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Malaria deaths on the increase

A report by WHO and UNICEF attributes the high Malaria death rates in Africa to inadequate medical care, failure to use insecticide treated nets and increased resistance to drugs.
Zachary Ochieng

The report, launched during celebrations to commemorate the African malaria day, says that the drugs hitherto used for the treatment of Malaria are losing their power while the next generation drugs are far beyond the reach of most families. The theme of the celebration was: "Insecticide treated nets and effective malaria treatment for pregnant women and young children by 2005".

The report was launched by Kenya’s Vice president Wamalwa Kijana on April 25 at Nairobi’s Kenyatta International Conference Centre. Among those in attendance were Health minister Charity Ngilu, Information and Tourism minister Raphael Tuju, UNICEF Kenya country representative Dr Nicholas Alipui and WHO Africa Regional Director Ibrahim samba.

The report attributes the high incidences of Malaria to failure by African governments to implement the Roll Back Malaria (RBM) strategies launched in 1998. In Kenya 34000 children are killed every year - almost 90 per cent of the global figures. Malaria is also responsible for 30 per cent of outpatient cases and 19 per cent of inpatients. Some 6000 women suffer from Malaria related anaemia during the first pregnancy, thereby increasing chances of abortion, stillbirths and low birth weights.

According to the report, the disease costs the continent US$ 12 billion a year - a major constraint to social and economic development. The commemoration came three years after the Abuja Summit of April 2000, of presidents and representatives of 44 Malaria endemic African countries. It sought their support for the RBM programme.

At Abuja, Nigeria, the leaders signed a historic Declaration and Plan of Action committing their governments to an intensive effort to reduce Malaria by half by 2010 and set interim targets for 2005. Other targets were that at least 60 per cent of those at risk, especially children and pregnant women benefit from the best use of insecticide treated nets and that 60 per cent of those stricken have access to effective preventive treatment.

But three years down the line and only two years away from the interim deadline of 2005, the situation in Kenya and other African countries remains grim. By January, less than 5 per cent of Africa’s children were sleeping under insecticide treated nets. Fewer than 15 per cent slept under any net at all. "It is clear that much of Africa is not moving at the speed required to hit the Abuja target. The principal problem is the gap between what nets cost and what families can and will pay for them", says the report.

And though 44 states committed themselves to scaling up net possession and use by waiving or reducing taxes on nets, only 19, including Kenya have either reduced or waived taxes and tariffs on nets and insecticides as demanded by the Abuja declaration.

The report notes that anti-malarial drug resistance is one of the greatest challenges in treatment. For decades, chloroquin was the drug of choice, but parasitic resistance has rendered it ineffective. "The next generation of anti-malarial drugs - the artemisinin-based combination treatment has been developed, but the cost - between US$1 and US$ 3 per treatment - puts them beyond the reach of most families", observes the report.

It adds: "The conclusion is alarming. Africa’s first line of defence is giving out and for the majority, there is no second line". Accordingly, the funding and delivery of effective drugs, especially to women and children most at risk, is now urgent across the continent.

The report decries the limited access to curative and diagnostic services in most endemic areas as a big let down in the fight. It recommends that sufferers, especially children aged below five years start treatment within 24 hours of the onset of symptoms.

On resource mobilization to reduce the burden, the report says that states must honour the Abuja Declaration, which called on them to allocate new resources - at least US$ 1 billion every year, sourced locally and from donors.

However, the report asserts that harnessing and co-ordinating resources require a consensus among potential partners and an effective working relationship as an integral part of the RBM strategy. The recently launched Global Fund to Fight Aids, Tuberculosis and Malaria (GFATM) is a major new source of grant funding for tackling Malaria in Africa.

On his part, President Mwai Kibaki has reiterated the government’s commitment to implementing prevention programmes and stocking hospitals with adequate drugs. In Kenya, Malaria is the greatest contributor to rising morbidity and mortality of all infectious diseases and is closely followed by HIV/AIDS. Over 36 per cent of Kenyan children die of Malaria before their first birthday. Currently, 93 children die in Kenya daily from the disease. In Sub-Saharan Africa, Malaria kills a child every thirty seconds.

Due to the increasing resistance to drugs, the Kenya Medical Research Institute (KEMRI) now wants the local medical authorities to consider reintroducing DDT, a Malaria fighting insecticide, which was banned several years ago. Dr Davy Koech, the KEMRI director says the drug could reduce Malaria deaths by 80 per cent and should be given a second thought.

DDT is credited with having led to the near eradication of the disease in the West since it was discovered in 1944 by a Swiss medicine Nobel laureate, Paul Harman Muller.

Debate on DDT continues to gather momentum following an alert issued last month by the Director of medical Services Dr Richard Muga. According to the warning, 21 of Kenya’s 60 districts are likely to experience an outbreak of Malaria following the heavy rains currently pounding various parts of the country. Last year, 240 people died from the traditional Malaria zones of Nyanza and Rift Valley.

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