The massive progress in the fight against malaria achieved over the last decade could stall because of lack of money, according to the World Malaria Report 2012, issued by the World Health Organization (WHO).

The authors explained that over the last ten years, countries where malaria is endemic have made a concerted effort, along with donors and global malaria partners in strengthening malaria control globally. Of the 1.1 million lives saved during the last decade, 58% were in the ten countries with the highest malaria burdens.

Scientists have also made some exciting discoveries and breakthroughs over the last few years. A team of researchers in Israel discovered a genetic cloaking device that the malaria parasite uses to evade the human immune system and establish infection. They think a treatment that interferes with the DNA of this cloaking device may help the immune system destroy the malaria parasite.

After five consecutive years of rapid expansion, which occurred between 2004 and 2009, global funding for malaria prevention and control lost steam and leveled off from 2010 to 2012, resulting in a serious slowing down in the progress of the delivery of several life-saving commodities.

The World Malaria Report 2012 warns that the recent slowdown could eventually reverse all the hard-fought gains made in the fight against malaria – one of the leading infectious killers worldwide.

For example:

  • 145 million long-lasting insecticidal nets (LLINs) were delivered to countries in sub-Saharan Africa where malaria is endemic in 2010
  • 66 million LLINs were delivered to the same countries in 2012

In other words, millions of households in 2012 will not be able to replace their existing bed nets when they require them, resulting in more exposure to bites from malaria-infected mosquitoes.

Indoor residual spraying programs increased substantially during the 2005-2009 period, but remained at 11% of the population at risk (77 million) between 2010 and 2011.

Ellen Johnson Sirleaf, President of Liberia and Chair of the African Leaders Malaria Alliance, who held an official launch event for the report in Monrovia, Liberia, said:

“During the past eight years, scaled-up malaria control helped us avert over a million deaths. We must maintain this momentum and do our utmost to prevent resurgences.”

Statistics can be made to sound impressive, but when the numbers are analyzed closely, much of the impact may be disappointing. The report says that 50 nations will reduce malaria rates by 75% by 2015, reaching the World Health Assembly and Roll Back Malaria targets. Unfortunately, these nations only represent 7 million people, or 3% of the malaria cases that experts believed occurred in 2000. The year 2000 figure is a benchmark against which any progress is measured.

Director of the WHO Global Malaria Program in Geneva, Dr Robert Newman, said:

“Global targets for reducing the malaria burden will not be reached unless progress is accelerated in the highest burden countries. These countries are in a precarious situation and most of them need urgent financial assistance to procure and distribute life-saving commodities.”

Fourteen countries account for 80% of the global malaria burden. The most affected countries in sub-Saharan Africa are Nigeria and the Democratic Republic of Congo, the most affected nation in South-East Asia is India.

Dr Fatoumata Nafo-Traoré, Executive Director of the Roll Back Malaria Partnership, said “The multi-pronged strategy to fight malaria, outlined in the Global Malaria Action Plan, is working. However, in order to prevent a resurgence of malaria in some countries, we urgently need fresh ideas on new financing mechanisms that will reap greater resources for malaria. We are exploring many options – financial transaction taxes, airline ticket taxes together with UNITAID, and a “malaria bond”, among others.”

The authors of the World Malaria Report 2012 warn that international funding for the fight against malaria has tailed off and reached a plateau nowhere near the level needed to reach the Millennium Development Goals, as well as other targets which had been agreed internationally.

Between 2011 and 2020, approximately $5.1 billion are required annually so that 99 countries can provide universal access to malaria interventions. Funding in 2011 reached only 2.3 billion; not even half the required amount. The report stresses that even when increased domestic financing for malaria control is taken into account, the shortfall is still huge.

Such a funding gap means hundreds of millions of people in highly endemic areas will not have effective malaria prevention, diagnostic testing and treatment. A lack of funding seriously undermines efforts to deal with the emergence and spread of parasites which have become resistant to current antimalarial medications. Scientists from the University of London reported in Malaria Journal that the deadliest malaria parasite in Africa is becoming resistant to the most powerful medications. The battle against mosquito resistance to insecticides is also affected when donations dry up.

Rapid diagnostics tests (RDTs) – there has been a considerable increase in the sales of RDTs, which stood at 88 million in 2010 and nearly doubled to 155 million in 2011. The authors added that the quality of these tests has improved substantially over the last few years.

Delivery to countries of ACTs (artemisinin-based combination therapies) also jumped from 191 million in 2010 to 278 million in 2011, mainly thanks to an increase in the sales of subsidized ACTs by private companies.

One of the major challenges in malaria control is tracking progress accurately. Current malaria surveillance systems can only detect about 10% of the estimated global number of cases. WHO estimates that it is not possible to reliably assess malaria trends in up to 41 countries because of the incompleteness or inconsistency of time-based reporting.

Accurate tracking of malaria control is essential. For this, WHO says stronger malaria surveillance systems are urgently required so that prompt and effective responses can be carried out in endemic regions to prevent outbreaks and resurgences, as well as making sure that help reaches areas that most need it.

WHO launched new malaria surveillance manuals in April 2012, as part of its T3: Test – Treat – Track initiative.

Poor quality or fake malaria drugs have become a serious problem in sub-Saharan Africa and South East Asia, a group of researchers reported in The Lancet Infectious Diseases in May 2012.

Malaria is a potentially fatal blood-borne disease caused by parasites that infect people through bites of infected Anopheles mosquitoes.

According to WHO:

  • 660,000 people died of malaria in 2010, most of whom were African children
  • There were approximately 219 million cases of malaria in 2010
  • Globally, malaria mortality rates have dropped by over 25% since 2000
  • In the WHO African Region, malaria mortality rates have dropped by 33% since 2000

Malaria is both preventable and treatable, i.e. people are currently dying unnecessarily from the disease.

Malaria infection duration can be considerably shortened if the disease is diagnosed and treated early on. Diseases of shorter duration are much less likely to lead to complications and death.

The word malaria means “bad” “air” (mala, aria in 18th century Italian). Medical historians say the term was first used by Dr. Francisco Torty, Italy, when it was thought the disease was caused by the foul air that lingers in marshy areas. In 1880, scientists discovered that it was, in fact, a parasitic disease transmitted by the anopheles mosquito.

The anopheles mosquito infects a human with a plasmodium, a one-cell parasite. Humans infect other humans via the bite of the female mosquito, which needs blood for her eggs – i.e. the uninfected female mosquito bites an infected human and becomes infected herself, flies off and bites another human, infecting him/her.

About 40% of all the people in the world are at risk of malaria infection. During the last century, virtually all non-tropical nations managed to eliminate malaria.

WHO says that an African child dies every minute from malaria. Malaria is both linked to poverty and a cause of poverty. Economists say the disease is a serious obstacle to economic development.

Malaria is caused by four Plasmodium parasites:

  • Plasmodium vivax
  • Plasmodium ovale
  • Plasmodium malariae
  • Plasmodium falciparum (the most deadly)

The most common types are Plasmodium falciparum and Plasmodium vivax.

Plasmodium knowlesi – which occurs in forested areas of South-East Asia and affects monkeys, has started to infect humans as well over the last few years.

In endemic areas, people either have immunity or semi-immunity, and have either no symptoms at all or very few and mild ones. Partial immunity is acquired after years of exposure. Although it never provides complete protection, it helps significantly reduce the risk of severe disease. That is why the majority of deaths in Africa occur in young children, while in areas with less transmission and low immunity, there is a wider spread in age groups that are at risk.

The severity of malaria symptoms depends on the type of parasite, the person’s immunity, and whether they still have their spleen.

The signs and symptoms of early stage malaria are

Symptoms of Malaria

Symptoms, which usually come in cycles, may do so at varying levels of severity. Symptoms may also last for different lengths of time, depending on each cycle.

Other signs and symptoms of malaria may include

  • Enlarged spleen
  • Dry cough
  • Back pain
  • Aching muscles

More rarely, some patients may have the following signs and symptoms

  • Loss of consciousness
  • Impaired spinal cord function
  • Impaired brain function
  • Fits (seizures)

The following illnesses or infections may have similar symptoms to malaria; it is important that the doctor rules them out when trying to make a diagnosis – non-malarial parasitic infections, meningitis and other bacterial infections, typhoid fever, hepatitis, gastroenteritis, tick bite diseases (rickettsia), colds, flu and other viral infections.

Written by Christian Nordqvist