MALARIA IS AMALARIA IS A SILENT KILLER SILENT KILLER · 17 April 2007 Malaria Consortium - Sunil...

MALARIA IS A SILENT KILLERMALARIA IS A SILENT KILLER

It is so silent that we cannot tell if 1 million or 3 million die in a year

in the world

Why are we SILENT about MALARIA?

17 April 2007 Malaria Consortium - Sunil Mehra

Presentation to the InterPresentation to the Inter--parliamentary Taskforceparliamentary TaskforceHouse of Commons, London, 17 April 2007House of Commons, London, 17 April 2007

Sunil Mehra & Sylvia MeekSunil Mehra & Sylvia MeekMALARIA CONSORTIUMMALARIA CONSORTIUM

MALARIA is a Global KillerMALARIA is a Global KillerBut no one should die, effective tools exist!But no one should die, effective tools exist!


The Burden of Malaria1

• 40% of the worlds’ population or 3.2 billion in 107 countries are at risk.

• Malaria kills up to 3 million people per year, mostly African children

• Malaria accounts for 20% of under-five mortality in Africa and is the leading killer of African children (1 million)

• Malaria causes up to 500 million cases of illness each year

• Malaria costs Africa $12 billion per year

1It is difficult to provide more accurate figures, as health information systems are weak, many people never enter the statistics as they never use health facilities,

measuring malaria deaths in the community is very difficult.


Why Malaria?

• Huge burden: mortality and illness• Affects the poorest most, so essential to

tackle it to achieve the Millennium Development Goals

• Highly cost-effective interventions are available to control it now

• But … many people are not benefiting


Economic burden on health Economic burden on health services in subservices in sub--Saharan AfricaSaharan Africa

•• 2020--40% of outpatient visits are for 40% of outpatient visits are for ‘‘feverfever’’•• Suspected malaria accounts for up to 50% Suspected malaria accounts for up to 50%

of inpatient admissions in highly endemic of inpatient admissions in highly endemic countriescountries


Economic burden on householdsEconomic burden on households

• The poorest are most affected– In Tanzania infants in poorest quintile had

46% and under fives 38% higher risk of death than the least poor.

• Much of the cost of malaria control is borne by households– e.g. 34% of poor households’ income in

Ghana


Key Interventions to Control Malaria

1. Prompt access to effective treatment2. High and equitable coverage with

Insecticide-treated nets - ITN (and other vector control methods where appropriate)

3. Prevention and control of malaria in pregnant women (Intermittent Preventive Treatment, ITNs, case management)

4. Effective control of epidemics and malaria in emergencies


Malaria Treatment Issues

• Rapidly increasing drug resistance is possibly the greatest threat to achieving the objectives of Roll Back Malaria and increases mortality

• Artemisinin Combination Therapy is a breakthrough - deployment needs to be scaled up

• It costs more than previous treatment• Choice of drug is not the only issue -

major improvements can be achieved by improving quality and access and educating users


We need to:• Advocate for strategies for mobilising

resources for drugs; e.g.– Sustaining support through the Global Fund

(GFATM)– Supporting new financing mechanisms such

as UNITAID and ACT subsidy• Advocate for PREDICTABLE LONGTERM

funding• Advocate for stronger systems• Advocate for access beyond the formal

system

Addressing Malaria Treatment


Malaria Prevention:Insecticide Treated Net Issues

• Coverage is much lower than it should be• Commercial market growing but limited outreach

to rural outlets• Supply issues

– Inadequate and late procurement forecasting• Long-lasting nets availability increasing

– Long-lasting treatment of nets is an exciting light on the horizon

• Retreatment of nets– Growing net numbers in countries – huge opportunity– If treated, effective coverage will increase markedly


• Coverage with insecticide-treated mosquito nets (ITNs) needs to increase – a huge opportunity!

• ITNs should be made affordable to all (free or highly subsidised for the poor)

• Supporting commercial reach to rural is also important for sustainable access

• Utilisation is important as well as ownership –behaviour promotion strategies are essential

• More effort is needed to scale up access to Intermittent Preventive Treatment (IPT) for pregnant women

Addressing Malaria Prevention


Important Support Areas to Control Malaria

• Strengthened health systems• Human capacity development• Effective financing• Behaviour promotion & communication• Monitoring and evaluation


Delivery Systems to Achieve Access

• Better access to malaria prevention and treatment depends on better delivery systems and services

• Capacity at district level and below needs to be expanded greatly by:– Training and motivation of health workers– Involving more community-based, private for

profit and not-for-profit organisations– Special efforts are needed to protect people

suffering from political conflict


The Cost

• The need: $3.2 billion per year to achieve MDGs for malaria

• The current funding: $600 million per year

• The shortfall is significant and needs concerted efforts to address


Benefit to Sub-Saharan Africa

• The incremental net economic benefit of eliminating 50% of malaria in sub-Saharan Africa between 2002 and 2015 was estimated at $95-429 billion

(Mills and Shillcutt, 2005)


Is it a good investment?

• Although the cost seems large:– It is equivalent of just 2-3 days of US and

European Union farm subsidies– Economists agree that malaria control is an

excellent investment in development, giving exceptional economic and health returns

– Copenhagen Consensus rated it in the top four priorities in development with benefits at least five times the cost


Progress in Controlling Malaria

• Africa is on the brink of making an impact on malaria

• Many of the elements of successful strategies are in place

• Inputs are accumulating• Outputs are due and approaches are sound• Measuring progress is challenging• Progress has not met the expectations of the

Abuja Summit of 2000 but accelerating now• Poverty and lack of human resources have

slowed progress• There is accelerated funding and scaling up of

procurement of essential malaria control products


What are the priorities?

• Increased and sustained funding• Increased commitment to fund a little more costly,

but highly effective, drugs and prevention tools• Improved and new financing mechanisms for

sustained and steady support• Investment in delivery systems and especially

human resources• Focus development aid through budgetary

support to address Africa’s major killer disease


If action is not taken..

• Economic growth will be slowed down

• More than a million lives will be lost unnecessarily every year

• Achievement of the Millennium Development Goals will be not be possible


ACT TODAY, ACT NOW

• Every thirty seconds an African child dies because of malaria

• A child can die within 24 hours• This child has to be saved today, not

tomorrow.• The child cannot wait for policy changes,

reforms for ten years. In that time another 8-10 million African children will die.

• We have a moral responsibility to act today, act now.


Europe’s dedicated organisation for control of malaria

malaria consortiumD is e a s e C o n tro l, B e t te r H e a lth

www.malariaconsortium.org

IMPLEMENTATION SUCCESS SHOULD

BE SUSTAINEDBE SUSTAINED




SUCCESSEritrea

High political support and implementation of comprehensive malaria control strategies.

• Comprehensive prevention and treatment approach and scaling-up can lead to rapid results.

• In 2005 the number of infected people was 85% less than in 2000.


Retreatment of nets doubles ITN coverage in three weeks

• Retreatment of nearly half a million nets in 20,000 communities in three weeks cost US$0.75 per net by delivering a simple, convenient net retreatment service to net owners. Leadership and ownership by MOH, using the partners and local structures, flexible logistic support allowedrapid scale-up. Subsequent retreatment rounds are budgeted in GFATM grant to sustain protection.

• Doubled household coverage of ITNs in target area.

SUCCESSUganda


Introducing new drugs in a complex emergency and epidemic

• During a very severe epidemic high levels of resistance to chloroquine and SP were found. Policy was changed to ACT, and a commission of Ministry of Health and several partner agencies guided systematic and implementation of the new policy.

• Although complex emergencies (epidemic plus post-conflict) increased seriously the burden of malaria, coordinated support for rapid response led to decline in mortality

SUCCESSBurundi


Rapid Increase of Insecticide Treated Net Coverage

• Combining ITN distribution with measles vaccination, high and equitable levels of coverage were achieved very rapidly.

• The Togo campaign, for example, delivered ITNs to >90% of eligible children, and a follow-up survey one month after the campaign showed that 43.5% of under-five children had slept under an ITN the previous night.

SUCCESSTogo and Niger


SUCCESSMalawi

Rapid Increase of Insecticide Treated Net Coverage• Combine delivery of ITNs with other services to increase

coverage: antenatal services (ANC) • In Malawi, ITNs are sold to pregnant women at a very

low token price. More than 100,000 nets have been delivered every month since.

• Net coverage of under-five children was 8% in 2000, had reached 38% by February 2004, and was still rising rapidly Similar trends were seen in coverage of pregnant women.Infant mortality rates declined in Malawi.


Home-based management of fever reduces children’s anaemia in conflict/post conflict situations

• Access to treatment can be increased by going beyond the formal health sector to treatment closer to home. Systematic well-planned strategies are essential.

• The number of children under five receiving treatment within 24 hours more than doubled (from 22% to 54%), and the proportion of 6-24 month old children with severe anaemia fell by almost two thirds from (from 10.1% to 3.9%).

SUCCESSNorthern Uganda


Vietnam combines interventions and aims for high coverage

• One of the world’s most impressive malaria control success stories. Broad combination of interventions, including improved diagnosis and treatment services, use of artemisinin derivatives, treated nets (with free insecticide) and house-spraying.

• Malaria mortality fell by 97% and morbidity 60% in nine years.

The impact of malaria in Asia is underestimated: • Mortality may be 7-10 times more, morbidity, 10 times more. Few

deaths may be reported but the impact and burden of malaria is mostly on the ethnic groups who are poor and marginalised. The economic impact is substantial.

SUCCESSA non-African story! Vietnam


Europe’s dedicated organisation for control of malaria



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