World Malaria Day: 25 April 2011

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Achieving Progress and Impact

This year's World Malaria Day theme "Achieving Progress and Impact" highlights recent successes in efforts to and causes global partners to take stock of what needs to be done to control, eliminate, and eventually eradicate malaria.
 
Success and Challenges

In the last 10 years, funding has increased and many partners have stepped up efforts and joined together to scale up life-saving malaria interventions, especially in Africa. For example, by the end of 2010, enough insecticide-treated bed nets (ITNs) had been delivered to sub-Saharan Africa to cover three-quarters of the 765 million people living in areas where malaria is transmitted.
Increased efforts and funding have led to progress and impact.

  • The 2010 World Health Organization (WHO) World Malaria Report estimates that malaria caused an estimated 781,000 million deaths globally in 2009, down from an estimated 985,000 in 2000.
  • At the end of this decade, 11 countries and one area in the WHO's African Region have shown a reduction of more than 50% in either confirmed malaria cases or admissions and deaths.
  • In 32 of the 56 malaria-endemic countries outside Africa, the number of confirmed malaria cases declined more than 50%.

Challenges to reaching near zero deaths by 2015 remain, including continuing high levels of intervention coverage, addressing insecticide resistance that can weaken the efficacy of ITNs and indoor residual spraying, and combating drug resistance that affects the ability of antimalarial drugs to cure a patient with malaria.
 
Malaria in South Africa 

In South Africa, the malaria season is between September and May. During the first quarter of 2011 (that is, from January to March), 4 560 cases of malaria were identified, versus 2 681 cases for the same period in 2010 (an overall 41% increase in cases). Many of these cases were imported with a history of travel to other African countries. Appropriate preventive measures need to be taken if travelling to malaria risk areas within or outside of South Africa. This includes both mosquito avoidance measures (use of insecticide- treated bed nets, use of DEET-containing insect repellents, wearing long-sleeved clothing, staying indoors after dusk, etc.) and chemoprophylaxis.
 
Travel Tips

It is important that those who are travelling to risk areas during the upcoming holidays take effective precautions against malaria. Many people travel to other African countries during the Easter holiday season, so healthcare workers must obtain a thorough travel history and include malaria in the differential diagnosis of any febrile illness in such cases. African countries where malaria is endemic (either in parts/all of the country) include: Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon,Cape Verde, Central African Republic, Chad, Comoros, Congo (DRC), Congo (Brazzaville), Côte d’Ivoire, Djibouti, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Madagascar, Malawi, Mali, Mauritania, Mayotte, Mozambique, Namibia, Niger, Nigeria, Rwanda, São Tomé and Principe, Senegal, Sierra Leone, Somalia, Sudan, Swaziland, Tanzania, Togo, Uganda, Zambia and Zimbabwe.
Current malaria chemoprophylaxis recommendations for travel in southern Africa include three regimen options: mefloquine, doxycycline or atovaquone-proguanil (Malanil®).1According to national guidelines,2 artemetherlumefantrine (Coartem®) is first-line treatment for uncomplicated falciparum malaria (except in children < 6 months of age and in the first trimester of pregnancy). Alternatively, quinine plus either doxycycline or clindamycin can be used. Quinine plus clindamycin is the treatment of choice in uncomplicated malaria cases for those in the first trimester of pregnancy and in children ≤ 5kg. Intravenous quinine should be used for cases of severe malaria. Where available, intravenous artesunate should be used for non-pregnant adults with severe malaria.
 
References:
 
1. South African National Department of Health.
Guidelines for the Prevention of Malaria in South
Africa(2009). http://www.doh.gov.za/docs/
factsheets/guidelines/prevention_malaria09.pdf
 
2. South African National Department of Health.
Guidelines for the treatment of malaria in South
Africa(2010). http://www.doh.gov.za/docs/
factsheets/guidelines/malaria/treatment/
guidelines2010.pdf
 

 Figure 1: Map of the Endemic Malaria areas within South Africa

Map of Endemic Malaria Areas