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Malaria death rates still high but there is progress to report

22 Sep 2008

Paul Chinnock

Source: World Health Organization (see original article)
Source: World Health Organization (see original article)

Cover of the latest report.

The World Health Organization (WHO), in its latest estimate of malaria mortality, has concluded that around 881,000 people died from the disease in 2006. Around 91% of those who died were children in Africa. There were an estimated 247 million cases globally (range: 189–327 million).

The figures are lower than estimates previously made for 2005, but WHO says this is due primarily to a refinement of calculation methods and that it is not known whether there has actually been a decline in the global figure.

Nevertheless, some national figures do show reductions in case numbers and deaths. In WHO’s African region, Eritrea, Rwanda, and Sao Tome & Principe reported declines in the number of cases and deaths of 50% or more between 2000 and 2006–2007, following high coverage of control activities. Four other African countries also reported reductions. Twenty-two countries outside Africa reported declines of 50% or more in malaria cases and deaths between 2000 and 2006.

There is encouraging news regarding the stepping up of control programmes, especially in Africa, where there has been an increase in the distribution of insecticide-treated nets (ITNs) especially the newer long-lasting insecticidal nets (LLINs) that are effective for three years. The number of LLINs distributed almost tripled to 36 million between 2004 and 2006. Of 647 million people at risk in Africa, the portion covered by ITNs rose from 3% in 2001 to 26% in 2006 and an estimated 39% in 2007. Surveys in 18 African countries in 2006 show 34% of households owned a mosquito net (from 6% in Côte d’Ivoire to 65% in Niger).

Despite this progress, coverage of nets and all other interventions are substantially below the 80% target set for 2010. Furthermore, usage rates remain low; even in those homes that have them, ITNs are not always used to protect the most vulnerable – only 23% of children and 27% of pregnant women sleep under a net, according to the African surveys.

Indoor insecticide spraying in 2006 protected more than 100 million people, including 70 million in India and 22 million in Africa, where it appeared linked to the decline in cases seen in Namibia, South Africa and Swaziland.

Some 38% of African children under five who had a fever received an anti-malarial drug in 2006. But only 3% of sick children were given the more effective artemisinin-based combination therapy treatment, even though there has been a big increase in its supply. 18% of pregnant women in 16 African countries received anti-malaria medicine as a preventive treatment to reduce the risk of babies with low birthweight.

Substantial increases in funding for the fight against malaria have supported an expansion of interventions against the disease. In 2006, WHO’s Africa region reported spending a total of $688 million on malaria control. The actual figure was higher, since only 26 of the region's 45 countries provided spending data. The major funders were the Global Fund to Fight AIDS, Tuberculosis and Malaria, bilateral organizations, and affected countries.

The full report is available from WHO as a PDF.

Comments

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1 Oct 2008 by Paul Chinnock:

A number of articles in the media have noted that the substantial change in WHO's estimate of malaria mortality is due to revised statistical techniques.

For example, the New York Times quotes Amir Attaran as saying, 'It’s better fudging, not better reporting. It’s still assumption built on assumption built on assumption.'

According to Bob Snow, 'Improving on what WHO did for their 2005 report does not equate to getting it right.' Dr Snow noted that the new estimate, like old ones, counted case reports from people who went to clinics in countries with broken-down health care systems and then tried to make statistical adjustments for those who never sought care in those countries.He called that practice 'ludicrous”and added that 'even a back-of-the-envelope calculation' would come up with higher caseloads through most of Africa, as well as in Indonesia, which is the fourth-most-populous country and has not recently been cooperative at sharing data with the WHO.

See the full New York Times article on http://www.nytimes.com/2008/09/23/health/23malaria.html?_r=2&adxnnl=1&oref=slogin&ref=science&adxnnlx=1222173520-beHFGfqZOG7SeYCpfGA3Mg&oref=slogin.