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. The burden of malaria is heaviest in sub-Saharan Africa but the disease also afflicts Asia, Latin America, the Middle East and even parts of Europe.
World Malaria Day - which was instituted by the World Health Assembly at its 60th session in May 2007 - is a day for recognizing the global effort to provide effective control of malaria. It is an opportunity:
* for countries in the affected regions to learn from each other's experiences and support each other's efforts;
* for new donors to join a global partnership against malaria;
* for research and academic institutions to flag their scientific advances to both experts and general public; and
* for international partners, companies and foundations to showcase their efforts and reflect on how to scale up what has worked.
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.
25 April is a day of unified commemoration of the global effort to provide effective control of malaria around the world. This year's World Malaria Day marks a critical moment in time. The international malaria community has merely two years to meet the 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.
World Malaria Day represents a chance for all of us to make a difference. Whether you are a government, a company, a charity or an individual, you can roll back malaria and help generate broad gains in multiple areas of health and human development.
Reducing the impact of malaria would significantly propel efforts to achieve the Millennium Development Goals, agreed by every United Nations member state. These include not only the goal of combatting the disease itself, but also goals related to women's and children's rights and health, access to education and the reduction of extreme poverty.
Hundreds of RBM partners - governments, international organizations, companies, academic and research institutions, foundations, NGOs and individuals - are already gaining ground against malaria. Diverse partner initiatives are guided by a single strategy, outlined in the Global Malaria Action Plan.
Global Malaria Programme (GMP)
The Global malaria Programme (GMP) is part of the WHO, the foremost global authority on health.
GMP is responsible for malaria surveillance, monitoring and evaluation, policy and strategy formulation, technical assistance, and coordination of WHO's global efforts to fight malaria.
Diagnosis
Prompt and accurate diagnosis of malaria is part of effective disease management and will, if implemented effectively, help reduce unnecessary use of antimalarial medicines. The two diagnostic approaches currently used are based on
1.- the symptoms and signs of the disease - i.e. a clinical diagnosis and
2.- detection of the causative parasite or its product(s).
The most commonly used being microscopic diagnosis, and more recently rapid diagnostic tests based on immunochromatographic techniques.
Treatment
Once diagnosed as malaria, either on a clinical or parasitological basis, the patient should be treated early with a safe and effective antimalarial medicine, the Roll Back Malaria goal being effective treatment within 24 hours of the onset of symptoms. This is because a delay in treatment of uncomplicated malaria, specially in the non-immune patient could result in progression to severe disease which is associated with a high case fatality rate.
The management of clinical malaria includes treatment with an antimalarial medicine which should be consistent with the national treatment policy, and also supportive therapy, and referral to appropriate health facilities.
Resistance
Antimalarial drug resistance hinders malaria control and is therefore a major public health problem. The WHO publication describes the state of knowledge about this problem and outlines the current thinking regarding strategies to limit the advent, spread and intensification of drug-resistant malaria.
Home management
Access to prompt, effective appropriate treatment is a key element of the Global Malaria Programme strategy and is based on the widespread recognition that untreated falciparum malaria contributes both directly and indirectly to the death of non-immune individuals. It is vital that treatment starts within 24 hours of the onset of symptoms, to prevent progression to severe malaria or death. A strong health system would provide for reliable diagnosis as the basis for optimal treatment. However, in most malaria-endemic areas, access to curative and diagnostic services is limited. The HMM strategy therefore aims to improve the common ineffective self-medication practices that are very common in these endemic countries.
Definition
Early recognition of, and prompt and appropriate response (treatment) to malarial illness in children under 5 years of age in the home or community. This is to be achieved through:
a) Enabling caretakers to recognize malaria illness early and take the appropriate response.
b) Ensuring that care providers have the adequate knowledge and capacity to respond to febrile illness or malaria.
c) Creating an enabling environment to implement the strategy.
The HMM strategic components:
1.- Availability of and access to effective, high-quality, prepacked antimalarial medicines at the community level.
2.- Training of community-based service providers to ensure they have the necessary skills and knowledge to manage febrile illness or malaria.
3.- An effective communication strategy to ensure correct early care seeking behaviour, and appropriate and effective home care of a febrile illness or malaria.
4.- A good mechanism for supervision and monitoring of the community activities.
Epidemics and emergencies
Malaria epidemics kill more than 100,000 people of all ages every year. People at greatest risk are those who have been exposed to malaria only infrequently and have developed little or no protective immunity. It is estimated that up to 124 million people in Africa live in areas at risk of seasonal epidemic malaria, and many more in areas outside Africa where transmission is less intense.
Up to 30% of malaria deaths in Africa occur in the wake of war, local violence or other emergencies. Malaria deaths often far exceed those caused by the conflict or problem. Displaced people living in makeshift housing are vulnerable to malaria because they are more likely to be bitten by mosquitoes, are often ill with other infections, and lack access to health care.
Pregnant women and infants
Each year, approximately 50 million women living in malaria-endemic countries throughout the world become pregnant, of whom over half live in tropical areas of Africa with intense transmission of Plasmodium falciparum. An estimated 10,000 of these women and 200,000 of their infants die as a result of malaria infection during pregnancy, and severe malarial anaemia contributes to more than half of these deaths.
Vector control
Vector control remains the most generally effective measure to prevent malaria transmission and therefore is one of the four basic technical elements of the Global Malaria Control Strategy. The principal objective of vector control is the reduction of malaria morbidity and mortality by reducing the levels of transmission. Vector control methods vary considerably in their applicability, cost and sustainability of their results. The choice of vector control will depend on the magnitude of the malaria burden, the feasibility of timely and correct application of the required interventions and the possibility of sustaining the resulting modified epidemiological situation. WHO recommends a systematic approach to vector control based on evidence and knowledge of the local situation. This approach is called Integrated vector management (IVM).
View the report of a WHO Study Group on Malaria Vector Control and Personal Protection that reviews the current vector control strategies and their effectiveness in various operational and eco-epidemiological settings and identified challenges for implementation in different health systems.
Request for proposals
Participate in a WHO pilot study for the sustainable management of nets used for malaria vector control
The WHO Global Malaria Programme, in partnership with UNEP, IFRC and with the financial support of the World Bank and UNEP-SAICM, is commissioning a public research institution or similar to conduct in a one year pilot study to identify and assess the feasibility of environmentally-sound management (ESM) options for management of expired nets that are beyond their useful life, including the options of collection, recycling and disposal of LNs used for malaria control.
The project will study the possibility and cost-effectiveness for local, regional and international approaches to the ESM of nets. The selected institute will be requested to address the technical questions related to the re-use, safe disposal and recycling of the nets.
The present call includes requests for expertise in the field of pesticide waste management, plastic waste recycling and disposal with proven experience in health and environmental impact studies. We would particularly like to hear from institutions that have previous experience working with WHO or other international organizations and implementing projects and research activities in countries with less developed economies.
Capacity development
Capacity development for Global Malaria Programme builds on the current capability in countries at all levels to prevent and control malaria through:
* Provision of an enabling environment (e.g., political commitment; development and implementation of appropriate recruitment and career policies; provision of facilities and resources; strengthened training institutions);
* Intensification of training and retraining of personnel;
* Technical support mechanisms (e.g., information, communication and supply systems to support trained personnel, supervision, monitoring and evaluation).
Lack of human resources or capacity at country / inter-country level is the key constraint to developing, implementing and sustaining malaria control. Lack of capacity can be addressed through several options (e.g. pre or in-services activities) targeting different key actors in the field. To increase national capacity, one important function of WHO is to develop and make available standardised documents based on the best up to date practices (training packages, software and tools) adjusted to intervention levels (from national to communities), as well as to organise national and international training courses and workshops with partners. Communication and continuous information from and to member states are essential parts of capacity building on agreed upon innovative strategies supported by WHO.
With greatly increased availability of funds, the needs are moving from planning towards implementation, monitoring and evaluation. The focus must be on the district level, but national institutional back-up is also essential. Capacity development must be part of a broader human resource and healthy system strategy, where GFATM, GAVI and similar factors are of overwhelming importance.
Surveillance, monitoring and evaluation
Monitoring and evaluation are essential components of GMP's work since monitoring measures the implementation of its range of strategic activities while evaluation measures the extent to which its objectives are being reached.
Many organizations use different indicators and methodologies to collect malaria data, contributing to the overall problem of monitoring malaria trends. The potential of existing health information systems (HIS) in malaria-endemic countries is not being fully exploited to enable accurate measurement of intervention coverage and impact.
GMP’s role is to provide guidance to improve country HIS inputs, including development of new surveys and tools that vastly improve the accuracy of information collected and that place greater emphasis on community and facility information systems.
In order to accurately estimate the burden of disease and measure the trends in malaria, greater coordination, better survey instruments and methods are being developed.
Malaria and HIV/AIDS
Malaria and HIV are two of the most devastating global health problems of our time. Together they cause more than 4 million deaths a year. Both are diseases of poverty, and both are causes of poverty. To a considerable extend, both are concentrated in the same geographical regions. The resulting co-infection and interaction between the two diseases have major public health implications.
* HIV-infected people must be considered particularly vulnerable to malaria;
* Antenatal care needs to address both diseases and their interactions;
* Where both diseases occur, more attention must be given to specific diagnosis for febrile patients.
Malaria
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.
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.
Sources:
http://www.who.int/mediacentre/events/annual/malaria/en/index.html
http://www.rollbackmalaria.org/worldmalariaday/
http://apps.who.int/malaria/
http://apps.who.int/malaria/diagnosis.html
http://apps.who.int/malaria/treatment.html
http://apps.who.int/malaria/resistance.html
http://apps.who.int/malaria/homemanagement.html
http://apps.who.int/malaria/epidemicsandemergencies.html
http://apps.who.int/malaria/pregnantwomenandinfants.html
http://apps.who.int/malaria/vectorcontrol.html
http://apps.who.int/malaria/capacitydevelopment.html
http://apps.who.int/malaria/monitoringandevaluation.html
http://apps.who.int/malaria/malariandhivaids.html
http://www.who.int/topics/malaria/en/index.html