MALARIA-AT-A-GLANCE
March 2001

Why tackle malaria?

Malaria is endemic to the poorest countries in the world, causing 300 to 500 million clinical cases and more than one million deaths each year. More than 90% of malaria deaths occur in Sub-Saharan Africa (approximately 3,000 deaths each day), and almost all the deaths are children younger than 5. In Sub-Saharan Africa, 15% of all disability-adjusted life-years (DALYs) are lost to malaria. In highly endemic countries, malaria during pregnancy is a leading cause of low birth weight, one of the primary causes of neonatal mortality. Women living in endemic countries are four times more likely to have symptomatic malaria attacks when they are pregnant.

Over the last two decades, morbidity and mortality from malaria have been increasing due to deteriorating health systems, growing drug and insecticide resistance, periodic changes in weather patterns, civil unrest, human migration, and population displacement.

Malaria disproportionately affects poor people

Rural populations carry the overwhelming burden of disease. People living in poor quality housing are particularly at risk. Poor people are at greater risk of complications and death, because their access to effective treatment is so limited. Malaria also contributes to poverty by reducing the productivity of infected people and their caretakers. Households spend significant sums (US$ 0.39 to 3.84/capita per year in Sub-Saharan Africa) to prevent and treat malaria.

The table below shows that approximately 60% of all deaths from malaria in the world occur among the poorest 20% of the world's population. This is a higher percentage than for any other disease. Efforts to reduce malaria are clearly pro-poor.

It has been estimated that malaria has slowed economic growth in African countries by 1.3% per year. Compounded over 35 years, this amounts to a 32% reduction in the GDP of countries in Africa where malaria is endemic. The economic losses due to malaria in Africa have recently been estimated at about US$12 billion per year.

A High Proportion of Program Benefits Accrue to the
Poorest 20% of the World’s Population

What can be done to reduce malaria morbidity and mortality?

Roll Back Malaria

The global partnership to Roll Back Malaria (RBM) was jointly founded by WHO, UNICEF, World Bank, and UNDP in 1998 with the objective of halving the malaria burden world-wide by the year 2010. This goal can only be achieved if all actors (e.g., governments, private sector, industry, NGOs and communities) and all sectors (e.g., health, education, agriculture, water, and infrastructure) engage and participate in malaria control activities. This is at the core of RBM’s approach.

The Core Strategies for RBM were selected because of their proven efficacy and effectiveness, their potential as sustainable interventions, and their demonstrated cost-effectiveness (<US$25 per DALY). The four central RBM strategies are:

1. Rapid, effective treatment of persons with malaria at home or in a health facility within 24 hours of onset of symptoms: As 60% to 80% of malaria cases are treated in the community, efforts must focus on ensuring that correct treatment is available at or near the home. RBM promotes Integrated Management of Childhood Illness (IMCI) as a key intervention for improving management of children with fever at health facilities and in the community.

Core Roll Back Malaria objectives and interventions, their intended beneficiaries, and indicators to track achievement

2. Widespread use of insecticide-treated materials (ITMs) and other appropriate methods to limit human-mosquito contact: In areas of Sub-Saharan Africa with high levels of malaria transmission, regular use of an insecticide-treated bednet can reduce mortality in children less than 5 years of age by as much as 30% and has a significant impact on anemia. Similar or greater benefits have been achieved for pregnant women and in other regions.



3. Prevention of malaria in pregnant women living in high transmission areas: In areas in which malaria is highly endemic, the incidence of low birth-weight (a leading cause of neonatal mortality) can be reduced by as much as half through use of intermittent presumptive treatment (IPT) with drugs such as sulfadoxine-pyrimethamine.



4. Detection and appropriate response to epidemics within two weeks of onset: Detection of epidemics requires timely, complete surveillance of malaria cases and monitoring of weather patterns. Reserve drug stocks, transport, and hospital capacity are needed to mount an appropriate response. In some epidemic zones, well-timed and targeted vector control activities have minimized the impact of epidemics.

Do's and Don'ts to Roll Back Malaria

• Target the population at-risk: In areas with high-level malaria transmission (e.g. most of tropical Africa), severe morbidity and mortality is mostly confined to children <5 years of age and pregnant women. All persons living in areas of low or moderate transmission and non-immune visitors to malarious areas are at risk.
• Promote evidence-based decision-making: Because the epidemiology of malaria differs between and within regions, program priorities must be based on relevant information gathered through routine surveillance and operational research. In particular, periodic drug efficacy studies are essential for guiding malaria treatment policies. Surveillance and HMIS systems also require strengthening.
• Expand strategies for improving the quality of treatment beyond the public sector: Recognizing that most people seek treatment outside of the public sector, strategies to improve treatment practices must include public, private, and NGO facilities, traditional healers, community practitioners, pharmacies, and drug sellers.
• Focus on home as the first line of treatment: Education campaigns to improve caretakers' abilities to recognize illness and danger signs in their children, seek care appropriately, and provide correct treatment are essential components of any malaria control strategy.
• Avoid development of vertical or stand-alone programs: Many of the activities required by successful malaria control programs (e.g., training of health workers, education campaigns, and improvement of drug availability) are also essential components of other disease control programs. Integration and coordination of activities should be encouraged. For example, IMCI is a key strategy for improving management of childhood illness, including malaria. Prevention of malaria is a core strategy of the "Making Pregnancy Safer" initiative.
• Expand capacity through partnerships: NGOs, communities, and the private sector may have clear comparative advantages in community education and social marketing campaigns and in distribution of essential commodities, such as ITMs and insecticides. The public sector has the primary responsibility for policy making, standard setting, quality control, targeted subsidies, and regulation.
• Engage all actors and sectors: Malaria control strategies require collaboration of other actors in the health sector (e.g., maternal child health and reproductive health). Collaborative design of operations in other sectors (e.g., Agriculture, Water and Power, Infrastructure) can mitigate malaria risk. Education and Information sectors have key roles in educational campaigns.