The East African (Nairobi)
Dagi Kimani
2 November 2008
opinion
IS THE WORLD COMMITTING EN-ough resources to fight malaria? How serious is the problem anyway?
These are among the questions some malaria experts are starting to ask themselves, as evidence mounts that the global response has been based on wrong data.
That perception gained currency when the World Health Organisation recently released new figures of the global malaria situation, downsizing the epidemic and the numbers of deaths the disease causes per year.
According to the WHO's World Malaria Report 2008, there are actually about 250 million cases of malaria in the world each year, and about 880,000 deaths. Previous official estimates had put the number of infections at 350 million to 500 million cases and more than a million deaths.
Critically, the drop in infections and estimated deaths did not result from greater use of bednets, better treatments or environmental interventions, only better statistics.
"Almost all the drop was in the methodology," Dr Mac W. Otten Jr, a WHO epidemiologist, was quoted by The New York Times as saying.
According to the WHO, much of the drop was a result of the revision of cases and deaths in such Asian countries as India, Indonesia, Pakistan, where over-estimates had occurred because epidemiologists had over the years been relying on population and vegetation maps dating to the 1960s.
Infection and death rates in much of sub-Saharan Africa, where over 90 per cent of infections occur, were not affected much. Significantly, however, the downsizing of malaria statistics was not without precedent.
Last year, UNAids, the United Nations agency responsible for the global response against HIV/Aids, reduced its estimates of the global epidemic to 33.2 million cases, down from 39.5 million.
In a startling admission, the agency also said that the Aids pandemic was unlikely to become as big anywhere as it had become in Africa, reversing years of warnings that Asia, China and Russia were on a cusp of major epidemics.
These revisions of two of the world worst epidemics are creating doubts whether the money being thrown into them is being targeted to the right interventions.
In the case of malaria, for example, should more dollars be used for bednets or treatment? Do environmental interventions work better than indoor spraying?
Without reliable data, malaria experts say it is hard to answer these questions with confidence.
Prof Bob Snow, a top malaria expert working at the Kenya Medical Research Institute, said, "Improving on what the WHO did for its 2005 report does not equate to getting it right."
DESPITE SUCH SCEPTIC-ism, there is also wide consensus that malaria remains a major killer in much of sub-Saharan Africa, including East Africa.
According to World Malaria Report 2008, of the 109 countries in the world in which malaria is endemic, 45 are within the WHO-Africa region.
Five countries -- Nigeria, Democratic Republic of the Congo, Ethiopia, Tanzania and Kenya -- account for half the cases recorded on the continent.
However, fresh data from Kenya and Tanzania is cause of optimism. According to Kenya's ministry of Health, for example, deaths of children below the age of five years have fallen from 36,000 at the turn of the Millennium to about 15,000 today, largely due to the distribution of 12 million free bednets and the rolling out of treatment with artemisinin-combination medicines. Kenya adopted the medicines in 2005 after high resistance rates were recorded with sulphamethamine-pyrimethamine treatments.
Kenya's experience seems to support the theory that the advent of long-lasting insecticidal nets and artemisinin-based combination therapy together with a revival of support for indoor residual spraying of insecticide presents a new opportunity for large-scale malaria control.
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