Control, not elimination, key to Africa malaria battle, argue experts

By KEMRI-Wellcome Trust Research Programme
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Global efforts focusing on eliminating malaria are “counterproductive” to the fight against the disease in Africa, experts have warned. They emphasise the importance of maintaining, and building on, control strategies rather than aiming for a target that may not be met.

Buoyed by a reduction in malaria mortality in Africa, health leaders at a 2007 meeting on global malaria control switched their primary goal from control to elimination.

But researchers from the Kenya Medical Research Institute-Wellcome Trust Research Programme say the emphasis on elimination or eradication in strategic plans for the next 10-20 years in Africa is “at best irrelevant and at worst counterproductive”, raising expectations that cannot be met.

Writing in The Lancet, they argue that using currently available methods can reduce malaria from a major health priority to a fairly minor burden. As Professor Bob Snow says “reaching low endemic control is achievable, its financing requirements are predictable and its effects measureable – the result would be a huge public health success, a legacy we'd all be proud of, but this isn't elimination which seems to be a more attractive term to donors”.

In 2000, heads of state from across Africa signed a declaration to halve malaria mortality for Africa by 2010. In the paper, the authors review malaria strategies and interventions of the past 10 years and their success toward this aim.

Increased use of insecticide-treated bednets, improved rapid diagnostic tests and the replacement of failing drugs with artemisinin-based combination therapy are among the interventions that have helped substantially reduce malaria transmission and incidence across the continent. On the coast of Kenya, for example, incidence of severe malaria has fallen by more than 90 per cent in the last five years.

However, the authors warn that positive results are not universal throughout Africa. For example, studies have shown coverage of less than 40 per cent in the use of insecticide-treated bednets in 33 African countries. Despite substantial evidence in favour of artemisinin-based combination therapies, they still only reach a small proportion of the African population. And a substantial funding gap remains to meet the estimated US$4 per head needed to properly control the

disease – research revealing that the average level of funding in 20 African countries was less than $1 per head in 2007.

In this context, the authors argue that the switch in focus in Africa to elimination over control is a fallacy. While it has invigorated global efforts, they say, the importance of maintaining investment in control cannot be underestimated. They warn that withdrawing funding from control efforts would be potentially disastrous.

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Juliette Mutheu
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Authors and possible commentary contacts
Professor Bob Snow: [email protected] (Tel: +254 20 2715160 or 2720163)