Education And Debate

Linking disease control programmes in rural Africa: a pro-poor strategy to reach Abuja targets and millennium development goals

BMJ 2004; 328 doi: http://dx.doi.org/10.1136/bmj.328.7448.1129 (Published 06 May 2004) Cite this as: BMJ 2004;328:1129
  1. David H Molyneux, director (fahy@liv.ac.uk)1,
  2. Vinand M Nantulya, senior adviser2
  1. 1Lymphatic Filariasis Support Centre, Liverpool School of Tropical Medicine, Liverpool L3 5QA,
  2. 2Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva 1216, Switzerland
  1. Correspondence to: D H Molyneux
  • Accepted 13 April 2004

The effectiveness of programmes to tackle malaria could be improved by linking them to initiatives to prevent other diseases

The global community has committed itself to halving the morbidity and mortality from malaria worldwide by 2010 through the Roll Back Malaria initiative (box).1 This goal was endorsed by the African heads of state at a summit held in Abuja, Nigeria, in April 2000.2 The leaders set three targets to achieve by 2005: 60% of malaria patients to have prompt (within 24 hours of malaria attack), affordable, and appropriate treatment; 60% of all pregnant women to have access to preventive presumptive intermittent therapy; and 60% of children under 5 years and pregnant women to be sleeping under insecticide treated mosquito nets. However, progress is currently slow. We suggest how progress could be increased through linking disease control or elimination programmes under way in Africa to malaria control programmes. These programmes, many of which are based on drug donations, bring additional public health benefits to affected populations such as reduced anaemia, improved nutrition, better child growth and development, and higher school attendance. Such a strategy would have a rapid effect on malaria morbidity and mortality among underserved populations.

Feasibility of targets

The tools for achieving the Abuja targets already exist—namely, insecticides, bed nets, and highly effective drugs. However, they are not being provided fast enough to the people who need them. Most malaria attacks are managed outside the formal health service as an out of pocket expenditure in the poorest countries.35 Indeed, because of the AIDS epidemic, children with malaria may be orphans cared for by their grandmothers. Thus, for many countries in sub-Saharan Africa, assuring treatment within 24 hours after a malaria attack means that antimalarial drugs have to be available at an affordable price and in simple formulations …

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