African countries push back malaria

Every 30 seconds a child dies from malaria in Africa. That means almost 3,000 every day or over 1 million a year, according to a report in the Times of Zambia on Sept. 28. Malaria can be deadly for children under the age of five and pregnant women, and even adults with resistance to the disease still can’t work when their malaria flares up, which causes severe economic hardship.

In Europe and North America, where malaria was common until the 19th century, it was eliminated by reducing the population of mosquitoes that transmit the parasite that causes the disease.

In Africa, a number of programs have been designed to control malaria. Glaxo
SmithKlineBio, a major European pharmaceutical company, is working on a vaccine that might be licensed by 2010. Some African countries, like Kenya, are distributing insecticide-treated netting (ITN) to keep mosquitoes from biting at night, when they are most active. ITN’s effectiveness is hampered by its high cost and people’s resistance to being covered during sleep.

In 1999, South Africa and Swaziland approached Mozambique with a proposal to jointly develop the Lubombo region. This region can be broadly defined as eastern Swaziland, southern Mozam bique and northeastern KwaZulu Natal (part of the northernmost province of South Africa, an area linked by the Lubombo mountains). One of the main obstacles to developing this area was the prevalence of malaria there.

South Africa and Swaziland realized that they couldn’t control malaria unless it was controlled in all three countries.

The program the three countries developed consists first of using Indoor Residual Spraying (IRS), which controls the mosquitoes that spread the malaria parasite, and then doing parasite control with effective medical treatment. The Regional Malarial Control Commission (RMCC) found that this sequence—reducing the mosquitoes, then quickly reducing the parasites—gave the best result.

The workers doing the spraying needed training in spraying and safety techniques, along with the proper equipment. Ento mologists needed to be trained to verify how the spraying was working, which insecticides were effective, what species of mosquitoes were present and so on.

The RMCC decided to use ACT for the medical treatment. ACT is the drug artemisinin, derived from the wormwood tree grown in China, combined with another anti-malarial drug. The latter drug lessens the chances that any parasites survive to develop a resistance.

The results have been impressive. In one of the Mozambican zones, the average infection rate for children 2-14 years old was 62 percent in 2000. This was reduced to 7.2 percent in 2004, and then reduced even further in 2005. In another zone the prevalence of infection, 70 percent in 2002, was reduced to 30 percent in 2004. In the South African part of the region, the rate of infection, which had been 10 percent to 40 percent in some areas, was reduced to less than 5 percent.

The success of these three countries in southeast Africa in controlling malaria is itself a triumph. In addition, it shows that with government attention to public health, it is possible for African countries to provide proper health care.

One of the arguments used by certain elements in the Bush administration and in the U.S. medical establishment to avoid furnishing Africa free or inexpensive medications for controlling AIDS is that the African countries don’t have the medical infrastructure to guarantee the proper administration of medication. This latest success exposes the falseness of this argument.