Successes and new problems in the fight against malaria

Successes and new problems in the fight against malariaFewer people are becoming infected with malaria, and fewer are dying from it. This is the positive news in the current WHO report. However, increasing resistance and epidemics such as Ebola could threaten this success.

By Thomas Muller Published: 21.01.2015, 05:01 h

successes and new problems in the fight against malaria

Malaria remains one of the most dangerous diseases in Africa.

© Michael Pettigrew /

GENEVA/SWITZERLAND. Malaria remains one of the deadliest diseases in Africa, with 584 deaths in 2013, according to the latest World Malaria Report from the World Health Organization (WHO).000 people died from the infection, 90 percent of whom lived in Africa, and 78 percent were children under five years of age.

Nearly 200 million people worldwide became infected with plasmodia in 2013. The good news: malaria hits. Kills far fewer people than it did 15 years ago.

Thus, since about 2008, there has been a significant decrease in the absolute number of infections.

While 170 to 180 million people in sub-Saharan Africa were infected by plasmodia every year between 2000 and 2008, WHO estimates that the figure had fallen to 128 million by 2013.

That is 26 percent less than in 2000, despite rising population figures.

Mortality rate among children reduced by two-thirds

Accordingly, malaria prevalence has also decreased significantly, especially among children: Prevalence among two- to ten-year-olds has almost halved in the African malaria belt – falling from 26 percent to 14 percent.

The most significant progress has been made in the Central Africa region, where about 40 percent of children contracted malaria in 2000, compared to only about 15 percent in 2013.

In the same period, the risk of dying from malaria also halved. For children in Africa under the age of five, the WHO even predicts a two-thirds lower mortality rate this year than in 2000.

This is likely to meet two important Millennium Development Goals set in 2000: a trend toward reversal in global prevalence has long since taken place, and 55 of the 97 countries with malaria are already reporting the targeted 75 percent decline in incidence and mortality rates.

Globally, malaria incidence in all risk areas has fallen from 12 percent to 9 percent.

Based on 2000 figures, 625 million malaria cases and 4.3 million deaths have been prevented worldwide since then, WHO estimates.

So, based on the data in the latest report, the nearly three billion dollars spent globally on malaria control programs each year appears to be paying off.

WHO cites two main points that have contributed to the decline in infection: First, about half of the population in the most affected areas now has insecticide-treated bednets – down from just 3 percent in 2004.

Second, 70 percent of diagnosed malaria patients are currently being treated with arteminisin-based combination therapies (ACTs).

Most children are not yet treated

However, the number of undetected and untreated malaria cases is still very high, especially among children.

WHO estimates that only a quarter of children with malaria receive ACT at all. Also still unsatisfactory are distribution. Acceptance of intermittent preventive therapy (IPTp) among pregnant women.

Prophylaxis with sulfadoxine-pyrimethamine and amodiaquine is used in 37 malaria countries and is intended to protect women from infection and disease outbreaks during pregnancy.

In 2013, only 57 percent of pregnant women in countries with IPTp received such prophylaxis, but most received only a single dose. Only 17 percent received all three recommended doses.

Resistance is a problem

Difficulties in malaria control are also posed by increasing insecticide resistance of vectors and increased resistance of plasmodia to ACTs.

Also, according to the WHO, the financial resources in the fight against the tropical disease are far from sufficient.

Instead of three billion dollars, five billion are needed annually to achieve the Millennium Goals. After all, funding has increased by an average of about a quarter per year since 2005.

Most of the money comes from abroad. Countries in the malaria belt bear only about one-fifth of the costs themselves and have not significantly increased their budgets in recent years, the report says.

Another milestone was reached in 2013: for the first time, the number of malaria tests exceeded the number of treatments.

In the past, treatment was often based on mere suspicion, but now it is more closely examined whether malaria is actually present. This could ease the resistance situation somewhat.

Ebola threatens success

By contrast, the Ebola epidemic in western Africa seems to be wiping out all efforts against malaria there.

"Ebola had a devastating impact on basic medical care in the most severely affected countries", makes WHO director Dr. Margaret Chan in a foreword to the Malaria Report.

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