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Snow RW, Amratia P, Kabaria CW, Noor AM, Marsh K. The changing limits and incidence of malaria in Africa: 1939-2009. ADVANCES IN PARASITOLOGY 2012; 78:169-262. [PMID: 22520443 PMCID: PMC3521063 DOI: 10.1016/b978-0-12-394303-3.00010-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Understanding the historical, temporal changes of malaria risk following control efforts in Africa provides a unique insight into what has been and might be archived towards a long-term ambition of elimination on the continent. Here, we use archived published and unpublished material combined with biological constraints on transmission accompanied by a narrative on malaria control to document the changing incidence of malaria in Africa since earliest reports pre-second World War. One result is a more informed mapped definition of the changing margins of transmission in 1939, 1959, 1979, 1999 and 2009.
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Affiliation(s)
- Robert W Snow
- Malaria Public Health & Epidemiology Group, KEMRI-Wellcome Trust Collaborative Programme, Nairobi, Kenya
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Jackson MC, Johansen L, Furlong C, Colson A, Sellers KF. Modelling the effect of climate change on prevalence of malaria in western Africa. STAT NEERL 2010. [DOI: 10.1111/j.1467-9574.2010.00453.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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International funding for malaria control in relation to populations at risk of stable Plasmodium falciparum transmission. PLoS Med 2008; 5:e142. [PMID: 18651785 PMCID: PMC2488181 DOI: 10.1371/journal.pmed.0050142] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Accepted: 05/14/2008] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND The international financing of malaria control has increased significantly in the last ten years in parallel with calls to halve the malaria burden by the year 2015. The allocation of funds to countries should reflect the size of the populations at risk of infection, disease, and death. To examine this relationship, we compare an audit of international commitments with an objective assessment of national need: the population at risk of stable Plasmodium falciparum malaria transmission in 2007. METHODS AND FINDINGS The national distributions of populations at risk of stable P. falciparum transmission were projected to the year 2007 for each of 87 P. falciparum-endemic countries. Systematic online- and literature-based searches were conducted to audit the international funding commitments made for malaria control by major donors between 2002 and 2007. These figures were used to generate annual malaria funding allocation (in US dollars) per capita population at risk of stable P. falciparum in 2007. Almost US$1 billion are distributed each year to the 1.4 billion people exposed to stable P. falciparum malaria risk. This is less than US$1 per person at risk per year. Forty percent of this total comes from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Substantial regional and national variations in disbursements exist. While the distribution of funds is found to be broadly appropriate, specific high population density countries receive disproportionately less support to scale up malaria control. Additionally, an inadequacy of current financial commitments by the international community was found: under-funding could be from 50% to 450%, depending on which global assessment of the cost required to scale up malaria control is adopted. CONCLUSIONS Without further increases in funding and appropriate targeting of global malaria control investment it is unlikely that international goals to halve disease burdens by 2015 will be achieved. Moreover, the additional financing requirements to move from malaria control to malaria elimination have not yet been considered by the scientific or international community.
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Artemisinin-based combination therapy for uncomplicated malaria in sub-Saharan Africa: the efficacy, safety, resistance and policy implementation since Abuja 2000. Trans R Soc Trop Med Hyg 2008; 102:621-7. [PMID: 18499204 DOI: 10.1016/j.trstmh.2008.03.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Revised: 03/24/2008] [Accepted: 03/31/2008] [Indexed: 11/21/2022] Open
Abstract
Following increased resistance of malaria parasites to conventional drugs in the malarial regions of the world, the WHO is promoting artemisinin-based combination therapy (ACT) for treating uncomplicated malaria. The objective of this report is to review the available scientific information on the efficacy, safety, resistance and policy implementation of ACT as it relates to sub-Saharan Africa since the Abuja 2000 Roll Back Malaria initiative. To achieve this, a Medline search was performed to identify scientific publications relevant to the review. The data reviewed indicated that ACT proved very effective in the treatment of uncomplicated Plasmodium falciparum malaria in the region. ACT was shown to be effective, safe and tolerable and no resistance has been detected so far. However, the major challenges to its widespread use in the region include its high cost, low drug quality and poor healthcare delivery systems, among others. It is absolutely imperative for sub-Saharan African countries to establish an effective national antimalarial drug policy which will provide safe, effective, high-quality, accessible and affordable antimalarial drugs such as ACT to the populations at risk of malaria but, at the same time, promote rational drug use in order to delay or prevent the development of antimalarial drug resistance.
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Sipilanyambe N, Simon JL, Chanda P, Olumese P, Snow RW, Hamer DH. From chloroquine to artemether-lumefantrine: the process of drug policy change in Zambia. Malar J 2008; 7:25. [PMID: 18230140 PMCID: PMC2248595 DOI: 10.1186/1475-2875-7-25] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 01/29/2008] [Indexed: 11/10/2022] Open
Abstract
Background Following the recognition that morbidity and mortality due to malaria had dramatically increased in the last three decades, in 2002 the government of Zambia reviewed its efforts to prevent and treat malaria. Convincing evidence of the failing efficacy of chloroquine resulted in the initiation of a process that eventually led to the development and implementation of a new national drug policy based on artemisinin-based combination therapy (ACT). Methods All published and unpublished documented evidence dealing with the antimalarial drug policy change was reviewed. These data were supplemented by the authors' observations of the policy change process. The information has been structured to capture the timing of events, the challenges encountered, and the resolutions reached in order to achieve implementation of the new treatment policy. Results A decision was made to change national drug policy to artemether-lumefantrine (AL) in the first quarter of 2002, with a formal announcement made in October 2002. During this period, efforts were undertaken to identify funding for the procurement of AL and to develop new malaria treatment guidelines, training materials, and plans for implementation of the policy. In order to avoid a delay in implementation, the policy change decision required a formal adoption within existing legislation. Starting with donated drug, a phased deployment of AL began in January 2003 with initial use in seven districts followed by scaling up to 28 districts in the second half of 2003 and then to all 72 districts countrywide in early 2004. Conclusion Drug policy changes are not without difficulties and demand a sustained international financing strategy for them to succeed. The Zambian experience demonstrates the need for a harmonized national consensus among many stakeholders and a political commitment to ensure that new policies are translated into practice quickly. To guarantee effective policies requires more effort and recognition that this becomes a health system and not a drug issue. This case study attempts to document the successful experience of change to ACT in Zambia and provides a realistic overview of some of the painful experiences and important lessons learnt.
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Affiliation(s)
- Naawa Sipilanyambe
- Department of Community Medicine, University of Zambia, RW 0001, Lusaka, Zambia.
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Komatsu R, Low-Beer D, Schwartländer B. Global Fund-supported programmes contribution to international targets and the Millennium Development Goals: an initial analysis. Bull World Health Organ 2007; 85:805-11. [PMID: 18038063 PMCID: PMC2636483 DOI: 10.2471/blt.06.038315] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Accepted: 04/02/2007] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The Global Fund to Fight AIDS, Tuberculosis and Malaria is one of the largest funders to fight these diseases. This paper discusses the programmatic contribution of Global Fund-supported programmes towards achieving international targets and Millennium Development Goals, using data from Global Fund grants. METHODOLOGY Results until June 2006 of 333 grants supported by the Global Fund in 127 countries were aggregated and compared against international targets for HIV/AIDS, tuberculosis and malaria. Progress reports to the Global Fund secretariat were used as a basis to calculate results. Service delivery indicators for antiretrovirals (ARV) for HIV/AIDS, case detection under the DOTS strategy for tuberculosis (DOTS) and insecticide-treated nets (ITNs) for malaria prevention were selected to estimate programmatic contributions to international targets for the three diseases. Targets of Global Fund-supported programmes were projected based on proposals for Rounds 1 to 4 and compared to international targets for 2009. FINDINGS Results for Global Fund-supported programmes total 544,000 people on ARV, 1.4 million on DOTS and 11.3 million for ITNs by June 2006. Global Fund-supported programmes contributed 18% of international ARV targets, 29% of DOTS targets and 9% of ITNs in sub-Saharan Africa by mid-2006. Existing Global Fund-supported programmes have agreed targets that are projected to account for 19% of the international target for ARV delivery expected for 2009, 28% of the international target for DOTS and 84% of ITN targets in sub-Saharan Africa. CONCLUSION Global Fund-supported programmes have already contributed substantially to international targets by mid-2006, but there is a still significant gap. Considerably greater financial support is needed, particularly for HIV, in order to achieve international targets for 2009.
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Affiliation(s)
- Ryuichi Komatsu
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland.
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Kouyaté B, Sie A, Yé M, De Allegri M, Müller O. The great failure of malaria control in Africa: a district perspective from Burkina Faso. PLoS Med 2007; 4:e127. [PMID: 17550300 PMCID: PMC1885453 DOI: 10.1371/journal.pmed.0040127] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Too many African children are dying from a disease for which we have effective and cost-effective prevention and treatment options, say the authors.
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Affiliation(s)
| | | | | | | | - Olaf Müller
- * To whom correspondence should be addressed. E-mail:
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Winstanley P, Ward S, Snow R, Breckenridge A. Therapy of falciparum malaria in sub-saharan Africa: from molecule to policy. Clin Microbiol Rev 2004; 17:612-37, table of contents. [PMID: 15258096 PMCID: PMC452542 DOI: 10.1128/cmr.17.3.612-637.2004] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The burden of falciparum malaria remains as great as ever, and, as has probably always been the case, it is carried mainly by tropical Africa. Of the various means available for the control of malaria, the use of effective drugs remains the most important and is likely to remain so for a considerable time to come. Unfortunately, the extensive development of resistance by the parasite threatens the utility of most of the affordable classes of drug: the development of novel antimalarials has never been more urgently needed. Any attempt to understand the vast complexities of falciparum malaria in Africa requires an ability to think "from molecule to policy." In consequence, the review ambitiously tries to examine the current pharmacopeia, the process by which new drugs are developed and the ways in which drugs are actually used, in both the formal and informal health sectors. The informal sector is particularly important in Africa, where around half of all antimalarial treatments are bought from informal outlets and taken at home without supervision by health care professionals: the potential impact of adherence on clinical outcome is discussed. Given that the full costs are carried by the patient in a large proportion of cases, the importance of drug affordability is explored. The review also discusses the splicing of new drugs into national policy. The various parameters that feed into deliberations on changes in drug policy are discussed.
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Affiliation(s)
- Peter Winstanley
- Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool L69 3GE, United Kingdom.
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Hay SI, Guerra CA, Tatem AJ, Noor AM, Snow RW. The global distribution and population at risk of malaria: past, present, and future. THE LANCET. INFECTIOUS DISEASES 2004; 4:327-36. [PMID: 15172341 PMCID: PMC3145123 DOI: 10.1016/s1473-3099(04)01043-6] [Citation(s) in RCA: 531] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this review was to use geographic information systems in combination with historical maps to quantify the anthropogenic impact on the distribution of malaria in the 20th century. The nature of the cartographic record enabled global and regional patterns in the spatial limits of malaria to be investigated at six intervals between 1900 and 2002. Contemporaneous population surfaces also allowed changes in the numbers of people living in areas of malaria risk to be quantified. These data showed that during the past century, despite human activities reducing by half the land area supporting malaria, demographic changes resulted in a 2 billion increase in the total population exposed to malaria risk. Furthermore, stratifying the present day malaria extent by endemicity class and examining regional differences highlighted that nearly 1 billion people are exposed to hypoendemic and mesoendemic malaria in southeast Asia. We further concluded that some distortion in estimates of the regional distribution of malaria burden could have resulted from different methods used to calculate burden in Africa. Crude estimates of the national prevalence of Plasmodium falciparum infection based on endemicity maps corroborate these assertions. Finally, population projections for 2010 were used to investigate the potential effect of future demographic changes. These indicated that although population growth will not substantially change the regional distribution of people at malaria risk, around 400 million births will occur within the boundary of current distribution of malaria by 2010: the date by which the Roll Back Malaria initiative is challenged to halve the world's malaria burden.
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Affiliation(s)
- Simon I Hay
- TALA Research Group, Department of Zoology, University of Oxford, Oxford, UK.
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Maitland K, Molyneux M. Malaria. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2004; 549:125-34. [PMID: 15250525 DOI: 10.1007/978-1-4419-8993-2_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kathryn Maitland
- The Center for Geographic Medicine Research, Coast, KEMRI, Kilifi, Kenya
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Müller O, Jahn A. Editorial: Expanding insecticide-treated mosquito net coverage in Africa: tradeoffs between public and commercial strategies. Trop Med Int Health 2003; 8:853-6. [PMID: 14516294 DOI: 10.1046/j.1365-3156.2003.01119.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
PURPOSE OF REVIEW This review addresses recent developments that relate to the pathogenesis of severe malaria and its treatment, and also highlights the increase in the global burden of malaria and provides a summary of clinical trials of malaria vaccines. RECENT FINDINGS Malaria, one of the world's most important parasitic infections, is on the increase globally. This has resulted in an increase in the morbidity and mortality from malaria in endemic areas, a resurgence in areas where it was previous eradicated, and an increase in imported malaria in Europe and North America. Mortality from severe malaria continues to be high, even when effective drugs are available, because most deaths occur within hours of admission to hospital. In severe malaria, the presence of acidosis is the most important prognostic factor in children and adults. A number of therapies have resulted in clinical improvements and the correction of acidosis in phase I and II studies, but larger trials are required to examine the effect on mortality. More malaria vaccines are now in phase I or II trials; however, available data do not yet promise an imminent impact on malaria control. SUMMARY Recent developments include a better understanding of the pathogenesis of severe malaria, and have given rise to a number of novel therapeutic strategies that should be examined in larger phase III trials. Similarly, there has been considerable progress in the field of vaccine development.
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Affiliation(s)
- Kathryn Maitland
- The Centre for Geographic Medicine Research, Coast, KEMRI, Kilifi, Kenya.
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Narasimhan V, Attaran A. Roll back malaria? The scarcity of international aid for malaria control. Malar J 2003; 2:8. [PMID: 12787469 PMCID: PMC156896 DOI: 10.1186/1475-2875-2-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2003] [Accepted: 04/15/2003] [Indexed: 11/23/2022] Open
Abstract
The WHO announced the Roll Back Malaria (RBM) movement in 1998, with the goal of halving malaria deaths by 2010, and halving again by 2015. It is widely agreed that reaching this goal requires a major increase in international aid funding for malaria control, to a budget of perhaps 1.5 - 2.5 billion dollars annually. To ascertain whether progress is being made, we compiled data self-reported by the donors to the Development Assistance Committee of OECD, and also to ourselves directly. We find that, in fact, the total amount of international aid dedicated to malaria control, from the 23 richest donor countries plus the World Bank, remains in the range of 100 million dollars annually - a figure that is virtually unchanged since the start of RBM. This lack of progress toward increasing funding very seriously threatens RBM and demands that WHO regularly audit and report on malaria control funding, with the certainty that RBM will fail to meet its deadline of 2010 if this is not done.
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Affiliation(s)
| | - Amir Attaran
- Carr Centre for Human Rights Policy, Kennedy School of Government, Harvard University, Cambridge, MA 02138 USA
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Tan DHS, Upshur REG, Ford N. Global plagues and the Global Fund: Challenges in the fight against HIV, TB and malaria. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2003; 3:2. [PMID: 12667262 PMCID: PMC155543 DOI: 10.1186/1472-698x-3-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2002] [Accepted: 04/01/2003] [Indexed: 11/10/2022]
Abstract
BACKGROUND: Although a grossly disproportionate burden of disease from HIV/AIDS, TB and malaria remains in the Global South, these infectious diseases have finally risen to the top of the international agenda in recent years. Ideal strategies for combating these diseases must balance the advantages and disadvantages of 'vertical' disease control programs and 'horizontal' capacity-building approaches. DISCUSSION: The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) represents an important step forward in the struggle against these pathogens. While its goals are laudable, significant barriers persist. Most significant is the pitiful lack of funds committed by world governments, particularly those of the very G8 countries whose discussions gave rise to the Fund. A drastic scaling up of resources is the first clear requirement for the GFATM to live up to the international community's lofty intentions. A directly related issue is that of maintaining a strong commitment to the treatment of the three diseases along with traditional prevention approaches, with the ensuing debates over providing affordable access to medications in the face of the pharmaceutical industry's vigorous protection of patent rights. SUMMARY: At this early point in the Fund's history, it remains to be seen how these issues will be resolved at the programming level. Nevertheless, it is clear that significant structural changes are required in such domains as global spending priorities, debt relief, trade policy, and corporate responsibility. HIV/AIDS, tuberculosis and malaria are global problems borne of gross socioeconomic inequality, and their solutions require correspondingly geopolitical solutions.
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Affiliation(s)
- Darrell HS Tan
- Department of Medicine, University of Toronto. University Health Network, Toronto General Hospital Site, R. Fraser Elliott Building 3-Suite 805, 190 Elizabeth St, Toronto, Ontario, M5G 2C4, Canada
| | - Ross EG Upshur
- Primary Care Research Unit, Sunnybrook and Women's College Health Sciences Centre, Departments of Family and Community Medicine and Public Health Sciences, Joint Centre for Bioethics, University of Toronto. Room E349B, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Nathan Ford
- Médecins Sans Frontières, 67–74 Saffron Hill, London EC1N 8QX, United Kingdom
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