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Tackling malaria today – missing the point
- Roly D Gosling, Daniel Chandramohan, Department of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine (3 September 2008)
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Roly D Gosling, Clinical Lecturer Department of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, Daniel Chandramohan, Department of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine
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Lines and colleagues1 are concerned that the strategy of “shrinking the map” to eliminate malaria will lead to inequitable allocation of resources, development of resistance to insecticides and drugs, and inefficient combination of interventions as if these risks are unique to elimination campaigns. The sustained malaria control strategy suggested by Lines et al1 as an alterative to elimination campaigns also has these risks. We would like to point out that there has been a widespread fall in malaria transmission across the African continent, documented in a number of countries including Kenya2, Tanzania3 4, Mozambique5, Swaziland5, South Africa5, Guinea Bissau6 and Eritrea7. This trend is probably due to multitude of events including decades of malaria control activities, economic development, urbanisation, improved education and access to health care. These countries also face the issues of inequitable and uncoordinated coverage of interventions, problems of drug and insecticide resistance, and inappropriate allocation of resources. In our view the “tipping point” has been reached in many regions of the endemic countries in Africa where incidence of malaria has fallen in large communities making them susceptible for resurgence of malaria. Thus action to eliminate malaria should not be delayed and malaria control programmes should be strengthened as described by Lines et al1 in the centre of the malaria map. We can and should move towards the elimination goal starting in the centre of the map but can only do this if there is sustained political and financial commitment. Otherwise we will face resurgence of malaria overburdening stretched health resources and repeat the failure of malaria control in Africa in the 1950s and 60s. 1. Lines J, Schapira A, Smith T. Tackling malaria today. Bmj 2008;337:a869. 2. Okiro E, Hay SI, Gikandi PW, Sharif SK, Noor A, Peshu N, Marsh K, Snow RW. The decline in paediatric malaria admissions on the coast of Kenya. Malaria Journal 2007;6(151):doi:10.1186/1475-2875-6-151. 3. Bhattarai A, Ali AS, Kachur P, Martensson A, Abbas AK, Khatib R, Al-mafazy A, Ramsan M, Rotllant G, Gerstenmaier JF, Molteni F, Abdulla S, Montgomery SM, Kaneko A, Bjorkman A. Impact of Artemesinin- based Combination Therapy and Insecticide- Treated Nets on Malaria Burden in Zanzibar. Plos Medicine 2007;4(11):e309. 4. Schellenberg D, Menendez, C., Aponte, J., Guinovart, C., Mshinda, H., Tanner, M., Alonso, P. The changing epideimology of malaria in Ifakara Town, Southern Tanzania. Tropical Medicine and International Health 2004;9(1):68-76. 5. Sharp B, Kleinschmidt, I., Streat, E., Maharaj, R., Barnes, K., Durrheim, DN., Ridl, FC., Morris, N., Seocharan, I., Kunene, S., La Grange, JJP., Mthembu, JD., Maartens, F., Martin, CL., Barreto, A. Seven years of regional malaria control colaboration- Mozambique, South Africa and Swaziland. American Journal of Tropical Medicine and Hygiene 2007;76(1):42-47. 6. Rodrigues A, Armstrong Schellenberg J, Kofoed PE, Aaby P, Greenwood B. Changing pattern of malaria in Bissau, Guinea Bissau. Trop Med Int Health 2008. 7. Nyarango PM, Gebremeskel T, Mebrahtu G, Mufunda J, Abdulmumini U, Ogbamariam A, et al. A steep decline of malaria morbidity and mortality trends in Eritrea between 2000 and 2004: the effect of combination of control methods. Malar J 2006;5:33. Competing interests: None declared |
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