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Africa: Ending Malaria in Sight?
AfricaFocus Bulletin
Nov 27, 2009 (091127)
(Reposted from sources cited below)
Editor's Note
On the Comoran island of Moheli, with a population of 36,000,
malaria has been eliminated with the aid of a comprehensive
Chinese-assisted treatment campaign. And at the 5th Pan-African
malaria conference, held in Nairobi in early November, Kenya's
minister of public health, Beth Mugo, announced that her country
had set the goal of eliminating the disease by 2017.
The conference also featured promising announcements of development
of a malaria vaccine. Although that is still uncertain and still
some years to come at the most optimistic, scientists and health
officials at the conference expressed confidence that current
measures, including bednets, indoor insecticide applications, and
new combination drugs, held the potential for victory over the
disease, if funding and political will could be maintained.
This AfricaFocus Bulletin contains several short reports and
article excerpts related to recent developments in the fight
against malaria, including reports on the Comoros, Kenya, and
Rwanda, on the multilateral initiative to reduce the prices of
treatment, on the potential for new medications based on African
plants, and the threat of new resistance to the current first-line
treatment, Artemesinin-based combination therapies.
For more information on the 5th Pan African MIM Malaria conference,
and links to a wide variety of related news and scientific reports,
see http://www.mimalaria.org/pamc/
Previous AfricaFocus Bulletins on malaria include:
Africa: Progress on Malaria, Apr 27, 2009
http://www.africafocus.org/docs09/mal0904.php
Africa: Malaria Control Up, Majority Not Covered, Sep 19, 2008
http://www.africafocus.org/docs08/mal0809.php
Africa: Dramatic Anti-Malaria Results Feb 5, 2008
http://www.africafocus.org/docs08/mal0802.php
Africa: Africanizing Malaria Research, Nov 20, 2005
http://www.africafocus.org/docs05/mal0511.php
Africa: Rolling Back Malaria?
May 4, 2005
http://www.africafocus.org/docs05/mal0505.php
For additional articles on health issues, see
http://www.africafocus.org/healthexp.php
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Latest in AfricaFocus FYI
http://www.africafocus.org/fyi/recent.php
Nov 25, 2009 - President Barack Obama, " Remarks at Presentation
of Human Rights Award ", AllAfrica.com (Published Nov 24, 2009)
http://allafrica.com/stories/200911240404.html
The full text of remarks by President Barack Obama at the
presentation to Magodonga Mahlangu and Jenni Williams of Women of
Zimbabwe Arise (Woza) of the 2009 Robert F. Kennedy Human Rights
Award at a ceremony in the East Room of the White House on
November 23, 2009. Links to remarks by Mahlangu and Williams as
well.
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Kenya: Govt Hopeful It Can Eliminate Malaria
David Njagi, SciDev.Net (London)
9 November 2009
http://allafrica.com/stories/200911091705.html
Nairobi - Kenya hopes to eliminate malaria by 2017, a malaria
conference heard last week.
The disease has been in decline in the country in recent years
and scientists say they are optimistic that it can be eliminated
by then.
The goal was announced by Beth Mugo, minister of public health
and sanitation, at the opening of last week's 5th MIM Pan African
Malaria conference in Nairobi. Implementation will be steered by
a National Malaria Strategy (NMS), which the government launched
at a separate event.
"We are at a point of moving towards a malaria-free Kenya in
2017," said Willis Akhwale, head of the country's Department of
Disease Control and Prevention.
"Health systems strengthening, the development of effective
medicines, human resources capacity building and more will be
necessary to achieve this," said Mugo.
"Eliminating malaria in 2017 is possible based on current
technologies and adequate funding," said Elizabeth Juma, head of
the Division of Malaria Control.
The timeline is based on the findings of a 2007 Malaria Indicator
Survey, which demonstrated that transmission is declining in most
parts of the country - although seasonal transmission in arid and
semi-arid areas is still at worrying levels.
"We plan to change the strategy of intervention in the arid and
semi-arid areas and launch a mass drug administration campaign in
areas where the disease is endemic," said Akhwale. Experts told
the MIM meeting that elimination was not possible without mass
drug administration. Elimination occurs when malaria prevalence
drops to zero in a region, while eradication achieves the same on
a global scale.
Some 13 per cent of pregnant women in Kenya now use insecticide
treated nets (ITNs) in all malaria endemic areas, according to
the 2007 survey. The number of children aged five and under using
ITNs rose from under five per cent in 2003 to more than half in
2006.
Robert Newman, director of the WHO's Global Malaria Programme,
said he was confident that Kenya would meet the 2017 target but
he added that success depended on improved political will as well
as the development of new tools to improve disease surveillance.
It was also essential for communities to realise that they are
"not just recipients of drugs but they play an important part in
the fight against malaria", he said.
Akhwale said Kenya would need US$100 million if it were to meet
the target. NMS plans to decentralise control and to prioritise
monitoring and evaluation.
The Affordable Medicines Facility-Malaria to begin delivering
subsidized ACTs within two weeks
November 6th, 2009
http://mim.globalhealthstrategies.com/blog/?p=550
http://www.theglobalfund.org/en/amfm/
The Affordable Medicines Facility malaria (AMFm) program,
hosted and managed by the Global Fund, will deliver subsidized
artemisinin-based combination therapies (ACTs) to select
countries within two weeks time. As a result of negotiations and
larger, direct payments to manufacturers, malaria drug prices
will be reduced from$6 to 40 cents per dose through AMFm.
Countries selected to participate in the program, originally
announced in April, are: Benin, Cambodia, Ghana, Kenya,
Madagascar, Niger, Nigeria, Rwanda, Senegal, Tanzania and Uganda.
The announcement came from the 5th Pan-African MIM Conference in
Nairobi on Monday. Experts hailed the drug-delivery decision as
key to eradicating malaria in sub-Saharan Africa.
Drug Resistance Threatens Anti-Malaria Drive:
Artemisinin,
Malaria "Miracle" Drug, Could Lose Its Potency
by Cathy Sunshine Nov 18, 2009
http://www.suite101.com/profile.cfm/csunshine
Artemisinin compounds are highly effective against malaria, but
they're too expensive for most people. Use of cheap substitutes
is leading to dangerous drug resistance.
Malaria kills nearly a million people each year, most of them
young children in Africa. The vast majority of deaths are due to
Plasmodium falciparum, a vicious malaria strain that has become
resistant to all but one of the malaria drugs on the market.
http://www.who.int/features/factfiles/malaria/en/index.html
That one drug is artemisinin, a derivative of Artemisia annua,
the sweet wormwood plant. When taken in combination with another
drug, artemisinin can knock out a lethal malaria infection
swiftly and completely.
Now, as an indirect result of the drug's high cost, malaria
parasites resistant to artemisinin have emerged along the
Thai-Cambodian border and are threatening to spread.
Treating Malaria with Artemisinin Combination Therapies
Since 2004, the World Health Organization (WHO) has recommended
artemisinin-based combination therapies as the frontline
treatment for malaria. The drug cocktails combine fast-acting
artemisinin with a longer-acting, older antimalarial, delivering
a one-two punch to the parasite.
It is crucial that artemisinin not be administered alone, a
method known as monotherapy. Without a companion drug, some
parasites linger in the body and can become resistant to
artemisinin.
For this reason, the WHO in 2006 called for artemisinin
monotherapies to be pulled from the market, except in special
cases. But many manufacturers and countries are failing to
comply.
Ineffective monotherapies still dominate the private market in
large countries such as Nigeria and the Democratic Republic of
Congo, which together account for 30 percent of malaria cases in
sub-Saharan Africa.
For full article, see http://tinyurl.com/ygkordn
Remaining sections include
"High Cost of Artemisinin Leads to Underuse"
"Malaria Eradication Efforts Threatened"
China adopts "malaria diplomacy" as part of Africa push
Nov. 6, 2009
Reuters Alertnet
[Excerpts. Full article at:
http://www.alertnet.org/thenews/newsdesk/SP503140.htm]
By Tan Ee Lyn
Hong Kong, Nov 6 (Reuters) - In a laboratory in China's southern
city of Guangzhou, scientists are trying to enhance the rare
sweet wormwood shrub, from which artemisinin -- the best drug to
fight malaria -- is derived.
China hopes to improve and use the drug as a uniquely Chinese
weapon to fight malaria not on its own soil, where the deadly
disease has been sharply pruned back, but in Africa, where it
still kills one child every 30 seconds.
Already, a Chinese-backed eradication programme on a small island
off Africa has proven a huge success.
...
Successful Trial
Tanzania, Kenya and Nigeria have begun farming hybrids of the
sweet wormwood shrub with Chinese and Vietnamese ancestry, said
Li Guoqiao at the Tropical Medicine Institute.
"I inspected the plantations and the plants are growing well," Li
told Reuters in an interview.
Asked if China would export the high-yielding Artemisia annua to
Africa, Li said: "We want to grow them in China and whatever we
export depends on bilateral relationships."
Li is spearheading a project on the tiny African island of
Moheli, which belongs to the Comoros group of islands at the
northern mouth of the Mozambique Channel.
In mid-November 2007, he launched a "mass drug administration"
exercise on the island. Its entire population of 36,000 had to
take two courses of anti-malarial drugs to flush the parasite
from their bodies -- on day one and day 40.
The rationale was that while mosquitoes pass the parasite from
person to person, they are merely "vectors" and not hosts. The
real reservoir of the disease is people, and many carry the
parasite in their bodies without even showing symptoms.
"The key is to eradicate the source, which is in people. Without
the source, the vectors are harmless," he said.
The results were startling. While the parasite carrier rate in
Moheli ranged from 5 to 94 percent from village to village before
the exercise, that fell to 1 percent or less from January 2008
and has stayed around that figure since.
"Before, 70 to 80 percent of hospital patients were there for
malaria. After that, you hardly find any," Li said.
Comoros now bars anyone from entering Moheli unless they take a
course of antimalarial drugs -- a mix of artemisinin, primaquine
and pyrimethamine that China provides for free.
Its government has asked Beijing to roll out the same programme
in two of its larger islands, Grande Comore and Anjouan, with a
total population of 760,000. Li said Beijing supported the idea
in principle and that funding was being worked out.
Kenya: Locally-Growing Moringa Tree Key in Fight Against Malaria
The Nation (Nairobi)
Gatonye Gathura and Isaiah Esipisu
3 November 2009
[Excerpts: full article at:
http://allafrica.com/stories/200911031216.html]
Nairobi A malaria treatment derived from a locally-growing
shrub is one of only a few herbal cures being presented at the
ongoing international conference in Nairobi.
The tree, moringa oleifera, commonly known as horseradish or
mlonge in Kiswahili, is competing alongside malaria medicines
developed by some of the world's best scientists with the backing
of global pharmaceutical giants.
According to a presentation at the Pan-African Malaria
Conference, moringa extract, in combination with other herbs, has
been seen to cure even drug-resistant malaria.
Unfortunately for Kenya, this development has been made by
Nigerians who say the drug called zogali has been approved by the
country's national drug registration agency.
Several herbal malaria cures are being presented at the
conference but none from Kenyans despite repeated claims by local
herbalists that they can easily treat and even cure the disease.
According to Dr N. Emetu of the National Research Institute for
Chemical Technology in Nigeria, the product has been endorsed and
accepted after trials by the World Health Organisation.
If this drug wins wider acceptance, it could do for the local
tree what another shrub, the sweet wormwood, has done for China.
An extract from the Chinese tree has become the drug of choice
for treating malaria across the world. As a result, it has become
a major cash crop in several countries.
While moringa grows wildly in some parts of the country, several
groups of farmers at the Coast, Western, Nyanza and Rift Valley
provinces are commercially planting the tree.
The leaves are crushed and sold as food supplements while the
seeds are pressed and the extract exported to Europe, China and
the US, where it is used in the cosmetics industry.
The main buyer of the seeds is Earth Oil, an export processing
zone firm in Athi River.
According to the Nigerian study, the combination herbal remedy
not only cures malaria but also boosts the immune system of
patients, thereby ensuring complete eradication, sustenance of
body resistance and protection from subsequent attack by the
parasite.
Evidence presented at the meeting by the University of Ghana and
that of Gezira, Sudan, indicated that plant extracts from Africa
have the capacity to treat malaria but so far are underutilised.
...
Healthy Lives:
Winning the Battle Against Malaria in Rwanda
http://psi.org
As few as five years ago, malaria was the leading cause of death in
Rwanda, with half of those fatalities in
children under five. However, this nation of seven million rapidly
scaled-up malaria interventions and
achieved dramatic reductions in the deadly disease In just over two
years of rapid scale-up, deaths due
to malaria have dropped to only 7%, a dramatic 60% reduction.
Rwanda stands out as one of PSI's platforms
that have made dramatic progress in controlling malaria.
A number of factors contributed to the significant gains in
reducing the malaria burden in Rwanda. Backed
by the strong political will and bold leadership of the Rwandan
government, the National Malaria Control
Program, together with its partner organizations and donors,
assembled a multifaceted approach that
currently has malaria on retreat across Rwanda.
Scaled-up Ownership and Usage of Long-Lasting Insecticide-Treated
Nets (LLINs)
Prior to 2005, there was a modest 30,000 mosquito nets distributed
by the national government to protect
its citizens against malaria. In 2005 however, Rwanda received its
first grant from the Global Fund to Fight
AIDS, Tuberculosis and Malaria 300,000 bednets were supplied. By
the next year, as the new resources
went to work, 1.4 million LLINs were distributed to the country's
most vulnerable populations. In 2006 and
2007, a coordinated national multi-channel distribution of three
million nets reached 10 million Rwandans
through antenatal clinics, vaccination sites and private sector
outlets in 100% of district towns.
Conversion to Artemisinin-Based Combination Therapy (ACT)
LLINs were just one piece of a well-planned, comprehensive malaria
control program in Rwanda. While LLIN
distribution was being scaled-up, the Rwandan Ministry of Health
introduced new guidelines making ACTs
the first line treatment of malaria, with both public clinics and
private pharmacies stocking the most effective
anti-malarial available. Expectant mothers were given intermittent
treatment in pregnancy, making them less
susceptible to malaria infections during this vulnerable time.
Improved Home-Based Management of Fever
Programs for home-based management of fever ramped up throughout
Rwanda, spearheaded by a new
cadre of trained community health care workers. With two selected
in each village, community health
workers put national malaria policies in motion at the local level.
Galvanizing community engagement in the
fight against malaria, community health workers played a vital role
in translating the national strategy into
impact by providing information and resources for prompt and
effective treatment and malaria prevention.
Behavior change communication programs such as mobile cinemas have
resulted in additional widespread
sensitization about net use and malaria transmission, even in the
most rural areas.
Increased Health Facility Utilization
Health center utilization rate is over 70%, with only 10% of
patients seeking treatment for malaria, due in part
to nationwide government health insurance and improvements in
quality of care and availability of services.
Last year, indoor residual spraying (IRS) with pesticide for
protection against malaria was provided to more
than 190,000 homes in targeted areas.
Even with such significant progress, the battle against malaria in
Rwanda is far from over, and the Rwandan
National Malaria Control Program is aiming to achieve even more
ambitious goals, including universal coverage of LLINs, expanded
IRS, subsidized ACTs nationwide, and bolstered monitoring and
evaluation to tackle epidemics. Decreased malaria also brings a
new set of challenges, including possible drops in net usage as
malaria prevalence declines, reductions in natural immunity to the
malaria parasite and the need to implement a regional strategy for
continued gains against the disease.
This expanding scope of new challenges underscores the need for
sustained resources to fully control
malaria. Rwandans have achieved remarkable success yet find
themselves at a critical turning point in the
fight against malaria. If current progress and achievements can be
expanded with the support of continued
investment, sustained political commitment and diligent management,
Rwanda is positioned to become a
global model of success. However, if funding recedes and national
programs lose momentum, Rwanda could
face tremendous and deadly disease resurgence and millions of lives
lost.
For more information, visit:
http://www.malariafreefuture.org/rwanda/index.php
AfricaFocus Bulletin is an independent electronic publication
providing reposted commentary and analysis on African issues,
with a particular focus on U.S. and international policies.
AfricaFocus Bulletin is edited by William Minter.
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