Malaria in Ethiopia

In 2005, US President George W. Bush instituted the President's Malaria Initiative (PMI) to "fight malaria in the region most affected by the disease. The President committed. . . $1.2 billion in malaria funding to this Initiative with the goal of reducing malaria-related deaths by 50 percent in 15 focus countries", including Ethiopia.

Five years later the PMI is still going strong. On the 26th of April 2010, "[t]housands of Long-Lasting Insecticidal Nets, or mosquito bed-nettings, were handed out by a U.S. Army Civil Affairs team to the people" in malaria-endemic regions of Ethiopia.

"We are distributing 35,000 nets to a population of approximately 93,000 people," said Lieutenant Daniel Deckard, commander of the Civil Affairs team, Combined Joint Task Force-Horn of Africa. "That's approximately two nets per household," he said.

The distributed nets are treated with insecticides to repel and kill mosquitoes in addition to serving as a physical barrier between humans and flying insects. Insecticide treated nets are estimated to be twice as effective as standard nets and may reduce malaria transmission by up to seventy percent (when used correctly). Participants in the PMI not only distribute nets, they are also "properly installing the nets in optimal locations within homes and are giving directions and other vital information to homeowners about proper use to minimize possible hazards and maximize protection" against malaria.

Malaria "is one of the leading causes of the deaths of pregnant women and children under five years of age in Africa. . .Malaria is a blood-borne infection caused by parasites and transmitted to people by the bite of female Anopheles mosquitoes, which are active from dusk to dawn, according to the PMI website. Malaria usually begins as a flu-like illness with fever and chills. Mild to moderate anemia is also common because the malaria parasite infects and destroys red blood cells."

Untreated, malaria may cause severe anemia, organ failure, coma, and death.

Based on the annual reports (reporting began in 2006), malaria relief efforts are producing results. For example:
* Zambia has seen a 10% decrease in malaria cases
* In Rwanda, child mortality rate has dropped from 168 deaths/1,000 to 119 deaths/1,000
* Infant mortality rate in Tanzania has also dropped

The initiative expects to see similar or better improvements in Ethiopia.


Sources:
Barnett, Robert. "Fighting Malaria in Ethiopia". The Ethiopian Review. 4 May 2010. http://www.ethiopianreview.com/articles/32007

PMI: Saving Lives in Africa. http://www.fightingmalaria.gov/

Substandard Medicines

"A high percentage of medicines circulating on national markets", in ten Sub-Saharan African countries, "are of substandard quality and thus may contribute to the growth of drug-resistant strains of Plasmodium falciparum, the most virulent form of malaria." First results of the "large-scale study of key antimalarial medicines" were released for Madagascar, Senegal, and Uganda by the Promoting the Quality of Medicines (PQM) Program, a USAID-funded program.

"Within Madagascar, Senegal and Uganda, the study" focused "on artemisinin-based combination therapy (ACT) products, currently the WHO's recommended form of first-line treatment for uncomplicated malaria, and sulfadoxine-pyrimethamine (SP) products, often used for preventative treatment of malaria during pregnancy." Researchers collected samples from "public and regulated private sectors" and from "informal markets, as many patients obtain their medicines from these sources."

"Substandard and counterfeit versions of antimalarial medicines are highly problematic throughout Africa, Asia and Latin America because of the direct threat they pose to the lives of individual patients as well as their contribution to the development of drug-resistant strains of these diseases." The "study found that approximately 44 percent of sampled medicines from Senegal, 30 percent of samples from Madagascar, and 26 percent of samples from Uganda that underwent full quality control laboratory testing failed such testing and were thus substandard."

"Substandard" medicines are classified as "those that do not meet the quality specifications set for them, primarily because they do not contain the correct amount of the active ingredient(s), do not dissolve properly in the body or include unacceptable levels of potentially harmful impurities." According to the released results, "[n]o samples in the full study completely lacked the active ingredient(s). The results also showed that, as a general rule, when a brand passed or failed in one country, it would also pass or fail in other countries. This indicates that the problem of quality is created at the source, rather than during passage through the distribution chain."

Substandard medicines were not limited to informal markets, and their point of sale varied by country. "In Madagascar, for instance, poor quality medicines appear to be widespread across regions and not limited to any particular type of distributor [public, private, or informal]. In Uganda, samples fared much better in the public sector than in the country's private sector. Despite overall failure rates, this was one of the bright spots the study revealed; in Uganda's public sector, all ACT and SP samples passed quality tests."

The purpose of this study was reveal "the prevalence of substandard antimalarials in Sub-Saharan Africa, which are believed to contribute to antimicrobial resistance of Plasmodium falciparum. Already, Plasmodium falciparum has become resistant to traditional" treatments "such as chloroquine, and more recently to SP products. The sustainability of treatment success depends to a large extent on preventing Plasmodium falciparum's exposure to incomplete doses of these medicines to minimize the possibility of the emergence of drug resistance."

Source:
US Pharmacopeia (2010, February 10). One-third of antimalarial medicines sampled in three African nations found to be substandard. http://vocuspr.vocus.com/vocuspr30/Newsroom/ViewAttachment.aspx?SiteName=USPharm&Entity=PRAsset&AttachmentType=F&EntityID=108111&AttachmentID=f2e22216-44a5-41a2-a9bc-464b7a98e3bf

Alarm amid medicine shortage

Kenya's rainy season is the most dangerous for contracting malaria, a deadly disease carried by mosquitoes, and children are the most susceptible. "A shortage of malaria drugs for children has hit hospitals as fears of an outbreak of the disease loom following heavy rains in various parts of the country."

"The Kenya Medical Supplies Agency said stocks of the drugs were running low, but were in the process of being procured and could be delivered by the beginning of February." The Chief executive, John Munyu, is hopeful that the crisis will be avoided because deliveries are continuing. He indicated that "adult malarial drugs are already being supplied after a reported shortage in parts of the country."

The minister of medical services, Anyang' Nyong'o, claims that "the shortage of drugs was caused by inadequate funding by the Treasury." The "budget for Health ministries was laughable when compared to that for the Ministry of Education", he says. This is not the first shortage that Kenya has suffered in recent years. Antibiotics used to treat cholera "were nearly exhausted due to last year's outbreak".

Still, Nyong'o is confident that disaster will be avoided. He says, "I do not envisage any crisis because the government is already adding stocks to what is already there in the health facilities. That is mere replenishment."

Ogo, Kenneth. "Children's malaria drugs run out." Daily Nation. 7 January 2010.

African Leaders Malaria Alliance

"Malaria is one of the biggest killers of African children." Recently, "African leaders have begun an ambitious program to eliminate nearly all malaria deaths in Africa over the next six years." Initiated by Tanzanian President Jakaya Kikwete, the African Leaders Malaria Alliance was established "to streamline the procurement and distribution of control and treatment methods while keeping the disease high on the international development agenda" (Scott). "The international community has already donated more than $3 billion to the project, the BBC reports, adding, "The money will pay for the distribution of 240 million insecticide-treated bed nets throughout sub-Saharan Africa by the end of next year" (Nyaria).

"Africa is the continent most affected by malaria, accounting for 86 percent of all cases and 91 percent of all malaria deaths worldwide" (Henry). The statistics are sobering. "Nearly twenty percent of African women who die in childbirth" suffer "from malaria. It accounts for one-quarter of all deaths of children under five" (Scott). Every year, nearly a million people die.

The goal of the alliance "is to provide universal access to malaria control methods to all at-risk Africans by the end of next year in hopes of eliminating all preventable malaria deaths by 2015" (Scott). Ray Chambers, the Secretary General's Special Envoy for Malaria, says, "This is a massive undertaking unlike anything that has ever been done before."

Sources:
Associated Press. (via VOAnews.com) [Photo]

Henry J. Kaiser Family Foundation. "African Leaders Malaria Alliance Launched At U.N. General Assembly." Medical News Today. 29 Sept 2009.

Nyaria, Sandra. "African Leaders in Alliance to End Malaria Deaths on Continent By 2015." VOAnews.com. 23 Sept 2009.

Stearns, Scott. "African Leaders Fight Malaria." VOAnews.com. http://www.voanews.com/english/2009-09-22-voa52.cfm?rss=topstories. 29 Sept 2009.

Malaria in Nigeria

Fatima (age of 31) has "seen five children into the world." Two of her babies have "died of malaria. When a member of her family falls ill, it is to home remedies and prayer to which Fatima turns. Living in a village in northern Nigeria that is 25 kilometres from the nearest town and without a health clinic or registered drug store, she has little choice" (DFID). [Photo from the DFID]

"Malaria is endemic in Nigeria with about 97% of the population at risk of infection" (Roll). "In Nigeria, malaria causes the deaths of an estimated 250,000 children under the age of five" and a total of 300,000 children every year (UNICEF). In 2007, there were nearly 5.5 million reported cases of malaria in Nigeria (Roll). "Malaria occurs in all parts of Nigeria, including large cities. Transmission is very intense, thus the risk of getting bitten by a malaria-carrying mosquito is very high" (CDC).

"Nigeria, with a population of 148 million, contributes a quarter of the malaria burden in Africa - 50% of the population will have at least one malaria attack each year" (DFID). Many will go unreported and untreated by medical professionals. Clinics are overloaded with the sick and many individuals cannot reach or afford medical help. Still, "malaria is responsible for about 66 per cent of all clinic visits in Nigeria. Health workers are sometimes forced to work overtime, and doctors and nurses can be on duty for over 12 hours a day. Still, women and children have to wait for hours before receiving medical consultation" (UNICEF).

"There is a lot of activity and momentum to combat malaria in Nigeria, but deadly gaps still exist. More needs to be done to prevent children from being infected and ensure access to quality malaria treatment," says Suomi Sakai (UNICEF Representative in Nigeria). Education of the local population "is an important part of UNICEF's malaria prevention work." Doctors and medical personnel must learn "how to prevent, recognize and treat malaria" (UNICEF). Furthermore, everyone needs to know how to properly protect themselves and their families from the mosquitoes that carry the deadly disease.

"However, even when people have been educated about malaria, poverty often stops them from seeking treatment. "Most can't afford the ITNs [Insecticide Treated Nets] or the ACT [Artemisinin-based combination therapy], which cures malaria," says Maryam Hashim (Wandi Primary Health Clinic).

Some level of resistance to malaria may exist in individuals suffering from blood disorders and those who have suffered "repeated attacks of malaria"; however, precautions to avoid mosquito bites should not be overlooked (CDC). Unfortunately, many misconceptions about malaria and its transmission exist. "Persons who were born in Nigeria are NOT protected against malaria, contrary to what many people think" (CDC).

"In 1998, the World Health Organization, UNICEF, the UN Development Programme and the World Bank came together in the Roll Back Malaria partnership, with the goal of halving the global burden of malaria by 2010...One of the objectives of Roll Back Malaria is to reduce malaria-related morbidity and mortality by 50 per cent in Nigeria by 2010, as well as to minimize the socio-economic impact of the disease" (UNICEF). This "intensive campaign" (lasting till December 2010) will distrubte "over 60 million nets...to around 30 million households during the campaign" (DFID). As part of this project, "over 800,000 Long Lasting Insecticide Nets and 55,000 long lasting insecticides kits for the re-treatment of mosquito nets have been procured and distributed by UNICEF in the past three years, with support from the Government of Japan" (UNICEF Nigeria).

Support Roll Back Malaria and its mission to reduce the number of malaria cases in Nigeria. You can also donate to Malaria No More to help provide mosquito nets to families who desperately need them.


Sources:

CDC. Malaria: Nigeria.

DFID [Department for International Development]. Nigeria gears up to roll back malaria.

Roll Back Malaria Partnership. Nigeria.

UNICEF. Nigeria: Together we can fight the scourge of malaria.

UNICEF. "Partnering to roll back malaria in Nigeria's Bauchi State."