World Malaria Day
Counting malaria out
Despite new drugs and strategies for combating malaria, the infectious illness remains one of the world's most dangerous and deadly diseases. Approximately half of the world's population is at risk of malaria, particularly those living in lower-income countries. It infects more than 500 million people per year and kills more than 1 million. WHO also estimates that a child dies from malaria every 30 seconds. Today, the world will observe World Malaria Day, a day of unified commemoration of the global effort to provide effective control of malaria around the world. This year's the day marks a critical moment in time. The international malaria community has merely two years to meet the ambitious 2010 targets of delivering effective and affordable protection and treatment to all people at risk of malaria, as called for by the UN Secretary-General, Ban Ki-Moon. The theme of this year's World Malaria Day is "Counting malaria out". The Roll Back Malaria Partnership — which includes WHO — is kicking off a campaign to engage partners in a comprehensive effort to count and quantify the progress and impact of the fight against malaria. Out of 64 districts, 13 bordering districts in the east and northeast in Bangladesh are seriously affected by malaria. A total of 14.7 million populations are at high-risk of malaria in the country, although there is sporadic incidence of malaria in other parts of the country. Plasmodium falciparum is the predominant infection (61-71%). The emergence and spread of antimalarial drug resistance and the resulting increase in treatment failures and case fatality rates due to falciparum malaria have seriously aggravated the malaria problem in Bangladesh. Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells. Symptoms of malaria include fever, headache, and vomiting, and usually appear between 10 and 15 days after the mosquito bite. If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs. In many parts of the world, the parasites have developed resistance to a number of malaria medicines. Travellers from malaria-free regions, with little or no immunity, who go to areas with high disease rates are very vulnerable. Non-immune pregnant women are at high risk of malaria. The illness can result in high rates of miscarriage and cause over 10% of maternal deaths (soaring to a 50% death rate in cases of severe disease) annually. Semi-immune pregnant women risk severe anaemia and impaired fetal growth even if they show no signs of acute disease. An estimated 200 000 of their infants die annually as a result of malaria infection during pregnancy. HIV-infected pregnant women are also at increased risk. Early treatment of malaria will shorten its duration, prevent complications and avoid a majority of deaths. Because of its considerable drag on health in low-income countries, malaria disease management is an essential part of global health development. Treatment aims to cure patients of the disease rather than to diminish the number of parasites carried by an infected person. The best available treatment, particularly for P. falciparum malaria, is a combination of drugs known as artemisinin-based combination therapies (ACTs). However, the growing potential for parasite resistance to these medicines is undermining malaria control efforts (see below). There are no effective alternatives to artemisinins for the treatment of malaria either on the market or nearing the end of the drug development process. WHO recommends
* prompt treatment for all episodes of disease (within 24 hours of the onset of symptoms if possible);
* use of insecticide-treated nets for night-time prevention of mosquito bites;
* for pregnant women in highly endemic areas, preventive doses of sulfadoxinepyrimethamine (IPT/SP) to periodically clear the placenta of parasites;
* indoor residual spraying to kill mosquitoes that rest on the walls and roofs of houses. Key interventions to control malaria include: prompt and effective treatment with artemisinin-based combination therapies; use of insecticidal nets by people at risk; and indoor residual spraying with insecticide to control the vector mosquitoes. The last global anti-malaria campaign, in the 1950s, failed. It was hoped that the insecticide DDT would eradicate mosquitoes, which transmit the disease. Sadly, the programme collapsed as a result of insecticide resistance and concerns about DDT's use. By the 1980s it was seen as distasteful even to discuss eradicating malaria. Things certainly have changed. We have drugs. Even vaccines are emerging. Along with targeted insecticide spraying and the use of bed nets, we have the tools to beat malaria. We also have the cash. Gates and the world's richest governments are pumping billions into combating the disease. Public-private partnerships such as the Medicines for Malaria Venture and Malaria Vaccine Initiative are also pushing new interventions. We may not reach the 2015 goal, but we will eventually "count malaria out", as the World Malaria Day campaign entreats, if we sustain the present momentum.
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