Control, not elimination, key to Africa malaria battle, argue experts
26 April 2010
Buoyed by a reduction in malaria mortality in Africa, health leaders at a 2007 meeting on global malaria control switched their primary goal from control to elimination.
But researchers from the Kenya Medical Research Institute-Wellcome Trust Research Programme in Nairobi say that the emphasis on elimination or eradication in strategic plans for the next 10-20 years in Africa is "at best irrelevant and at worst counterproductive", raising expectations that cannot be met.
Writing in the 'Lancet', they argue that using currently available methods can reduce malaria from a major health priority to a fairly minor burden. "Reaching low endemic control is achievable, its financing requirements are predictable and its effects measureable," says Professor Bob Snow, one of the authors.
"The result would be a huge public health success, a legacy we'd all be proud of, but this isn't elimination, which seems to a more attractive term to donors."
In 2000, heads of state from across Africa signed a declaration to halve malaria mortality for Africa by 2010. In the paper, the authors review malaria strategies and interventions of the past 20 years and their success toward this aim.
Increased use of insecticide-treated bed nets, improved rapid diagnostic tests and the replacement of failing drugs with artemisinin-based combination therapy are among the interventions that have helped to reduce malaria transmission and incidence substantially across the continent. On the coast of Kenya, for example, the incidence of severe malaria has fallen by more than 90 per cent in the last five years.
However, the authors warn that positive results are not universal throughout Africa. Studies have shown that 33 African countries have coverage of less than 40 per cent in the use of insecticide-treated bed nets. Despite substantial evidence in favour of artemisinin-based combination therapies to treat malaria, these drugs still only reach a small proportion of the African population. And a substantial funding gap remains to meet the estimated US$4 per head needed to treat malaria. Research has found that the average level of funding in 20 African countries was less than $1 per head.
In this context, the authors argue that the switch in focus to elimination over control in Africa is a mistake. While it has invigorated global efforts, they say, the importance of maintaining investment in control cannot be underestimated. They warn that withdrawing funding from control efforts would be potentially disastrous.
Image: Mosquitoes killed by insecticide on a treated net. Credit: Wellcome Images
Reference
Snow RW, Marsh K. Malaria in Africa: progress and prospects in the decade since the Abuja Declaration. Lancet 2010 [Epub ahead of print].
