24 October 2006

Mozambique: Strategic Plan Against Malaria

Maputo — The Mozambican Health Ministry is seeking to ensure funding for its strategic plan for the fight against malaria, which requires 60 million US dollars a year from now up to 2009.

"We have already begun to implement this plan, and our ambitions are realistic", the director of the national anti- malaria programme, Francisco Saute, told reporters on Tuesday.

"It's been noted that the plan is possible and not a utopia. We're putting on paper something we've already started to do".

Among the components of this drive to lessen the economic and social burden of this disease, are to ensure that rapid malaria diagnostic tests can be carried out, to expand spraying against mosquitos, to step up the distribution of insecticide- treated bed nets, and to treat malaria victims with effective drugs.

In 2005, about six million cases of malaria were diagnosed in Mozambique (out of a population of about 19 million), and 4,000 deaths were attributed to the disease. But these figures are just the cases the health service knows about: the real figures are bound to be higher, since victims in remote areas may have been unable to reach health units.

Rapid diagnostic tests, Saute said, are intended to minimise the time patients have to spend in health units waiting for results of blood analyses. The tests can also be carried out in health centres that do not possess clinical laboratories.

As for spraying, Mozambique is gradually reintroducing the use of the insecticide DDT. This is highly effective in preventing the breeding of mosquitos - but ecological scares in Europe led to its discontinuation in the 1970s.

Saute said that the use of DDT has already resumed in Maputo and Zambezia provinces.

He also told the reporters that the health ministry wants to abolish the use of chloroquine in treating malaria. The malaria parasite is now so resistant to chloroquine that many experts regard this drug as virtually useless.

"We don't want chloroquine to be used, even in community health posts", said Saute. "We want effective modern drugs to be available everywhere in the country, even in the most remote areas".

Saute, who was speaking in an interval in a two day seminar on a "Malaria Vaccine Decision Making Framework", was optimistic that some of the malaria vaccines currently under development could be available by 2011.

The target is that by 2015 there should be a vaccine on he market that is at least 50 per cent effective, and that confers immunity to malaria for at least a year. It is hoped that by 2025 vaccines on offer will be 80 per cent efficient, providing immunity of at least four years.

"The scientific community has agreed that a licensed vaccine can be available by 2015 to be used as a public health instrument", said Saute. "But current evidence indicates that some vaccines being researched may be available in 2011".

So far there are 15 candidate vaccines, undergoing clinical tests. One of the lead units in developing vaccines is the Manhica Health Research Centre, about 80 kilometres north of Maputo.

Here clinical tests in 2004 of the most advanced candidate vaccine, RTS,S/AS02A, concluded that the vaccine protected a significant percentage of children against malaria. Over a follow-up period of 18 months, the vaccine was shown to reduce clinical episodes of malaria by 35 per cent, and serious bouts of malaria by 45 per cent.

The Maputo meeting is backed by the Malaria Vaccine Initiative (MVI), a global programme established with grants of over 250 million dollars from the Bill and Melinda Gates Foundation.

It is discussing not only the strictly scientific issues, but also the economic, financial and socio-cultural questions that need to be taken into account when introducing an anti- malaria vaccine.

The concept of a "Decision Making Framework" is to cut the time required to deploy new vaccines. According to the documentation for the meeting, such a framework "will offer a guide to countries and global players about key information requirements along the path to making a decision about whether or not to introduce a malaria vaccine. With such a framework in place, countries will be able to minimise the time lag between vaccine licensing and implementation".

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