Malaria in Angola
 |
|
| Dr. Margaret Chan, World Health Organization (WHO) Director-General, and Dan Mozena, U.S. Ambassador to Angola, chat at a national meeting, releasing the President’s Malaria Initiative (PMI)-funded 2006-07 Angola Malaria Indicator Survey results. Addressing this national meeting, with the participation of relevant partners from the UN system, the U.S. Agency for International Development (USAID), political leaders, and other stakeholders, Dr. Chan thanked PMI and appealed for the reinforcement of partnerships to fight this killer disease, as well as a higher political commitment in the implementation of the appropriate strategies for controlling malaria. Source: Macro International | |
Overview
Malaria is considered the greatest public health problem in Angolaa and the country's largest single cause of child mortality at an estimated 23 percent of possible causes of under-five mortality.b,c Pregnant women are also at serious risk from malaria. The U.S. Agency for International Development (USAID) through the President’s Malaria Initiative is committed to decreasing the burden of malaria by providing commodities and building capacity in the Angola Ministry of Health for more effective treatment and prevention of malaria. The Initiative will assist to rapidly scale up coverage of target groups with four highly effective interventions: artemisinin-based combination therapy (ACT), intermittent preventive treatment (IPT) for malaria in pregnancy, insecticide-treated mosquito nets (ITNs), and indoor spraying with residual insecticides (IRS). USAID Angola will address malaria prevention and treatment through partnerships with WHO, the Ministry of Health (MOH), National Directorate of Public Health, and local and international partners, including the Roll Back Malaria Partnership (RBM), UNICEF, The Global Fund to Fight AIDS, TB and Malaria (GFATM), and The World Bank.
Malaria in Angola
Malaria transmission in Angola is hyperendemic in the north and in the lowlands of the Atlantic coast; southern Angola has epidemic-prone areas. Approximately 90% of the population is at endemic or epidemic risk of malaria, with over half the population living in highly endemic areas of perennial transmission. Malaria is the principal cause of morbidity and mortality in children under five years of age.a Sixty-six percent of the 1.4 to 2 million cases reported in 2002 occurred among children under five years. The primary malaria vector in Angola is the Anopheles gambiae mosquito, which carries the malaria parasite Plasmodium falciparum and has a preference for biting humans. Because antimalarial treatment is not always available and not standardized across health units, self-medication is high among the public. This has contributed to high levels of resistance to the antimalarial drugs in use.
|
Angola Assessment Results
As part of the planning process for the President’s Malaria Initiative, a team from USAID, HHS/CDC, WHO, UNICEF, the Angolan National Malaria Control Program, and the Rational Pharmaceutical Management Plus Project of Management Sciences for Health carried out an assessment of the current status of malaria prevention and control activities in Angola and identified any unmet needs. In addition, the team evaluated the potential and feasibility of two high-impact activities that would build momentum for the President’s Initiative on Malaria in Angola: (1) distribution of long-lasting ITNs as part of a nationwide measles immunization campaign scheduled for June 2006; and (2) IRS with synthetic pyrethroids in epidemic-prone areas of the southern provinces of Namibie, Huila, and Cunene. Implementation of these key activities over the next 3-9 months is being discussed.
|
|
| Rear Adm. Tim Ziemer, U.S. Malaria Coordinator, and Vice Minister of Public Health Dr. Jose Van Dunem participate in the symbolic handover of approximately $900,000 of Coartem combination therapy anti-malarial medication used by the Angolan health ministry's essential drugs program. Photo Source: Alonzo Wind/USAID |
|
The President’s Malaria Initiative
In June 2005, President Bush announced a significant increase in resources from the US Government in order to fight Malaria in Africa. This groundbreaking Initiative challenges other countries, partners, donors and foundations to increase their commitment and funding for combating this disease in sub-Saharan Africa. To launch this Initiative, the United States will significantly expand resources for malaria in Angola, Tanzania and Uganda beginning in 2006, and will expand to at least four more highly endemic African countries in 2007, and at least five more in 2008. By 2010, the U.S. Government will provide an additional $500 million per year for malaria prevention and treatment. The goal of the President’s Malaria Initiative is to reduce malaria deaths by 50 percent in each of the target countries after three years of full implementation. This effort will eventually cover more than 175 million people in 15 or more of the most affected African countries.b
Country Status (annual figures)
| Total Populatione | 13.6 million |
| Population growth rateg | 2.9 |
| Life expectancy at birthg | 40 |
| Per capita GDP in international $f | $1,856 |
| Total expenditure on health as % of GDPh | 5% |
| Per capita total expenditure on health (US$)h | $38 |
| Per capita government expenditure on health (US$)h | $16 |
Population at Risk for Malariag
Endemic Risk: 90%
Epidemic Risk: 8%
Negligible Risk: 1%
Angolan Districts Most Affectedh
Malaria is endemic throughout Cabinda, Cuando Cubango, Cuanza Norte, Lunda Norte, Lunda Sul, Malanje, Uige, and Zaire Provinces.
US Government Support for Malaria
USG support for the malaria response in Angola is estimated to be: $1,000,000 (FY 2003).
USAID Implementing Partners in the President’s Malaria Initiative
TBD
General Health and Development Indicators (UNICEF MICS Data)
| Indicator | 1996i | 2000/1e |
| Infant mortality rate (per 1,000 live births) | 166 | 150 |
| Under-five mortality rate (per 1,000 live births) | 210 | 250 |
| Percentage of women with no education | 35% | -- |
| Total fertility rate (children per women) | 6.9 | 7.1 |
| Percentage of women who received antenatal care from a trained health professional prior to most recent live birth | -- | -- |
| Percentage of children fully immunized | 16.7% | 26.6% |
| Percentage of children with acute respiratory infection or fever taken to a health facility | 27.5% | 63.2% |
| Percentage of children underweight (-2 SD) | 41.6% | 30.5% |
| Percent pregnant women attending an ANC at least once during pregnancy | -- | -- |
Indicators for the President's Malaria Initiative
The outcome and impact indicators listed below will be collected by the President’s Malaria Initiative and have been agreed upon by the RBM Partnership, of which the USG is a partner.
Malaria Impact indicators1
| Key Impact Indicators | Baseline | Midterm | End of Initiative 2010 Target |
| Under-5 mortality rate (per 1000) (baseline 2000/1) | 250e | -- | -- |
| Proportion of deaths attributed to malaria among children under five in selected health facilitiesa (baseline 2000/1) | 23%e | -- | -- |
| Under-5 case fatality fate in selected health facilities (baseline 2000/1) | -- | -- | -- |
| Proportion of morbidity inpatients attributed to malaria in under fives in selected health facilities. (baseline 2000/1) | 66%a | -- | -- |
1 Select information was not available
2 Data source for future collection of this indicator will be determined.
Malaria Outcome Indicators1
| Key Outcome Indicators | Baseline | Midterm | End of Initiative 2010 Targetb |
| Proportion of under five with fever/malaria receiving correct treatment according to national guidelines within 24 hours of onset of fever. | -- | -- | 85% |
| Proportion of households with at least one ITN. (baseline 2000/1) | -- | -- | -- |
| Proportion of children under five sleeping under a mosquito net the previous night. (baseline 2000/1) | 10%e | -- | -- |
| Proportion of children <5 sleeping under an ITN the previous night. (baseline 2000/1) | 2%e | -- | 85% |
| Proportion of pregnant women sleeping under a mosquito net the previous night. (baseline 2000/1) | -- | -- | -- |
| Proportion of pregnant women sleeping under an ITN the previous night. (baseline 2000/1) | -- | -- | 85% |
| Proportion of pregnant women receiving at least two doses of IPT. | -- | -- | 85% |
| Proportion of health facilities surveyed with no stockout of nationally recommended antimalarial drugs continuously for one week during the last three months at the time of survey. | -- | -- | -- |
| Proportion of children under five with uncomplicated malaria correctly managed in health facilities.c | -- | -- | -- |
| Proportion of houses targeted for IRS successfully sprayed. | -- | -- | -- |
1 Select information was not available
3 These targets reflect the Abuja Targets to be met by 2005: http://rbm.who.int/docs/abuja_declaration_final.htm
4 Data on this indicator will be collected from sentinel sites.
Angola: Distribution of Endemic Malaria5
5 This map was developed using MARA data available at: http://www.mara.org.za/. Malaria distribution model: Craig, M.H. et al. 1999. Parasitology Today 15: 105-111. Boundaries distributed by ESRI.
References
a Strategic Plan for the Accelerated Reduction of Maternal and Child Mortality in Angola [PDF, 2.4MB], 2004-2008, Republic of Angola Ministry of Health, National Directorate of Public Health, WHO, UNICEF, and UNFPA.
b UNICEF Angola/2003.
c Ministry of Health-Angola. Studies, Planning and Statistics Office. Deaths in Luanda cemeteries. 2002-2003.
d USAID Angola.
e UNICEF Angola MICS 2, 2000/1 (End-Decade Assessment).
f United Nation Population Division - 2000 World Population Prospects: Population Database: The 2002 Revision.
g WHO Statistical Information System (WHOSIS): Country Official Health Indicators.
h Africa Malaria Report 2003, RBM/WHO.
i UNICEF Angola MICS 1996.