Malaria

In 2006, Médecins Sans Frontières (MSF) treated more than 1.7 million people for malaria. Every year, malaria kills nearly two million people and infects 400 to 500 million, according to the World Health Organization (WHO). 90% of these deaths occur in sub-Saharan Africa, but the disease is present in more than 100 countries and in nearly every tropical area where MSF has field programmes, from Sierra Leone to Cambodia to Pakistan.

Children account for 75% of the deaths caused by this disease while pregnant women are also high-risk targets.

Malaria's effects are far-reaching and can wreak havoc on a socioeconomic level. Patients are often bedridden and incapable of carrying out normal daily activities, and children who survive the disease may suffer neurological damage. The results can be the loss of income and heavy burdens on families, health systems and society as a whole.

But this suffering and loss of life are tragically unnecessary; malaria is largely preventable, detectable, and treatable.

Symptoms typically appear within 9 to 14 days after the infected bite and include fever, headache, vomiting, and other flu-like manifestations. If effective drugs are not available for treatment, the infection can rapidly become life-threatening.

The advantages of ACTs – low toxicity, few side-effects, easy and patient-friendly treatment, rapid action against the parasite – are widely acknowledged. The World Health Organization (WHO) declared ACT the preferred method for treating malaria in 2001, the same year that MSF began using them in its programmes. Two years later, MSF started advocating for their use in national programmes.

Today, 41 out of 54 African countries have officially changed their protocol to treat first-line malaria with ACTs. However, in many places where MSF works, ACTs are scarcely available. The global need for ACTs is estimated to be at 300 to 500 million treatment courses per year, however, last year, drugs for less than 90 million treatments were purchased. One of the challenges is the higher price of ACTs in comparison to older therapies like chloroquine.

Diagnostics
Antigen tests for falciparum malaria, including one marketed as Paracheck®, are simple to use and produce results rapidly, making them adaptable for use in remote areas. MSF uses confirmed diagnosis, either through rapid tests or through microscope examination in laboratories, for all its malaria programs. But such tools are not used everywhere.

MSF staff in Ethiopia undertaking paracheck rapid tests to see if the children have malaria. © Stefan Pleger

Diagnosing malaria based on clinical symptoms alone, and not by microscopy or rapid test, leaves significant room for error. However, clinical diagnosis is still the norm in many places. An MSF study carried out in southern Sudan confirmed that over-diagnosis of malaria is common. There is also the problem of self-diagnosis. Malaria is so common in Africa, many people who are sick assume they have the disease and will purchase malaria drugs on their own, often leaving the real reason for their symptoms untreated.

Prevention
There are some promising developments, but an effective malaria vaccine is still years away. In the meantime, sleeping under insecticide-treated bed nets or spraying houses with insecticides can save lives. Unfortunately, many children, especially in Africa, continue to die from malaria because they do not sleep under these nets, mainly for reasons of cost.

The Fight Continues
In 2000, the Roll Back Malaria (RBM) initiative set up by WHO, UNICEF, the World Bank, and others pledged to cut malarial deaths by half before 2010. Seven years later, however, the spread of the disease continues. In spite of radically improved diagnostics and treatments, the rates of death, illness, and socioeconomic disruption caused by malaria has not abated.

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Copyright | Privacy | Acknowledgements | This page last updated 3 January, 2008