More resources needed for malaria

Malaria accounts for around 35% of all deaths among children under five, and the high prevalence is a major contributing factor to Mozambique having one of the highest child mortality rates in the world. In order to step up the fight against the deadly disease, Unicef, WHO, the United Nations Development Programme (UNDP) and the World Bank launched the Roll Back Malaria Partnership (RBM) in 1998. The RBM partnership brings together the governments of countries affected by malaria, their development partners, the private sector, NGOs and community-based organizations, foundations, and research and academic institutions around the common goal of halving the global burden of malaria by 2010. Last year the Global Fund to Fight Aids, Tuberculosis and Malaria signed an agreement, worth 12-million, with the government of Mozambique to support malaria programmes, one of which includes the distribution of insecticide-treated bed nets (ITN) that prevent bites and kill mosquitoes.

Studies have shown that the widespread use of ITNs can reduce child mortality by 20%. Nevertheless, most children in Mozambique still sleep unprotected. According to the Demographic and Health Survey of 2003, only about 10% of under-five children were using ITNs, and there are large geographical disparities, ranging from 3% in Sofala province to 15% in Maputo City, and Zambezia and Gaza provinces. Alicia Carbonell, WHO's programme officer for reproductive health in Mozambique, said that more resources were needed to assist the most vulnerable groups, especially children under five and pregnant women. Contracting malaria during pregnancy could cause the child to be stillborn, and also result in severe anaemia, thought to be a factor involved in up to 30% of maternal deaths.

Mozambique has a very high maternal mortality rate, with 408 women in every 100000 live births dying from pregnancy-related complications. Malaria during pregnancy also leads to a low birth weight -- one of the most important factors in determining a child's future survival and development. The prevalence and intensity of malaria during pregnancy is higher in women who are HIV positive. ITNs were being distributed freely to HIV positive pregnant women and sold at a subsidized rate to mothers with children under five years old. Last year Mozambique became one of 19 countries to adopt the intermittent preventive treatment policy for pregnant women. The Ministry of Health has recommended that all health facilities offer pregnant women at least two doses of Fansidar (a malaria prevention and treatment drug) after their fifth month of pregnancy.

We are now in the process of implementing this, said Carbonell. We need to make sure there is a stock of Fansidar and proper training of health personnel, but we need more resources for our programme.

Anti-DDT lobby could slow fight against malaria , minister says

Environmentalists against the use of the pesticide DDT could harm efforts to eradicate malaria in Uganda, the minister of health, Jim Muhwezi, said on Monday. If environmentalists continued to pressure donors to discourage the use of DDT, he said on Africa Malaria Day, Any efforts to roll back malaria would be fruitless. DDT has been proven, over and over again, to be the most effective and least expensive method of fighting malaria, he said. Europe and America became malaria free because of using DDT, and now we too intend to get rid of malaria by using it. He added, Cases have continued to increase since launching the Roll Back Malaria programme in 1998, from 5,5-million to 16,5-million in 2004.

Malaria is transmitted by the bite of an infected mosquito. According to the UN World Health Organization (WHO), the disease occurs in at least 100 countries and kills at least a million people every year, mostly young children in Africa south of the Sahara. The Roll Back Malaria programme, initiated by 90 organizations including WHO, the UN Children's Fund, the UN Development Programme and the World Bank, aims to halve malaria deaths in Africa by 2010. However, up to 515-million people around the world continue to suffer from malaria every year, according to a recent study by Oxford University, UK, with 90% of the cases occurring in Africa. In Uganda, malaria kills between 70000 and 110000 children every year, Muhwezi said. He added that the country spent an average of 347-million annually to buy anti-malaria medicine.

In April 2004, the Ministry of Health announced plans to use DDT to combat the nation's rising prevalence of malaria, a move widely condemned by environmentalists. Concerns have been raised about the pesticide's long-term effects on the environment, as well as possible consequences to the health of humans and animals. Although Europe and the US used DDT to eradicate malaria, they banned its use decades ago, over fears that it could be harmful to the environment. On its website, the conservation organization, WWF, says it has found sufficient evidence of hazards to human health and wildlife to justify a global ban on the production and use of DDT.

WWF says the pesticide could harm human health by damaging the developing brain, causing hypersensitivity, behavioral abnormalities and a suppressed immune system. The Ugandan government has authorised the National Environment Management Authority to organize an environmental impact assessment analysis before the importation of the pesticide. We decided to consult with all stakeholders, including the environmentalists, before beginning to use DDT, Muhwezi said. We will start once their environmental impact assessment is complete. He said Uganda intended to use DDT only indoors, as recommended by WHO.

Moreover, he said, the pesticide would initially be sprayed in pilot areas before being used countrywide. According to the malaria programme control manager in the Ministry of Health, Dr John Rwakimari, treatment of the disease has become more complicated with patients developing high resistance to common malaria drugs. Chloroquine and fansidar are no longer effective against malaria, he said on Friday. He added that part of the 66-million the country recently secured from the Global Fund to Fight AIDS, TB and Malaria, would be used to buy more effective drugs. Muhwezi said lack of access to health centres was another cause of many malaria deaths. He added that by June, the government planned to double -- from 30% -- the number of patients able to access medical attention within 24 hours of the onset of the disease's symptoms. DDT would be used, Muhwezi said, in conjunction with insecticide-treated bednets. The government has already distributed 1,4-million nets free, while another 600000 have been sold through the private sector. Muhwezi said a further two million nets would be distributed to vulnerable groups such as young children and pregnant women. The chief of the EU mission in Uganda, Sigurd Illing, said there could be dire consequences for the country's exports to Europe -- which account for more than 30% of Uganda's total exports -- if DDT was detected in export commodities such as horticultural produce.

Asked if the government feared the loss of trade with the EU, Muhwezi said: We are confident that because we plan to follow WHO regulations regarding the use of DDT, we will have no problems on that issue.

(Source: M&G, April 28, 2005)