How to fight malaria – Kenya’s example

Kenya has cut malaria by nearly half. Without further comment from me, here’s the news story from Gulf Times, Doha, Qatar, and below that, from a few other sources:

Kenya nearly halves child deaths from malaria

Published: Friday, 17 August, 2007, 01:27 AM Doha Time

NAIROBI: Kenya announced yesterday that it almost halved malaria deaths among small children by using insecticidal nets (INTs), spurring the World Health Organisation (WHO) to advocate free nets for all as it tackles Africa’s deadliest disease.

Health Minister Charity Ngilu said distribution of 13.4mn INTs over the past five years among children and pregnant women had helped curtail infections, a key success against a disease threatening 40% of the world’s population.

“Childhood deaths have been reduced by 44% in high-risk districts, in-patient malaria cases and deaths are falling (and) there are reduced cases at the community level,” she said in a statement.

“For every 1,000 treated nets used, seven children who might have died of malaria are saved.”

Malaria kills 34,000 children under the age of five each year in Kenya, and threatens the lives of more than 25mn of its population of 34mn people, the ministry said.

Children sleeping under INTs in malaria risk areas are 44% less likely to die than those who are not, according to a survey carried out in four districts representing the country’s epidemiological pattern.

The government has distributed 12mn doses of artemisinin-based therapy (ACT), the latest surefire anti-malaria drug cocktail to replace the mono-therapies that had developed resistance.

In addition, some 824,600 houses in 16 epidemic-prone districts underwent indoor spraying this year.
The government and donors spent 4.7bn shillings ($70.2mn) for the campaign, yet the funds were not enough.

Ngilu said the government would freely provide 2mn treated nets annually to ward off mosquitoes at night when they are active, calling on donors to boost the blanket distribution.

“The impact we have seen and the lessons we have learnt through massively distributing INTs, rather than selectively marketing and selling them, will not only benefit Kenya’s children but all Africa’s children,” she said.

In a statement, the WHO said it had abandoned its earlier guideline of targeting only vulnerable groups – under fives and pregnant women – in favour of “making their protection immediate while achieving full coverage”.

“Recent studies have shown that by expanding the use of these nets to all people in targeted areas, increased coverage and enhanced protection can be achieved while protecting all community members.”

WHO chief Margaret Chan said that Kenya’s success “serves as a model that should be replicated throughout ‘malarious’ countries in Africa.”

“This data from Kenya ends the debate about how to deliver the long-lasting nets. No longer should the safety or well-being of your family be based upon whether you are rich or poor,” said WHO’s Global Malaria Programme director Arata Kochi.

Chan and Kochi were deriding the “social marketing” model widely backed by donors of distributing INTs by selling them at subsidised rates, even to vulnerable groups, and raising awareness of their importance.

Although supporting anti-malaria campaigns, public health watchers have chided British and US foreign development agencies for pushing for social marketing in the world’s poorest continent.

The WHO launched a global programme in 1955 to eradicate the disease that has frustrated attempts to create a vaccine owing to its constant mutations.

Using dichloro-diphenyl-trichloroethane (DDT), a powerful insecticide, and the drug chroloquine, the organisation managed to eradicated the disease in the West by the 1960s.

But the programme never got off the ground in the humid and low-lying tropics in sub-Saharan Africa where the disease persisted.

By 1969, the programme collapsed as financing withered in the face of rising poverty, political upheavals and surging opposition to DDT for misuse, not by anti-malaria campaigners, but farmers.

But Kochi said the Stockholm Convention on Persistent Organic Pollutants allowed the use of DDT in endemic countries for “public health only” and Uganda and Malawi were the only African nations keen on the chemical.

Malaria affects more than 1bn people worldwide and kills 1mn – mainly under age five – every year, the vast majority in sub-Saharan Africa. – AFP (Agence France Press)

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From The Nation, Nairobi, Kenya, August 17, 2007:

Malaria Deaths Drop By Half

The Nation (Nairobi)
NEWS
17 August 2007
Posted to the web 16 August 2007

By Mike Mwaniki
Nairobi
Kenya has reduced the number of malarial deaths by almost half among children aged five years and below.

The World Health Organisation identified the mass distribution of insecticide-treated bed nets as the biggest contributing factor in reduction of malaria deaths from 34,000 in 2005 to 16,000 last year.

“Impressive results in Kenya, achieved by means of the new WHO-recommended strategy, show that free mass distribution of long-lasting treated bed nets is a powerful way to quickly and dramatically increase coverage, particularly among the poorest people,” said visiting WHO global malaria programme head, Dr Arata Kochi.

Protect people

Following the impressive results achieved in Kenya, Dr Kochi said WHO yesterday issued new global guidance for the use of treated bed nets to protect people from malaria.

“For the first time, WHO recommends that treated bed nets be distributed either free or highly subsidised,” the WHO boss said during a media breakfast briefing held at Pan Afric Hotel in Nairobi.

The official was flanked by Health minister Charity Ngilu, Permanent Secretary Hezron Nyangito and Director of Medical Services James Nyikal.

Mrs Ngilu said: “We now have evidence that recent massive scaling up of malaria control interventions such as treated bed nets has dramatically reduced child deaths due to malaria by 44 per cent in malaria risk areas”.

“In addition, the number of people suffering from malaria is dropping while admissions to public health facilities due to severe malaria are falling,” she added.

Mrs Ngilu said the 3.4 million bed nets that were distributed for free by the Health ministry during a recent campaign benefited children from poor homes.

“I’m therefore glad to note that we have been able to save the lives of seven children for every 1,000 mosquito nets being used,” the minister added.

She went on: “In order to sustain the gains so far made, my ministry will be providing two million long-lasting mosquito nets to pregnant women and children every year through our health facilities.”

According to experts, before the campaign for mass distribution of treated bed nets started, malaria was killing 34,000 children aged five years and below or 92 children daily.

Yesterday, Dr Nyikal said political commitment, strong technical assistance from WHO and “adequate” funding from donors had contributed to the reduction of malaria deaths among children.

Fielding questions from journalists, Dr Nyikal said the use of DDT to curb malaria was still banned.

“However, we will monitor a study on the controversial pesticide now being conducted in Uganda. We know in East Africa, Uganda has done a study to see if they’re going to use it,” Dr Nyikal said.

After more than 40 years of spraying DDT to kill the female anopheles mosquito – the only mosquito species that spreads malaria – Kenya banned its use in 1990 because of health concerns.

While the health effects of DDT on humans are disputed, with possible links to cancer being found through research, the pesticide is well documented as having killed wildlife such as birds and fish when it is sprayed in large quantities.

As a result, the chemical was banned in the United States in 1972 and many other countries have since followed suit.

Copyright © 2007, The Nation and AllAfrica.com

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From Africast.com:

EAST REGION NEWS

Kenya cuts malaria child deaths

NAIROBI, August 16 — Kenya has cut malaria deaths among children under five by 44% on 2002 levels, thanks largely to the increased use of insecticide treated nets (INTs), says the government.

The health ministry said the distribution of 13.4 million INTs for the past five years among children and pregnant women had helped curtail infections, a key success against a disease threatening 40% of the world’s population.

It said: “Childhood deaths have been reduced by 44% in high-risk districts, in-patient malaria cases and deaths are falling (and) there are reduced cases at the community level.

“For every 1 000 treated nets used, seven children who might have died of malaria are saved.”

Malaria killed 34 000 children under the age of five each year in Kenya, and threatened the lives of more than 25 million of its population of 34 million people, said the ministry.

According to a survey carried out in four districts representing varied transmission patterns, children sleeping under ITNs in malaria risk areas were 44% less likely to die than those who are not.

The government had distributed 12 million doses of artemisinin-based therapy (ACT), the latest surefire anti-malaria drug cocktail to replace the mono-therapies that had developed resistance. In addition, some 824 600 houses in 16 epidemic-prone districts underwent indoor spraying this year.

Health Minister Charity Ngilu said the government would boost distribution of free treated nets – a policy backed by the World Health Organisation – to keep away mosquitoes at night.

She said: “The impact we have seen and the lessons we have learnt through massively distributing INTs, rather than selectively marketing and selling them, will not only benefit Kenya’s children but all Africa’s children.”

The WHO launched a global programme in 1955 to eradicate the disease that had frustrated attempts to create a vaccine.

Using dichloro-diphenyl-trichloroethane (DDT), a powerful insecticide, and the drug chroloquine, it managed to eradicate the disease in the West by the 1960s. But the programme never got off the ground in the humid and low-lying tropics in sub-Saharan Africa, where the disease persisted.

By 1969, the programme collapsed as financing withered in the face of rising poverty, political upheavals and surging opposition to the use of DDT.

Malaria affected more than a billion people worldwide and killed a million – mainly under age five – every year, the vast majority in sub-Saharan Africa. – AFP

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From TimesOnline (London Times), August 17, 2007:

August 17, 2007

Free malaria nets are gift of life

Rob Crilly

NAIROBI Free distribution of mosquito nets has dramatically reduced cases of malaria, which kills a million people in Africa every year.

Kenyan health officials said a study showed that seven lives were saved for every thousand nets given away, reducing deaths among children in high-risk areas by almost half. About 25 million Kenyans are at risk from the mosquito-borne disease and it accounts for one fifth of all hospital admissions.

Lack of progress in tackling malaria is considered one of the key obstacles to meeting some of the health targets among the UN’s millennium development goals.

African governments have been hampered by lack of funds and disagreements over the best way to get the nets to vulnerable people. Kenya initially sold the nets at a subsidised rate but then, with donor funding, started giving them away to families with young children.

The World Health Organisation hailed the results as a breakthrough and said it was changing its own guidance to advocate free nets for all.