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Anti-Malaria Effort Gets Results That Must Be Maintained

06 June 2012
African children peeking out from under bed net (Gilbert Awekofua/Photoshare)

Children peek out from under their ITN hung in northern Uganda. ITNs reduce deaths and illnesses from malaria, if used correctly and consistently every night.

Washington — An independent evaluation team finds that the President’s Malaria Initiative (PMI) has been “very successful” in reducing children’s deaths from the mosquito-borne parasitic disease, but also warns that the program must gear up if those gains are to be sustained.

The Center for Global Health and Development (CGHD) at Boston University delivered its report to the U.S. Congress June 5.

The President’s Malaria Initiative began in 2006 and has been sustained to the present as a component of the Global Health Initiative advocated by President Obama. The program's objective was to reduce the occurrence of malaria among the most fragile population — children under age 5. The disease killed an estimated 655,000 in 2010, and young African children are the demographic group most severely affected.

But the disease has been on a steady downward trend since 2000, with the World Health Organization calculating that deaths have declined by 33 percent in Africa since 2000 and by more than 25 percent globally.

The CGHD evaluation team spent seven months conducting visits and interviewing health workers in the nations where PMI has been in place.

“The history of malaria control has been one of temporary success followed by failure,” according to the team. “PMI has helped create a success in this latest attempt at malaria control; figuring out a strategy for sustaining these advances and adapting to biologic, political, and financial challenges is essential for keeping history from repeating itself.”

PMI targets 15 high-risk countries in sub-Saharan Africa with massive application of the measures known to stop the disease — the use of insecticide-treated bed nets (ITNs) to prevent mosquito bites and insecticide applications inside dwellings. A World Malaria Day report prepared by the U.S. Agency for International Development in late April said spraying programs protected 28 million people in 2011, and more than 31 million bed nets have been distributed since 2006.

“Though major biologic, political, and financial challenges exist that could seriously erode the accomplishments made to date,” the report continues, “PMI, through its first five years of activities, has earned and deserves the task of sustaining and expanding the U.S. Government’s response to global malaria control efforts.”

The CGHD report recommends a re-evaluation of malaria prevention methods, including insecticide use, which, the researchers find, covers a fraction of the at-risk population at a high cost.

In individual countries, PMI is devoted to building relationships and cooperation with national malaria control programs, and the report suggests consideration begin of a transfer of some operational programs to in-country agencies that have developed the necessary capabilities.

Regarding the future, the researchers suggest that fiscal difficulties affecting even the world’s strongest economies may bring a slowdown in health aid to developing countries. In view of that prospect, the report cites “a profound imperative” for programs to operate in the most cost-effective way possible.