Health

Malaria

© UNICEF/HQ 99-0454/ Pirozzi

A woman nurse demonstrates how to impregnate a mosquito net with insecticide for malaria prevention, Rwanda.

Malaria kills a child somewhere in the world every 30 seconds. It infects 350-500 million people each year, killing 1 million, mostly children in Africa. Ninety per cent of malaria deaths occur in Africa, where malaria accounts for about one in five of all childhood deaths. The disease also contributes greatly to anaemia among children — a major cause of poor growth and development.

Malaria infection during pregnancy is associated with severe anaemia and other illness in the mother and contributes to low birth weight among newborn infants — one of the leading risk factors for infant mortality and sub-optimal growth and development.

Malaria has serious economic impacts in Africa, slowing economic growth and development and perpetuating the vicious cycle of poverty. Malaria is truly a disease of poverty — afflicting primarily the poor who tend to live in malaria-prone rural areas in poorly-constructed dwellings that offer few, if any, barriers against mosquitoes.

Malaria is both preventable and treatable, and effective preventive and curative tools have been developed.

Sleeping under insecticide treated nets can reduce overall child mortality by 20 per cent. There is evidence that ITNs, when consistently and correctly used, can save six child lives per year for every one thousand children sleeping under them.

Prompt access to effective treatment can further reduce deaths. Intermittent preventive treatment of malaria during pregnancy can significantly reduce the proportion of low birth weight infants and maternal anaemia.

Unfortunately, many children, especially in Africa, continue to die from malaria as they do not sleep under insecticide-treated nets and are unable to access life-saving treatment within 24 hours of onset of symptoms. Most recent data  on household use of insecticide treated nets reveal low coverage rates of only around 5 per cent across Africa.  However, recent efforts to scale up coverage have contributed to significant progress in several countries.

Increasing resistance of the malaria parasite to chloroquine and sulphadoxine-pyrimethamine — previously the most widely used antimalarial treatments — has prompted sixty-eight countries to change their national treatment protocols to incorporate the new and highly-effective artemisinin-based combination therapies or ACTs.

There is increasing evidence that where they occur together, malaria and HIV infections interact.  Malaria worsens HIV by increasing viral load in adults and pregnant women; possibly accelerating progression to AIDS; and potentially increasing the risk of HIV transmission between adults, and between a mother and her child. In adults with low CD4 cell counts and pregnant women, HIV infection appears to make malaria worse.

Goals

In accordance with the Millennium Development Goals, the Abuja Declaration  on Roll Back Malaria in Africa, the goals contained in the outcome document of the UN Special Session on Children: “A World Fit for Children,” and updated targets contained in the Roll Back Malaria Strategic Plan 2005-2015, UNICEF aims to help ensure that:

By 2010, particularly in the lowest two economic quintiles:

• 80 per cent of people at risk from malaria are protected, thanks to locally appropriate vector control methods such as insecticide-treated nets (ITNs), and, where appropriate, indoor residual spraying (IRS) and, in some settings, other environmental and biological measures;
• 80 per cent of malaria patients are diagnosed and treated with effective antimalarial medicines, e.g. artemisinin-based combination therapy (ACT) within one day of the onset of illness;
• in areas where transmission is stable, 80 per cent of pregnant women receive intermittent preventive treatment (IPTp);
• malaria burden is reduced by 50 per cent compared with 2000.

And by 2015:

• malaria morbidity and mortality are reduced by 75 per cent in comparison with 2005, not only by national aggregate but particularly among the poorest groups across all affected countries;
• malaria-related Millennium Development Goals are achieved, not only by national aggregate but also among the poorest groups, across all affected countries;
• universal and equitable coverage with effective interventions.

How does UNICEF Help?

UNICEF is a founding partner, with the World Health Organization (WHO), the United Nations Development Programme (UNDP), and the World Bank of the Roll Back Malaria (RBM) initiative, a global partnership established in 1998 to halve the world’s malaria burden by 2010.

In recognition of its role as one of the biggest killers of children in Africa, malaria prevention and control interventions form an integral component of a minimum package of UNICEF’s high impact maternal and child survival interventions. Integrated programming of this kind utilizes existing systems with relatively high utilization by target groups, including the Expanded Program on Immunization (EPI), Integrated Management of Neonatal and Childhood Illness (IMNCI), child health days for children under five and ante-natal care (ANC) for pregnant women.

Insecticide-Treated Nets

UNICEF is the largest global procurer and deliverer of ITNs, procuring over 24 million nets in 2006.

Major recent efforts to scale-up the availability of ITNs in Africa are yielding impressive results. Some countries with new coverage data have already shown remarkable progress. For example, in Togo, ITN coverage increased from 2% to 54% in just 5 years (MICS 2000 and CDC/MOH 2005 preliminary results). A number of other countries, including Kenya, Rwanda and Malawi have greatly increased the number of ITNs distributed recently, and are therefore expected to make significant progress toward achieving the Abuja targets for ITN coverage.

Together with its partners, UNICEF distributes ITNs using routine health services and campaign approaches. UNICEF works with Ministries of Health, non-governmental organizations (NGOs) as well as community and village health workers to develop local distribution systems.

Intermittent Preventive Treatment

Intermittent preventive treatment involves providing pregnant women with at least two doses of an anti-malarial drug, currently sulphadoxine-pyrimethamine (SP), at each scheduled antenatal visit after the first trimester, whether they show symptoms of infection with malaria or not. Such preventive treatment has been shown to substantially reduce the risk of anaemia in the mother and low birth weight in the newborn.

UNICEF’s partnership with the Making Pregnancy Safer initiative and national antenatal care services helps ensure that women and their newborns access quality antenatal care and reproductive health services, including intermittent preventive treatment against malaria and insecticide-treated nets.

Research shows that intermittent preventive treatment for infants (IPTi) may be effective in reducing anaemia and clinical malaria in young children, and may soon be provided as part of their routine immunization visits. UNICEF is a member of the IPTi Consortium, which is currently conducting research into the feasibility of introducing this additional intervention in Africa.

Effective antimalarial treatment

Waiting even six hours for treatment can mean life or death to a child sick with malaria. Through integrated child survival programming, UNICEF supports national governments and partners for treatment of malaria with the new and highly effective ACTs through static health facilities, and increasingly for treatment of malaria in the home as part of IMNCI. UNICEF works with governments and communities to improve and promote prompt and effective malaria case management, and to ensure that children have access to medications within 24 hours of the onset of illness.

UNICEF is also involved in the procurement and supply of ACTs. In 2006, UNICEF procurement services provided 7.3 million doses of ACT for malaria treatment in Ethiopia, of which 3.9 million have already been distributed through the public health system.

Malaria and HIV

UNICEF and partners support improved communication on the increased risks from malaria in people with HIV and the need for intensified prevention and treatment, including provision of ITNs through routine services to people living with HIV, especially pregnant women. Recent evidence suggests that co-trimoxazole prophylaxis for all people with HIV as part of a Basic Care Package and alongside ITNs has the potential to reduce mortality and morbidity and to delay the need for anti-retroviral therapy.

Global Partnerships for Malaria Prevention and Control

UNICEF plays a key role in global, regional and country malaria partnerships.

UNICEF is a founding partner of the Roll Back Malaria partnership and is a key member of the RBM Board. The RBM partnership includes governments of countries affected by the disease, representatives of the private sector, research institutions, non-governmental organisations and others. UNICEF is also strengthening partnerships in malaria with the World Bank, the US President’s Malaria Initiative, the Global Fund to Fight AIDS, Tuberculosis and Malaria, Malaria No More and UNITAID.

On 25 April 2000, Heads of State and senior representatives from 44 malaria-afflicted countries in Africa came together in Abuja, Nigeria to attend a milestone Summit on Malaria. Africa Malaria Day is celebrated each year on 25 April to focus world attention on the challenge and responses. The theme for Africa Malaria Day 2007 is Leadership and Partnership for Results, and the focus is on the need to work in partnership to reverse the progression of malaria and make a significant impact in endemic countries.

It is estimated that approximately US$ 3 billion is required annually to effectively prevent and control malaria worldwide (World Malaria report). Donors include the Global Fund, the World Bank, bilateral agencies such as USAID; specialized United Nations agencies, international NGOs, foundations, large multinational corporations and high net-worth individuals, Other sources of funding include domestic financing through national budgets and incorporation of malaria control needs in national poverty reduction strategy papers (PRSPs), sector-wide approaches (SWAps) and essential health packages. Significant resources for malaria prevention and control have been made available during the last few years through several key initiatives.

UNICEF supports advocacy and partnership efforts by leveraging its own resources and results to ensure that women and children are placed at the centre of national and international development and funding agendas. UNICEF has recently entered into partnership with Malaria No More, an umbrella organization that acts as a central clearinghouse for donations from individuals and private organizations with the goal of providing an ITN to every family that needs one in sub-Saharan Africa.

UNICEF is partnering with the Global Fund and WHO to access funds from UNITAID to support procurement of antimalarial medicines, specifically ACTs.

This new funding mechanism, launched at the Paris Conference on Innovative Financing for Development, will raise funds of up to US$ 600 million annually via an international air-ticket levy for the purchase of medicines to treat HIV/AIDS, tuberculosis and malaria.

UNICEF is also a partner in the US President’s Malaria Initiative (PMI), which was established in June 2005 and pledged to increase funding of malaria prevention and treatment by more than $1.2 billion over five years.