World Malaria Report 2014: Dramatic progress (no call for DDT)

December 9, 2014

World Malaria Report 2014 dropped this week.  It’s the annual report from the World Health Organization (WHO) on the fight against malaria, the problems, critical needs — and this year, wonderful news of progress.

Cover of WHO's World Malaria Report 2014, a child, and the red blood cells the malaria parasites attack.

Cover of WHO’s World Malaria Report 2014, a child, and the red blood cells the malaria parasites attack.

Copies of the report in .pdf format come in English, French and Spanish.  A host of supplemental materials and statistical compilations accompany the report every year.

The World Malaria Report 2014 summarizes information received from malaria-endemic countries and other sources, and updates the analyses presented in the 2013 report.

It assesses global and regional malaria trends, highlights progress towards global targets, and describes opportunities and challenges in controlling and eliminating the disease. The report was launched in the United Kingdom Houses of Parliament on 9 December 2014.

The press release on the report, from WHO:

Scale-up in effective malaria control dramatically reduces deaths

News release

The number of people dying from malaria has fallen dramatically since 2000 and malaria cases are also steadily declining, according to the World malaria report 2014. Between 2000 and 2013, the malaria mortality rate decreased by 47% worldwide and by 54% in the WHO African Region – where about 90% of malaria deaths occur.

New analysis across sub-Saharan Africa reveals that despite a 43% population increase, fewer people are infected or carry asymptomatic malaria infections every year: the number of people infected fell from 173 million in 2000 to 128 million in 2013.

“We can win the fight against malaria,” says Dr Margaret Chan, Director-General, WHO. “We have the right tools and our defences are working. But we still need to get those tools to a lot more people if we are to make these gains sustainable.”

Between 2000 and 2013, access to insecticide-treated bed nets increased substantially. In 2013, almost half of all people at risk of malaria in sub-Saharan Africa had access to an insecticide-treated net, a marked increase from just 3% in 2004. And this trend is set to continue, with a record 214 million bed nets scheduled for delivery to endemic countries in Africa by year-end.

Access to accurate malaria diagnostic testing and effective treatment has significantly improved worldwide. In 2013, the number of rapid diagnostic tests (RDTs) procured globally increased to 319 million, up from 46 million in 2008. Meanwhile, in 2013, 392 million courses of artemisinin-based combination therapies (ACTs), a key intervention to treat malaria, were procured, up from 11 million in 2005.

Moving towards elimination

Globally, an increasing number of countries are moving towards malaria elimination, and many regional groups are setting ambitious elimination targets, the most recent being a declaration at the East Asia Summit to eliminate malaria from the Asia-Pacific region by 2030.

In 2013, 2 countries reported zero indigenous cases for the first time (Azerbaijan and Sri Lanka), and 11 countries succeeded in maintaining zero cases (Argentina, Armenia, Egypt, Georgia, Iraq, Kyrgyzstan, Morocco, Oman, Paraguay, Uzbekistan and Turkmenistan). Another 4 countries reported fewer than 10 local cases annually (Algeria, Cabo Verde, Costa Rica and El Salvador).

Fragile gains

But significant challenges remain: “The next few years are going to be critical to show that we can maintain momentum and build on the gains,” notes Dr Pedro L Alonso, Director of WHO’s Global Malaria Programme.

In 2013, one third of households in areas with malaria transmission in sub-Saharan Africa did not have a single insecticide treated net. Indoor residual spraying, another key vector control intervention, has decreased in recent years, and insecticide resistance has been reported in 49 countries around the world.

Even though diagnostic testing and treatment have been strengthened, millions of people continue to lack access to these interventions. Progress has also been slow in scaling up preventive therapies for pregnant women, and in adopting recommended preventive therapies for children under 5 years of age and infants.

In addition, resistance to artemisinin has been detected in 5 countries of the Greater Mekong subregion and insufficient data on malaria transmission continues to hamper efforts to reduce the disease burden.

Dr Alonso believes, however, that with sufficient funding and commitment huge strides forward can still be made. “There are biological and technical challenges, but we are working with partners to be proactive in developing the right responses to these. There is a strong pipeline of innovative new products that will soon transform malaria control and elimination. We can go a lot further,” he says.

While funding to combat malaria has increased threefold since 2005, it is still only around half of the US$ 5.1 billion that is needed if global targets are to be achieved.

“Against a backdrop of continued insufficient funding the fight against malaria needs a renewed focus to ensure maximum value for money,” says Fatoumata Nafo-Traoré, Executive Director of the Roll Back Malaria Partnership. “We must work together to strengthen country ownership, empower communities, increase efficiencies, and engage multiple sectors outside health. We need to explore ways to do things better at all levels.”

Ray Chambers, who has served as the UN Secretary-General’s Special Envoy for Malaria since 2007, highlights the remarkable progress made in recent years. “While staying focused on the work ahead, we should note that the number of children dying from malaria today is markedly less than 8 years ago. The world can expect even greater reductions in malaria cases and mortality by the end of 2015, but any death from malaria remains simply unacceptable,” he says.

Gains at risk in Ebola-affected countries

At particular risk is progress on malaria in countries affected by the Ebola virus. The outbreak in West Africa has had a devastating impact on malaria treatment and the roll-out of malaria interventions. In Guinea, Sierra Leone and Liberia, the 3 countries most severely affected by the epidemic, the majority of inpatient health facilities remain closed, while attendance at outpatient facilities is down to a small fraction of rates seen prior to the outbreak.

Given the intense malaria transmission in these 3 countries, which together saw an estimated 6.6 million malaria cases and 20 000 malaria deaths in 2013, WHO has issued new guidance on temporary measures to control the disease during the Ebola outbreak: to provide ACTs to all fever patients, even when they have not been tested for malaria, and to carry out mass anti-malaria drug administration with ACTs in areas that are heavily affected by the Ebola virus and where malaria transmission is high. In addition, international donor financing is being stepped up to meet the further recommendation that bednets be distributed to all affected areas.

Note to editors

Globally, 3.2 billion people in 97 countries and territories are at risk of being infected with malaria. In 2013, there were an estimated 198 million malaria cases worldwide (range 124-283 million), 82% of which were in the WHO African region. Malaria was responsible for an estimated 584 000 deaths worldwide in 2013 (range: 367 000 – 755 000), killing an estimated 453 000 children under five years of age.

Based on an assessment of trends in reported malaria cases, a total of 64 countries are on track to meet the Millennium Development Goal target of reversing the incidence of malaria. Of these, 55 are on track to meet Roll Back Malaria and World Health Assembly targets of reducing malaria case incidence rates by 75% by 2015.

The World malaria report 2014 will be launched on 9 December 2014 in the United Kingdom Houses of Parliament. The event will be co-hosted by the All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases (APPMG) and Malaria No More UK.

Contacts for press queries will be found at the link above.

Canadian-educated, Dr. Margaret Chan of the Peoples Republic of China heads the World Health Organization.

Canadian-educated, Dr. Margaret Chan of the Peoples Republic of China heads the World Health Organization, the world’s leading anti-malaria organization.

You may note that the press release says nothing about DDT, the pesticide most famous in the malaria fight after World War II.  WHO abandoned its ambitious campaign to eradicate malaria from the Earth, in the mid-1960s, when it was discovered that mosquitoes in central Africa and other malaria-endemic regions near the tropics were already resistant or immune to the pesticide.  DDT had been used by super-mosquito fighter Fred Soper, in campaigns by the Rockefeller Foundation and WHO, to knock down mosquito populations temporarily, to get breathing room to beat malaria.  While the populations were temporarily reduced, health workers would frantically work to diagnose and completely treat to a cure, malaria infections in humans. Then, when the mosquito populations came roaring back, the bugs would have no well of disease from which to draw parasites for new infections.

Soper’s methods used DDT sprayed on walls of homes, to specifically get those mosquitoes that bite humans. Anopheles spp. mosquitoes carry malaria parasites through a critical part of the parasites’ life cycle; those mosquitoes typically bite from about dusk to just after midnight.  After a blood meal, mosquitoes pause to rest on nearby vertical structures — walls in this case — to squeeze out excess water from the blood they’ve ingested, so they’re light enough to fly.  When the mosquito encounters DDT on the walls, the hope is that the DDT kills the mosquito, ending the transmission cycle.

A brutal public relations campaign in Africa, the U.S. and Europe through the late 1990s to now, has vilified science writer Rachel Carson for her indictment of DDT in Silent Spring, her brilliant book on the dangers of indiscriminate use of untested new chemicals.

So it’s important to note that the world’s leading organization that fights malaria makes no call for more DDT.  Professional health care workers worldwide have not been hornswoggled by pro-DDT, anti-environment, anti-science, anti-WHO propaganda.  That’s good news, too.

More:


U.N. General Assembly notes progress against malaria

September 16, 2014

In Ghana:  Community members perform a scene to educate others on how and why to use bednets. (USAID/Kasia McCormick) 2012. USAID Africa Bureau

In Ghana: Community members perform a scene to educate others on how and why to use bednets. (USAID/Kasia McCormick) 2012. USAID Africa Bureau, via Wikimedia

In stark contrast to the usual hoax stories we get in the U.S. about malaria and DDT, the United Nations General Assembly this past week passed a resolution noting progress made in fighting the parasitic disease.

Quoting wholesale from Ghana Web:

The United Nations General Assembly at its 68th Session, adopted Resolution A/68/L.60, “Consolidating Gains and Accelerating Efforts to Control and Eliminate Malaria in Developing Countries, Particularly in Africa, by 2015” by consensus.

Recognising progress made through political leadership and a broad range of national and international actions to scale-up malaria control interventions, this annual resolution urges governments, United Nations agencies, and all stakeholders to work together to meet the targets set out in the Roll Back Malaria Partnership’s Global Malaria Action Plan (GMAP) and the UN’s Millennium Development Goals (MDGs).

An official statement issued in Accra and copied the Ghana News Agency said with just less than 500 days until the 2015 deadline of the MDGs, the adoption of this resolution by the General Assembly reiterates the commitment of UN Member States to keep malaria high on the international development agenda.

“We have seen tremendous progress against this killer disease in recent years, but continued success will require increased political and financial commitment from donor and endemic governments alike. Together we can scale-up efforts and continue saving lives,” it said.

The statement said since 2001, the World Health Organisation (WHO) estimated that malaria death rates have decreased by nearly 50 per cent in Africa alone, where 90 per cent of all malaria-related deaths still occur – contributing to a 20 per cent reduction in global child mortality and helping drive progress towards UN MDG 4.

“Between 2001 and 2012, collective efforts helped avert an estimated 3.3 million deaths (69 per cent) of which were in the 10 countries with the highest malaria burden in 2000 and more than half of the 103 countries that had ongoing malaria transmission in 2000 are meeting the MDG of reversing malaria incidence by 2015.

“Despite these advances, almost half of the world’s population remains at risk from malaria, with an estimated 207 million cases of infection around the world each year and 627,000 deaths. Around the world, a child still dies from malaria every minute.

“The resolution calls for donor and endemic governments alike to support global malaria control efforts, including the secretariat of the Roll Back Malaria Partnership, and to intensify efforts to secure the political commitment, partnerships and funds needed to continue saving lives.

“Increased financing will be critical to further advancements, as current international and domestic financing for malaria of US 2.5 billion dollars in 2012 amounts to less than half of the US 5.1 billion dollars estimates to be needed annually through 2020 to achieve universal coverage of malaria control interventions,” the statement said.

In 2012, United Nations Secretary-General Ban Ki-moon named malaria as a top priority of his second mandate. Malaria control has consistently proven to be a strong global health investment, generating high return on low investments.

Impacting all eight of the United Nations MDGs, malaria prevention and treatment serves as an entry point to help advance progress against other health and development targets across the board by reducing school absenteeism, fighting poverty, and improving maternal and child health.

Did you see that report in your local newspapers, or on radio or television?

More:


World Malaria Day 2014 – How can you help beat the disease?

April 25, 2014

Poster from BioMed Central:

Poster from BioMed Central for World Malaria Day 2014

Poster from BioMed Central for World Malaria Day 2014

Time for a big push to smash the disease’s hold on humanity, maybe eradicate it.  Are you in?

No, DDT is not the answer, not even much of AN answer.

How can you help, right now?

  1. Send $10 to Nothing But Nets. Bednets are dramatically more effective than just insecticides, in preventing malaria infections and saving lives.  Your $10 donation will save at least one life.
  2. Write to your Congressional delegation, and urge them to increase funding to the President’s Malaria Initiative. Malaria does well when people in non-malaria regions turn their backs on the problem.  Malaria declines with constant attention to nation-wide and continent-wide programs to prevent the disease, by diminishing habitat for mosquitoes, curing the disease in humans so mosquitoes have no well of disease to draw from, and preventing mosquitoes from biting humans, with window screens, education on when to stay indoors, and bednets.

More:


Yogi Berra and ObamaCare

April 2, 2014

Cartoon from Tom Toles at the Washington Post, April 2, 2014:

“ObamaCare: Nobody goes there. It’s too crowded.” Tom Toles in the Washington Post, April 2, 2014.

Why you need to know a little history to get good jokes:

Yogi Berra is famous for his sayings, some of which sound foolish at first, but which generally pack a lot of wisdom or sharp observation.

Berra grew up in St. Louis, which has many famous restaurants.  On some occasion, someone suggested the group should go eat at Ruggeri’s, and Yogi’s reply became famous:

On why he no longer went to Ruggeri’s, a St. Louis restaurant: “Nobody goes there anymore. It’s too crowded.”


How has ObamaCare (the Affordable Care Act) affected your family? Please take this poll

March 31, 2014

Taking America's pulse and heartbeat

Taking America’s pulse and heartbeat

Answers cannot be traced by me, by the way; answer accurately, with abandon.


Still have questions on Obamacare? Here’s the answer site (and a poll)

March 22, 2014

Here.  NPR is our most trusted news organization, and it has answers to specific questions and a collection of great stories on the entire law.

Is that a coincidence, or did they plan it that way?

Your Questions About The Affordable Care Act

By Danny DeBelius, Christopher Groskopf, Jessica Pupovac, Matt Stiles, Christopher Swope and Julie Rovner

NPR’s guide to the dozens of common questions about the new health care law known as Obamacare. Did we miss something? Send us your questions, and read our latest news stories on the issue.

Questions on the Affordable Care Act? Answers all over. Click the picture to go to the New York Daily News FAQ on the law, and how it affects you.

Questions on the Affordable Care Act? Answers all over. Click the picture to go to the New York Daily News FAQ on the law, and how it affects you.

Wait a minute, you say: “I want answers to questions, not just news stories.”

Yeah, they know:

Find Answers To Common Questions

What are the basics of the law?

Am I eligible?

How do I enroll?

How do the exchanges work?

Get the picture?  Click over there and start learning.

Then, when you’ve changed yoru health care plan (if you change it), come back here and answer this poll.  It should go without saying that you can answer the poll now if you’re not going to change.  Please answer only once.

The Millard Fillmore’s Bathtub Poll – Affordable Care Act


World malaria report 2013 shows major progress in fight against malaria, calls for sustained financing (but not DDT)

March 21, 2014

News release from the World Health Organization:

World malaria report 2013 shows major progress in fight against malaria, calls for sustained financing

News release

Cover of World Malaria Report 2013

Cover of World Malaria Report 2013

11 December 2013 | Geneva/Washington DC - Global efforts to control and eliminate malaria have saved an estimated 3.3 million lives since 2000, reducing malaria mortality rates by 45% globally and by 49% in Africa, according to the “World malaria report 2013″ published by WHO.

An expansion of prevention and control measures has been mirrored by a consistent decline in malaria deaths and illness, despite an increase in the global population at risk of malaria between 2000 and 2012. Increased political commitment and expanded funding have helped to reduce incidence of malaria by 29% globally, and by 31% in Africa.

The large majority of the 3.3 million lives saved between 2000 and 2012 were in the 10 countries with the highest malaria burden, and among children aged less than 5 years – the group most affected by the disease. Over the same period, malaria mortality rates in children in Africa were reduced by an estimated 54%.

But more needs to be done.

“This remarkable progress is no cause for complacency: absolute numbers of malaria cases and deaths are not going down as fast as they could,” says Dr Margaret Chan, WHO Director-General. “The fact that so many people are infected and dying from mosquito bites is one of the greatest tragedies of the 21st century.”

In 2012, there were an estimated 207 million cases of malaria (uncertainty interval: 135 – 287 million), which caused approximately 627 000 malaria deaths (uncertainty interval 473 000 – 789 000). An estimated 3.4 billion people continue to be at risk of malaria, mostly in Africa and south-east Asia. Around 80% of malaria cases occur in Africa.

Long way from universal access to prevention and treatment

Malaria prevention suffered a setback after its strong build-up between 2005 and 2010. The new WHO report notes a slowdown in the expansion of interventions to control mosquitoes for the second successive year, particularly in providing access to insecticide-treated bed nets. This has been primarily due to lack of funds to procure bed nets in countries that have ongoing malaria transmission.

In sub-Saharan Africa, the proportion of the population with access to an insecticide-treated bed net remained well under 50% in 2013. Only 70 million new bed nets were delivered to malaria-endemic countries in 2012, below the 150 million minimum needed every year to ensure everyone at risk is protected. However, in 2013, about 136 million nets were delivered, and the pipeline for 2014 looks even stronger (approximately 200 million), suggesting that there is real chance for a turnaround.

There was no such setback for malaria diagnostic testing, which has continued to expand in recent years. Between 2010 and 2012, the proportion of people with suspected malaria who received a diagnostic test in the public sector increased from 44% to 64% globally.

Access to WHO-recommended artemisinin-based combination therapies (ACTs) has also increased, with the number of treatment courses delivered to countries rising from 76 million in 2006 to 331 million in 2012.

Despite this progress, millions of people continue to lack access to diagnosis and quality-assured treatment, particularly in countries with weak health systems. The roll-out of preventive therapies – recommended for infants, children under 5 and pregnant women – has also been slow in recent years.

“To win the fight against malaria we must get the means to prevent and treat the disease to every family who needs it,” says Raymond G Chambers, the United Nations Secretary General’s Special Envoy for Financing the Health MDGs and for Malaria. “Our collective efforts are not only ending the needless suffering of millions, but are helping families thrive and adding billions of dollars to economies that nations can use in other ways.”

Global funding gap

International funding for malaria control increased from less than US$ 100 million in 2000 to almost US$ 2 billion in 2012. Domestic funding stood at around US$ 0.5 billion in the same year, bringing the total international and domestic funding committed to malaria control to US$ 2.5 billion in 2012 – less than half the US$ 5.1 billion needed each year to achieve universal access to interventions.

Without adequate and predictable funding, the progress against malaria is also threatened by emerging parasite resistance to artemisinin, the core component of ACTs, and mosquito resistance to insecticides. Artemisinin resistance has been detected in four countries in south-east Asia, and insecticide resistance has been found in at least 64 countries.

“The remarkable gains against malaria are still fragile,” says Dr Robert Newman, Director of the WHO Global Malaria Programme. “In the next 10-15 years, the world will need innovative tools and technologies, as well as new strategic approaches to sustain and accelerate progress.”

WHO is currently developing a global technical strategy for malaria control and elimination for the 2016-2025 period, as well as a global plan to control and eliminate Plasmodium vivax malaria. Prevalent primarily in Asia and South America, P. vivax malaria is less likely than P. falciparum to result in severe malaria or death, but it generally responds more slowly to control efforts. Globally, about 9% of the estimated malaria cases are due to P. vivax, although the proportion outside the African continent is 50%.

“The vote of confidence shown by donors last week at the replenishment conference for the Global Fund to Fight AIDS, Tuberculosis and Malaria is testimony to the success of global partnership. But we must fill the annual gap of US$ 2.6 billion to achieve universal coverage and prevent malaria deaths,” said Fatoumata Nafo-Traoré, Executive Director of the Roll Back Malaria Partnership. “This is our historic opportunity to defeat malaria.”

Notes for editors:

The “World malaria report 2013″ summarizes information received from 102 countries that had on-going malaria transmission during the 2000-2012 period, and other sources, and updates the analyses presented in 2012.

The report contains revised estimates of the number of malaria cases and deaths, which integrate new and updated under-5 mortality estimates produced by the United Nations Inter-agency Group for Child Mortality Estimation, as well as new data from the Child Health Epidemiology Reference Group.


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