Malaria status & challenges of the epidemic

2. Which strategies were adopted to prevent and treat malaria?

• 2.1 Which strategies and targets are recommended by the WHO?
• 2.2 What are the targets for the future and how is progress measured?

2.1 Which strategies and targets are recommended by the WHO?

The WHO recommends strategies on how to prevent malaria transmission by controlling the mosquito population and on how to diagnose and treat malaria infections.

There are two main prevention methods:

• Protective bed nets treated with long-lasting insecticides prevent bites from malaria-infected mosquitoes and kill them. Nets should be available for free or at low prices thanks to high subsidies. There should be one net per two people at risk. Priority should be given to pregnant women and children under five years of age, who are most vulnerable.
• Spraying the inside walls of houses with insecticide is an effective way to kill large numbers of mosquitoes. The best choice of insecticide for a given area depends on different factors such as costs, efficacy, product safety, and the mosquitoes’ resistance to the insecticide. The spraying should be done just before the mosquito season starts and repeated over several consecutive years. If the timing is wrong or if the spraying activities are likely to be short-lived or interrupted, it is better not to do it at all to avoid generating resistant mosquitoes.

To be more effective, in high-risk areas (i.e. with one or more new malaria cases per 1000 inhabitants per year), these methods can be used together or be complemented, when needed, by other methods such as the management of mosquito breeding sites in order to reduce the larvae population. When using an insecticide, it is vital to check whether mosquitoes are becoming resistant to it.

The anti-malarial treatment recommended by the WHO aims to cure cases quickly before they become more serious, to protect unborn children, to avoid drug resistance and to prevent malaria in travellers. It includes the following recommendations:

• Only people in whom laboratory blood tests confirmed the presence of malaria should be treated with anti-malarial drugs. However, in high-risk areas, children under five years of age with malarial symptoms should be treated straight away.
• Malaria has become increasingly resistant to drugs and, at present, medicines based on artemisinin are the only recommended treatment measures against Plasmodium falciparum, which causes the deadliest form of malaria. To avoid this infectious agent from becoming drug-resistant, artemisinin should not be given on its own but should be combined with one or more effective anti-malarial drugs.
• People with severe malaria should be treated immediately and then transferred to a health facility where they can get full treatment and care. Patients who cannot swallow or are very young should initially be treated via injections or suppositories, and then be given a complete course of drugs.
• Effective diagnosis and treatment should be of good quality, affordable and available at all health facilities. Where quick treatment in a health facility is not possible, there should be a programme to manage the disease at the patient’s home.
• Pregnant women in high-risk areas should be given suitable anti-malarial drugs at least twice during the second and the third trimester of pregnancy, and three times if they are also HIV positive.
• It is important to monitor how effective the treatment is and to identify any possible development of drug resistance, any adverse reactions to medicines, as well as any effects on pregnant women and on pregnancy outcomes.

This text is a summary of: WHO, World Malaria Report (2008) ,
2. Policies, strategies and targets for Malaria Control, p.3-5

2.2 What are the targets for the future and how is progress measured?

One of the United Nations Millennium Development Goals for 2015 is to have “halted, and begun to reverse, […] the scourge of malaria and other major diseases that afflict humanity.” Since the late 1990s, several international organizations have set targets to control malaria, reduce the number of malaria cases and deaths, and eliminate the burden it imposes on social and economic growth and development.

Intensive efforts to control malaria in most of the heavily-affected countries began in 2005 and 2006. Current targets are to reduce the number of cases and deaths caused by malaria to one half of the 2005 values by 2010, and to one quarter by 2015. To achieve this, the global objective is to provide access to preventive and treatment measures to at least 80% of the population at risk by 2010.

In 2007, malaria experts determined specific indicators to measure progress made.

Trends in malaria cases and deaths can be followed based on:

• the proportions of confirmed malaria cases and deaths inside and outside hospitals; and
• the proportions of confirmed malaria cases and deaths of children younger than five inside and outside hospitals.

The coverage of prevention and treatment measures can be assessed based on:

• the proportion of children younger than five who receive appropriate drugs within 24 hours of developing fever;
• the proportion of people within a specific population group (e.g. children younger than five and pregnant women) that have and use mosquito nets;
• the number of households at risk that are sprayed with insecticide; and
• the proportion of pregnant women that receive adequate preventive anti-malarial treatment.

The effectiveness of health facilities and national malaria control programmes can be assessed based on:

• the proportion of suspected malaria cases that are checked by laboratory tests;
• the proportion of laboratory tested suspected malaria cases that are confirmed;
• the number of patients attending clinics and hospitals without staying overnight that are given appropriate treatment;
• the proportion of people at risk who receive insecticidal nets;
• the proportion of health facilities with sufficient medicines, diagnostic kits and mosquito nets; and
• the quality of the records that each health facility sends to the WHO.

This text is a summary of: WHO, World Malaria Report (2008) ,
2. Policies, strategies and targets for Malaria Control, p.5-7