The risk of malaria worldwide: prospects for control and elimination
Bob SnowKEMRI-University of Oxford
collaboration, Nairobi, Kenya
www.map.ox.ac.uk
Evangelism and global malaria eradication - 2008
Context
Risks and types of disease different in different parts of the world
Suites of control strategies need to be tied to the basic scientific understanding of risk
The future of malaria control worldwide must be driven by a map – the last one developed almost 50 years ago
Global limits of P. falciparum malaria – 87 countries in 2007
Guerra et al. (2008) PLoS Medicine
Iterated spatial Pf limits based on – Med Intelligence mapping and biology of parasite with remotely sensed satellite data on Temperature and Aridity
Guerra et al. (2008) PLoS Medicine
Interpolated global stable endemic surface of P. falciparum parasite prevalence to 2007
Hay et al. (2009) PLoS Medicine
0.9 Billion people at unstable risk < 1 case per 10,000 people each year
1.4 Billion people at stable risk
67% of world population exposed to any risk of P. falciparum live in Central and South Asia and Pacific
73% of P. falciparum risk world live in areas of unstable or low endemic risk
Only 14% of Pf world live in areas of high transmission – 98% in Africa
In 2007…..
Americas
91 million people at risk of Pf
50 Million in Unstable areas
41 Million in areas where PfPR < 5%
South, Central and Eastern Asia
1.6 Billion people at Pf risk911 million at risk of unstable transmission (57%)603 million at risks of stable transmission with PfPR <5% (38%)80 million people at risk of transmission > 5% (5%)
Africa679 million people at risk of Pf – ¾ Africans171 million (25%) in stable PfPR 5-39%377 million (56%) in Stable PfPR 40%+
428 Million clinical events in all ages
0.98 Million deaths directly due to PF among children aged 0-4 years
Malaria-specific mortality in African children aged 0-4 years per 1000 children p.a. from 31 community-based
surveillance studies between 1985-2004
What are we shooting for in Africa?
What can be done to reduce the public health burden of P. falciparum?
Just two simple interventions that cost a few dollars per person each year
Effective and prompt treatment with drugs that work
Protection from infectious bites through the use of a net treated with insecticide or IRS
Speed of international public health policy change
2003
2004
2007
Percentage of Kenyan Health facilities without Paed doses of AL on day of survey?
3/5 health facilities don’t have drugs to treat malaria effectively in young children……….
Of children living in stable endemic areas of Africa
c. 2000 4% under an ITN
c. 2007 18% under an ITN
Intervention Coverage - ITNs
90 million children do not sleep under an ITN in 2007
Most within only 7 countries
25% of all unprotected children are Nigerian
Noor et al., Lancet 2009, 373: 58-67
2004 Social Marketing & Commercial Sector approaches – 33 Million USD
2005 Above + heavily subsidized – 54 Million USD
2006 Above + FREE – 17 Million USDNoor et al., PLoS Med (2007)
The Kenyan Example
Financing Stable populations at risk per capita national and international funding unmet financial need in 2007
20 countries < 1$ per person
Only three countries > 4$ per person
Djibouti
ST&P Equatorial Guinea
Snow et al., PLoS Medicine 2008, 5: e142
We must get the plan for Africa right
We can make a huge public health difference in our life-times without elimination – a legacy we’d all be proud of
We can predict this impact and we can measure it
The way forward?
There are some areas of the world where regional or small scale elimination is feasible but these areas must ensure political and financial sustained commitment themselves
World Vision launches bold initiative for worldwide elimination of mosquitoes15 Oct 2008 - Source: ASSIST News Service
Richard Stern pointed out that now it's time for the rest of the world to benefit from the U.S experience and that by God's mercy and in partnership with other humanitarian organisations and individuals, World Vision is determined to end malaria in the entire world.
Tanzania still expecting to eradicate malaria by 201520 Oct 2008 By Christopher Magola, Dar es Salaam
Rwanda - Anti-mosquito spraying19 Oct 2008 By Frank Kagabo – The New Times Rwanda Late last year, the country embarked on a spirited anti-mosquito spray in homes with a view of eradicating malaria, from the country
How is this interpreted internationally and regionally?
Malaria to be eradicated in Nigeria by 201514 Aug 2008 by AbdulAzeez Sani Lagos Times Minister of State for Health, Arc. Gabriel Aduku, has disclosed that the federal government has set 2015 for the total eradication of malaria in the country
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