases
index.html
campaign’s Malaria Funding and Resource Utilization, the in burden, apparent emergence of artemisinin resistance For Roll Back Malaria’s Malaria
huge funding inputs from organisation such as the Global in southeast Asia and Haiti is a cause for grave concern. Funding and Resource Utilization
report see http://www.
Fund to Fight AIDS, Tuberculosis and Malaria, the US In this month’s Reflection and Reaction, Joseph Keating rollbackmalaria.org/
President’s Malaria Initiative, The Gates Foundation, and and colleagues discuss the possibility of eliminating ProgressImpactSeries/report1.
html
the Wellcome Trust, to name a few, have spurred on efforts malaria on Hispaniola, the island comprising Haiti and the
to eradicate malaria through programmes targeting Dominican Republic. Elimination of disease on Hispaniola
parasite reservoirs, habitat management, treatment of would not only maintain the momentum of elimination
infected people, and prevention of transmission. of malaria on the borders of its endemic range, but also
In Africa, the hardest hit continent, the high-burden give renewed impetus to elimination in other complex
regions Eritrea, Rwanda, Sao Tome and Principe, Zambia, settings characterised by inadequate health systems,
and Zanzibar all reported greater than 50% declines in struggling national malaria control programmes,
numbers of cases between 2001 and 2008, as did five low- and poverty that have so far not achieved substantial
burden countries—Botswana, Cape Verde, Namibia, South reductions in disease burden.
Africa, and Swaziland. Outside Africa, the picture is even Because of the disease’s effect on mothers and children
more hopeful, with 29 of 56 malaria endemic countries under 5 years of age, malaria control is essential to the
reporting greater than 50% decreases. Nearly all the achievement not only of MDG 6, but also of those goals
countries reporting substantial decreases in malaria burden related to economic growth, primary education, and
have successfully implemented effective prevention and maternal and child health. Hence, ongoing support
vector control strategies including widespread ditribution for control efforts in all malaria endemic countries and
of insecticide-treated bednets, indoor residual spraying, redoubled efforts to achieve elimination in the countries
and use of artemisinin combination therapies. Among the on the malaria endemic borders is essential.
countries with the best records, ten are predicted to be in Despite an at times discouraging global picture,
an elimination phase by 2015, bringing the number of malaria control, elimination, and eradication are
countries with substantial malaria transmission to fewer potentially achievable within a century. However, bodies
than 100. involved in the many disparate branches of malaria
But the good news is belied by the global malaria control programmes need to coordinate their efforts
statistics. In 2008 there were an estimated 243 million more effectively, to enable national malaria control
cases and 863 000 deaths worldwide; the vast majority, programmes to integrate with national health systems,
85% and 89% respectively, were in sub-Saharan Africa. and to ensure that funds are not wasted on duplicated
Scale-up in funding, prevention, and vector control is not research and surveillance. Only then will maximum
always matched by reductions in disease burden. Success benefits be realised and real progress made in the most
stories such as Eritrea and Argentina are cancelled out by intractable settings. ■ The Lancet Infectious Diseases
www.thelancet.com/infection Vol 10 May 2010 289

Coordination Essential in Malaria Battle Laninf

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Leading Edge

Coordination essential in malaria battle

www.thelancet.com/infection Vol 10 May 2010 289

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