Tackling malaria today

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