Massive scale-up of malaria control in endemic nations must be sustained, says WHO

BMJ 2010; 341 doi: (Published 23 December 2010) Cite this as: BMJ 2010;341:c7361
  1. John Zarocostas
  1. 1Geneva

The massive scale-up of malaria interventions that have saved the lives of nearly three quarters of a million children in the past decade must be maintained and accelerated, says the World Health Organization and leaders in the global fight against the disease.

“We cannot let this momentum slip,” said Margaret Chan, WHO director general, and she stressed that the unprecedented control efforts must be maintained, the results measures, and the problems identified.

“The results set out in this report are the best seen in decades. After so many years of deterioration and stagnation in the malaria situation, countries and their development partners are now on the offensive,” she said.

Dr Chan also said during the launch of the World Malaria Report 2010 that progress on every front “is fragile,” and cautioned, “Malaria is a complex disease that can take advantage of lapses in vigilance.”

Largely because of the surge in malaria control programmes, the number of malaria cases declined from 244 million in 2005 to 225 million in 2009, says WHO. The organisation estimates that deaths declined between 2000 and 2009 from 985 000 to 781 000.

Of the deaths, 91% occurred in sub-Saharan Africa and 85% of them in children younger than 5 years of age.

The WHO report said 11 countries and one area in the WHO African Region reported decreases of more than 50% in confirmed malaria cases or malaria admissions and deaths in recent years. In 32 of the 56 countries outside Africa where malaria is endemic, a reduction of more than 50% in confirmed cases of malaria occurred between 2000 and 2009.

In addition, two nations—Morocco and Turkmenistan—were certified by WHO as free of malaria in 2010, it said, but also noted that resurgences in malaria were registered last year in Rwanda, Sao Tome and Principe, and Zambia.

The report says that from 2008 through to the end of 2010 an estimated 289 million mosquito nets will have been delivered to sub-Saharan Africa, enough to cover 76% of the 765 million people at risk of malaria.

It also outlines that in 2009 the number of people protected by indoor residual spraying increased to 75 million, up from 13 million four years earlier, and corresponding to about 10% of the population at risk.

The study also shows that, at the end of last year, about 35% of cases in sub-Saharan Africa had been confirmed with a diagnostic test, up from less than 5% at the beginning of the decade, and the number of artemisinin based combination therapy courses procured by the public sector reached 158 million in 2009, up from 76 million in 2006.

Ray Chambers, the UN Special Envoy on Malaria, said the phenomenal expansion in access to malaria control interventions “is translating into lives saved.”

But the envoy said, “The focus must now be on maintaining coverage and ensuring high levels of utilisation, while increasing efforts to expand access to effective diagnosis and treatment.”

Chambers indicated that if the strategic scale-up were maintained, the UN goal of “reaching near zero malaria deaths” by the end of 2015 could be achieved.

“We must urgently fill the coverage gaps in diagnostics and lifesaving antimalarial medicines,” said Awa Marie Coll-Seck, executive director of the Roll Back Malaria Partnership.

Funding for malaria control in 2010 levelled off, however, at $1.8bn (£1.16bn; €1.37bn), far short of the more than $6bn needed, WHO said.


Cite this as: BMJ 2010;341:c7361


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