MDG target on malaria achieved amid sharp drop in cases, mortality, says WHO/UNICEF report

• ‘Nigeria misses out but still on track, records over 85% insecticide-treated bednets coverage’• 89% of infections, 91% deaths were in sub-Saharan Africa* N1.96 tr needed to eliminate disease by 2030 as 3 bn people remain at risk

Unlike Nigeria, most countries of the world have met the Millennium Development Goal (MDG) target on malaria as death rates have plunged by 60 per cent since 2000, translating into 6.2 million lives saved, the vast majority of them children.

A joint World Health Organisation (WHO)-United Nation Children Fund (UNICEF) report “Achieving the malaria MDG target”,released yesterday, shows that the malaria MDG target to “have halted and begun to reverse the incidence” of malaria by 2015, has been met “convincingly”, with new malaria cases dropping by 37 per cent in 15 years.

According to the report, an increasing number of countries are on the verge of eliminating malaria.

But National Coordinator National Malaria Elimination Programme (NMEP), Dr. Nnenna Ezeigwe, told The Guardian yesterday in a telephone chat: “Nigeria did not meet the MDG target on malaria but is still on track to halting the disease.

“I think we have come a long way and therefore need to celebrate along with the rest of the world. On a broader epidemiological perspective, Nigeria moved from a classification of predominantly hyper and holo-endemic to meso-endemic status between 2000 and 2010. Hyper-holo-endemicity is malaria prevalence of 50 to 75 per cent, while meso-endemicity is prevalence of 10 to 49 per cent.

“In the recently conducted World Bank Malaria Control Booster Project End of Project Survey carried out in seven project states and two comparison states, the percentage of households with at least one Insecticide Treated Net (ITN)/Long Lasting Insecticide treated Nets (LLINs) was 85 per cent, above the target of 80 per cent.

“Also, the percentage of women with children under one year of age, who received Ante Natal Care (ANC) during last pregnancy (one or more visits), surpassed the project target of 80 per cent, at 87.2 per cent. Generally, there is impressive national coverage of most of the available interventions, especially with the LLINs, where over 80 per cent coverage has been recorded.”
Also, new research from the Malaria Atlas Project – a WHO Collaborating Centre based at the University of Oxford – shows that ITNs have been by “far the most important intervention” across Africa, accounting for an estimated 68 per cent of malaria cases prevented since 2000. Artemisinin Combination Therapies (ACTs) and indoor residual spraying contributed to 22 per cent and 10 per cent of cases prevented, respectively. The research, published yesterday in the journal Nature, provides strong support for increasing access to these core interventions in post-2015 malaria control strategies.

The WHO-UNICEF report notes that these targets can only be achieved with political will, country leadership and significantly increased investment. Annual funding for malaria will need to triple – from US$ 2.7 billion (N607.5 billion) today to US$ 8.7 billion (N1.957 trillion) in 2030.

According to the report, in 2015, 89 per cent of all malaria cases and 91 per cent of deaths were in sub-Saharan Africa and of the 106 countries and territories with malaria transmission in 2000, 102 are projected to reverse the incidence of malaria by the end of 2015.

The report noted that between 2000 and 2015, the proportion of children under five sleeping under an ITN in sub-Saharan Africa increased from less than two per cent to an estimated 68 per cent; one in four children in sub-Saharan Africa still lives in a household with no ITN and no protection provided by indoor residual spraying; and in 2015, only an estimated 13 per cent of children with a fever in sub-Saharan Africa received an ACT.

It noted: “In 2014, 13 countries reported zero cases of the disease and six countries reported fewer than 10 cases. The fastest decreases were seen in the Caucasus and Central Asia, which reported zero cases in 2014, and in Eastern Asia.

“Despite tremendous progress, malaria remains an acute public health problem in many regions. In 2015 alone, there were an estimated 214 million new cases of malaria, and approximately 438 000 people died of this preventable and treatable disease. About 3.2 billion people – almost half of the world’s population – are at risk of malaria.

“Some countries continue to carry a disproportionately high share of the global malaria burden. Fifteen countries, mainly in sub-Saharan Africa, accounted for 80 per cent of malaria cases and 78 per cent of deaths globally in 2015.

“Children under-five account for more than two-thirds of all deaths associated with malaria. Between 2000 and 2015, the under-five malaria death rate fell by 65 per cent or an estimated 5.9 million child lives saved.”
Director-General of WHO,Dr. Margaret Chan, said: “Global malaria control is one of the great public health success stories of the past 15 years. It is a sign that our strategies are on target, and that we can beat this ancient killer, which still claims hundreds of thousands of lives, mostly children, each year.”

UNICEF Executive Director, Anthony Lake, said: “Malaria kills mostly young children, especially those living in the poorest and most remote places. So the best way to celebrate global progress in the fight against it is to recommit ourselves to reaching and treating them. We know how to prevent and treat malaria. Since we can do it, we must.”

According to the report, global bi-lateral and multi-lateral funding for malaria has increased 20-fold since 2000. Domestic investments within malaria-affected countries have also increased year by year.
A number of donor governments have made the fight against malaria a high global health priority. In the United States of America, the President’s Malaria Initiative has mobilized hundreds of millions of dollars for treatment and prevention, while the government of the United Kingdom tripled its funding for malaria control between 2008 and 2015.
Many governments have also channeled their investments through the Global Fund to Fight AIDS, Tuberculosis and Malaria, or directly to countries.

Secretary of State for International Development of the United Kingdom,Rt. Hon. Justine Greening, said: “A healthy, prosperous world is in all our interests and the prevention of deadly diseases is one of the smartest investments we can make.
“That is why, working with malaria-affected countries and partners like the Global Fund, Britain will continue to provide bednets to millions, tackle resistance to life saving medicines and insecticides, and boost health systems across Africa to help bring an end to this terrible disease.”

According to the report, the surge in funding has led to an unprecedented expansion in the delivery of core interventions across sub-Saharan Africa. Since 2000, approximately one billion ITNs have been distributed in Africa. The increased use of rapid diagnostic tests (RDTs) has made it easier to distinguish between malarial and non-malarial fevers, enabling timely and appropriate treatment. ACTs are highly effective against Plasmodium falciparum, the most prevalent and lethal malaria parasite affecting humans, but drug resistance is a looming threat which must be prevented.
In May 2015, the World Health Assembly adopted the WHO Global Technical Strategy for Malaria – a new 15-year road map for malaria control. The strategy aims at a further 90 per cent reduction in global malaria incidence and mortality by 2030.