Positive impact of mass media campaign on bed net use in Cameroon

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A mass media health education intervention in support of investments in malaria control commodities such as insecticide-treated mosquito bed nets can result in significant, large-scale positive health changes, according to a study conducted in Cameroon.

Bed net, Photo by Gates Foundation on Flickr, Creative Commons licenseThe study found that Cameroonians with at least one bed net in their household were more likely to use the bed nets after being exposed to the “KO Palu” (Knock Out Malaria) national campaign. Approximately 298,000 adults and more than 221,000 of their children under age five slept under a bed net because of the knowledge, motivation, and/or timely reminder provided by KO Palu NightWatch activities.

The health communication program cost less than $0.16 per adult reached, and less than $1.62 per additional person protected by a net.

According to the World Health Organization’s World Malaria Report 2011, every one of Cameroon’s 19.6 million citizens is at risk of malaria, with 71 percent of them living in high transmission areas. More than 1.8 million suspected cases of malaria were recorded countrywide in 2010, along with over 4,500 recorded malaria-attributed deaths. Malaria was estimated to be responsible for 19 percent of under-five child deaths in 2008, more than any other single cause.

1. Bowen HL. Impact of a mass media campaign on bed net use in Cameroon. Malaria Journal 2013; 12: 36. (open access)

Slowdown in fight against malaria

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An effective concerted effort to strengthen malaria control globally in the last decade has had the greatest impact in countries with high malaria transmission. Close to 60 percent of the 1.1 million lives saved during this period were in the 10 highest burden countries. However, the expansion of funding for malaria prevention and control has leveled off in recent years, and progress in the delivery of some life-saving commodities has slowed. These developments are signs of a slowdown that could threaten to reverse the recent gains in the fight against one of the world’s leading infectious diseases, according to the World Malaria Report 2012.

World Malaria Report 2012The number of long-lasting insecticidal neets delivered to endemic countries in sub-Saharan Africa dropped from a peak of 145 million in 2010 to an estimated 66 million in 2012. The expansion of indoor residual spraying programs also leveled off, with coverage levels in the World Health Organization (WHO) African Region staying at 11 percent of the population at risk (77 million people) between 2010-2011.

The malaria burden is concentrated in 14 endemic countries, which account for an estimated 80 percent of malaria deaths. The Democratic Republic of the Congo and Nigeria are the most affected countries in sub-Saharan Africa, while India is the most affected country in South-East Asia.

The report indicates that international funding for malaria appears to have reached a plateau well below the level required to reach the health-related Millennium Development Goals and other internationally-agreed global malaria targets.

While the plateauing of funding is affecting the scale-up of some interventions, the report documents a major increase in the sales of rapid diagnostics tests, from 88 million in 2010 to 155 million in 2011, as well as a substantial improvement in the quality of tests over recent years. Deliveries to countries of artemisinin-based combination therapies (ACTs), the treatment recommended by the WHO for the treatment of falciparum malaria, also increased substantially, from 181 million in 2010 to 278 million in 2011, largely as a result of increased sales of subsidized ACTs in the private sector.

The report summarizes information received from 99 countries with on-going transmission and other sources, and updates the analyses presented in the 2011 report. Malaria is an entirely preventable and treatable vector-borne disease. In 2010, an estimated 219 million cases occurred globally, while the disease killed about 660,000 people, mostly children under age five years.

1. World Health Organization. World Malaria Report 2012. Geneva, Switzerland: WHO, 2012.

Bed nets prevent malaria when used in farming huts in Laos

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Bed nets prevent malaria infection

Overnight stays in farming huts are known to pose a risk of malaria infection. But a study conducted among farmers in rural Laos suggests that malaria infection is likely preventable if insecticide-treated bed nets are properly used in farming huts.

Malaria is the leading cause of illness and death in Laos, with 70 percent of the population at risk. Most of the Laotian population lives in rural areas and 84 percent of households engage in rice farming. During the rice farming season, farmers and their family members often move from their village to a farm, where they stay in a temporary shelter (farming huts).

“The finding is important not only because overnight stays in farming huts are reported in malaria endemic countries other than Laos, but because overnight stays in farming huts are not confined to adult population,” the study reported. Children under age five years, those most vulnerable to malaria infection, are usually taken to the farming huts by their parents.

1. Nonaka D, Laimanivong S, Kobayashi J, et al. Is staying overnight in a farming hut a risk factor for malaria infection in a setting with insecticide-treated bed nets in rural Laos? Malaria Journal 2010; 9: 372. (open access).

Malaria death trends among children in Mali

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Children under age 5 are disproportionately affected by malaria in Mali

Presumptive malaria diagnostic rates have decreased by 66 percent between 1998-2006 among health care-seeking children under age five years in the twin towns of Mopti and Sévaré in Mali. Up to 37 percent of this decrease is likely due to the distribution of bed net treatment kits initiated in 2001.

In Mali, malaria is the leading cause of death and of outpatient visits for children under five. Nationally, 76 percent of deaths attributed to malaria occur in children under five.

The results corroborate previous findings that suggest that the Fulani ethnicity is protective against malaria. The findings are useful to encourage dialogue around the urban malaria situation in Mali, particularly in the context of achieving the target of reducing malaria morbidity in children younger than five by 50 percent by 2011 as compared to levels in 2000.

1. Rose-Wood A, Doumbia S, Traoré B, Castro MC. Trends in malaria morbidity among health care-seeking children under age five in Mopti and Sévaré, Mali between 1998 and 2006. Malaria Journal 2010; 9: 319. (open access)

The Lancet: Malaria Elimination

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On the Frontline Against Malaria


The Lancet has launched a Series that puts malaria elimination under the microscope and examines the technical, operational and financial challenges that confront malaria-eliminating countries.

The first paper in the Series places malaria elimination in a historical context, provides detailed information about present malaria-eliminating countries, and summarizes the risks and benefits of elimination. The second paper uses mathematical modeling to quantify the relative feasibility of elimination, from both an operational and technical viewpoint. The third paper investigates the operational challenges of achieving elimination and preventing subsequent reintroduction. The fourth paper presents information about the costs and benefits of elimination and the challenges of maintaining elimination and postelimination finance over a long period.

The call to action draws attention to what needs to be done over the next decade to fully maintain the momentum of shrinking the malaria map.

The first three Series papers, the call to action and three additional commentaries are available open access. Free registration required.

The Lancet: Malaria Elimination

New estimates of malaria deaths in India

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A study has found that approximately 205,000 deaths due to malaria occur in India every year. The majority of malaria deaths occur in people age 15-69 years (120,000), followed by children under age five (55,000) and age 5-14 years (30,000).

India is the most populous country in which malaria is common. The cases and deaths reported by the Indian government are concentrated mainly in a few states in east and northeast India (the so-called high-malaria states; mainly Orissa but also Chhattisgarh, Jharkhand, and the states in the far northeast of India).

These new results greatly exceed the World Health Organization’s estimate of only 15,000 malaria deaths per year in India. “This low estimate should be reconsidered, as should the low WHO estimate of adult malaria deaths worldwide,” the study said.

The methods of the new study, which used “verbal autopsies” to assign the cause of death, have been criticized by WHO.

1. Dhingra N, Jha P, Sharma VP, et al. Adult and child malaria mortality in India: a nationally representative mortality survey. Lancet, published online 21 Oct 2010. (open access: free registration required)

Malaria prevention practices of adolescent students in Nigeria

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The problem of malaria among adolescents in sub-Saharan Africa has largely been overshadowed by the huge burden of the disease among younger children, as well as the huge burden of HIV/AIDS among adolescents.

A study of school adolescents in the coastal community of Calabar, Nigeria, highlighted the need to empower teachers with malaria information in order to address the lack of knowledge and misconceptions about the transmission and treatment of malaria among teenage students. The study indicated that more than 75 percent of the students were aware that mosquitos transmit the malaria parasite through biting.

The adolescents’ malaria prevention practices demonstrated their lack of knowledge. Few would prevent malaria attacks by:

  • clearing the vegetation in their peri-domestic environment (13.5%),
  • filling up potholes (16.9%),
  • opening up drainage (11%),
  • using insecticide-treated nets (25.7%) or
  • using antimalarial drugs (11.2%).

Less than one-tenth said they would use various other methods such as not accepting unscreened blood, while only 11 percent obtained the information from their teachers.

1. Udonwa NE, Gyuse AN, Etokidem AJ. Malaria: Knowledge and prevention practices among school adolescents in a coastal community in Calabar, Nigeria. African Journal of Primary Health Care and Family Medicine 2010; 2(1): 103. (open access)

Universal access to effective malaria treatment

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Access to artemisinin combination therapy (ACT) remains low in most malaria endemic countries. A paper published in Malaria Journal indicates that the Affordable Medicines Facility-malaria (AMFm) will support interventions to address socio-economic barriers, strengthen regulatory systems, improve supply chains and improve quality of services as a means to improve access to life-saving ACT.

A major impediment to access to these life-saving medicines is unaffordable prices. The AMFm seeks to address the price barrier by drastically reducing the price of ACT. In addition to unaffordable prices, distance to facilities, locations of outlets and socio-economic status can hinder prompt and effective access to quality-assured ACT.

1. Matowe L, Adeyi O. The quest for universal access to effective malaria treatment: how can the AMFm contribute? Malaria Journal 2010; 9: 274. (open access)

Education about bed nets to prevent malaria needed in Congo-Kinshasa

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Educating parents about using bed nets to prevent malaria is necessary to reduce misconceptions and increase use of the bed nets in villages outside Kinshasa, according to a study from the Democratic Republic of the Congo (DRC). Insecticide-treated bed nets offer essential protection against mosquitoes and significantly reduce illness and death due to malaria, particularly in endemic areas.

The number of bed nets reported was enough to cover all the villagers. Nevertheless, fewer than half of the nets were used, and half of the villagers did not sleep under the nets. The most common reason given for not using bed nets was discomfort due to heat within the net—most likely a misconception. Although the bed net may reduce airflow and increase temperature, the increase might not be noticeable, and if it is noticeable, one’s health should not be comprised due to discomfort. Another problem is that bed nets are occasionally misused for other purposes such as fishing.

Even though bed nets have gained popularity, the effectiveness of these bed nets against malaria transmission will be impaired without their proper use.

Malaria is one of the leading causes of illness and death in the DRC, with approximately 180,000 deaths attributed to malaria each year (one-fifth of the 863,000 malaria deaths reported worldwide in 2008). The large number of malaria cases in the DRC is due to high malaria transmission rates, and it is exacerbated by two decades of civil war that have decimated the health care infrastructure and the government’s ability to deliver social services.

1. Ndjinga JK, Minakawa N. The importance of education to increase the use of bed nets in villages outside of Kinshasa, Democratic Republic of the Congo. Malaria Journal 2010; 9: 279. (open access)