FIRST GLOBAL REPORT ON MALARIA
FIRST GLOBAL REPORT ON MALARIA
More people are accessing prevention and treatment services for malaria, sparking hope that the number of people who become sick and die from malaria will begin to decline. However, challenges remain to reduce the burden of the disease which still kills one million people every year, most of those in Africa, according to the 2005 World Malaria Report.
The report, released in May 2005, by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), finds that progress has been made in preventing and treating malaria since 2000. It finds that more countries are introducing the newest medicines to treat malaria, and that more people are receiving long-lasting insecticide-treated mosquito nets through innovative new programmes.
However, proven interventions such as insecticide- treated nets, and the latest artemisinin-based combination therapies must reach many more people before we can have a real impact on malaria.
A number of countries are now engaged in intense ant malarial campaigns. In particular, more and more people are protected with insecticide-treated nets – a highly effective method of malaria prevention. In Africa, all countries reporting on nets collectively had a 10-fold increase in the number of insecticide-treated nets distributed over the last three years.
Countries where the former mainstays of malaria treatment, such as chloroquine, are no longer effective are also moving forward on new therapies. Si nee 2001, 42 malaria- endemic countries, 23 of them in Africa, have adopted artemisinin-based combination therapies recommended by WHO. Halting and reversing the incidence of malaria by 2015 is a target of the Millennium Development Goals. The more immediate goal of Roll Back Malaria is to halve the burden of malaria worldwide by 2010. A major obstacle to achieving that goal, the report explains, is lack of funds. The report estimates that US$ 3.2 billion per year is needed to effectively combat malaria in the 82 countries with the highest disease burden.
Highlights
- After a 2003 campaign to distribute treated nets in five districts of Zambia at least 80% of children under five were sleeping under the nets.
- At present malaria remains the infectious disease that takes more lives of children in Africa than any other- three times as many as HIV infection.
- In 2003, some 350 to 500 million people worldwide became ill with malaria-a slight revision of the estimate of 300 to 500 million annual cases that WHO has used since 2000.
- Of the 5 million confirmed cases of malaria which are reported each year from countries outside of Africa, nearly 3 million are from India and Pakistan.
- ndia reported 1.86 million confirmed cases and 1000 deaths in 2003. 45 percent of these cases, or about 850,000, were Plasmodium falciparum.
- In India, the risk of contracting malaria is unevenly distributed across the country; 20 percent of the population is reporting 80 percent of the cases. 80 percent of the India’s population now lives in areas with low incidence of malaria.
- Orissa has the highest number of cases and deaths in the country. Other high disease burden states include Gujarat, West Bengal, Chhattisgarh, Madhya Pradesh, Rajasthan, Uttar Pradesh, Karnataka, Jharkand, and Maharashra.
- The Northeast states not only have a high burden of malaria, but also a significant share of Plasmodium falciparum and drug resistance
- Artemisinin: These are the latest generation of antimalarial medicines and the most effective treatment against falciparum malaria, the deadliest form of the disease.
Enhanced Malaria Control Programme (EMCP) in India
The project initially covered 1045 tribal blocks (PHCs)in 100 districts in 8 states, namely AP, Chhattisgarh, Gujarat, Jharkhand, MP, Maharashtra, Orissa, and Rajasthan. In 2003, it expanded to cover 200 PHCs, and added 2 states, Karnataka and West Bengal.
EMCP has five components: (i) Early Diagnosis and Prompt Treatment (EDPT);(ii) Selective Vector Control; (iii) Insecticide-treated Bed Nets (ITNs); (iv) Epidemic Response and Inter-Sectoral Collaboration; and (v) Institutional Strengthening.
In 2004, approximately 650,000 malaria cases were reported in EMCP Districts, which represent a 45 percent decline since 1997. In addition, mortality in these districts fell by 58 percent. Experience from EMCP demonstrated wide variability in implementation capacity and resources between the states. States, such as Maharashtra, Gujarat, and Andhra Pradesh, have a more established health infrastructure and significant financing from their state governments. Implementation in these states took off rapidly and impact was dramatic. Malaria burden dropped more than 70 percent during the project period. In contrast, infrastructure and financing in states like Orissa, Jharkhand, and Chhattisgarh were less well established.
INDIA’S PROGRESS IN POLIO ERADICATION
India has made tremendous progress in polio eradication, thanks to the consistent implementation of high-quality immunization campaigns. India has been observing pulse polio immunization campaign from 1995 for eradication of polio virus from this country and achieved tremendous success in controlling the spread of the virus in most parts of the country. The only challenge today is that each child below 5 years of age is given Oral Polio Vaccine during the supplementary immunization rounds during 2005. Indian Expert Advisory Group (IEAG) reviews the polio virus transmission situation and the implementation of the programme from time to time and the Government has been implementing its recommendations. In accordance with IEAG recommendations, high-risk districts in the country have been identified for better implementation of the programme.
In 2004, in high-risk states, such as Uttar Pradesh and Bihar, immunization campaigns were conducted on an average every sixth weeks. As a result of these tremendous efforts, the incidence of polio in India has been reduced from an estimated more than 75,000 annual cases in 1996tojust 136 cases in 2004, the lowest number ever. India now stands on the verge of being polio-free.
A similar campaign schedule will be necessary throughout 2005 and into 2006. Such numerous immunization campaigns are necessary to:
- Ensure children are fully protected against polio. All children under the age of five years must receive at least four doses of the polio vaccine, and in many cases additional doses are necessary to ensure full protection;
- Each month, 250,000 children are born in the state of Uttar Pradesh alone, all of whom will be completely unimmunized and vulnerable to the polio virus;
- Many children are suffering from a vast array of competing viruses which stretches their immune system – additional doses will offer added protection against polio;
- Coincidental diarrhoeal diseases, at a time of an immunization campaign, may cause an individual dose to be flushed out of a child’s system, requiring additional doses in future immunization activities.
The Global Polio Eradication Initiative
In 1988, the 41st World Health Assembly, consisting then of delegates from 166 Member States, launched a global initiative to eradicate polio by the end of the year 2000. Overall, in the 15 years since the Global Polio Eradication Initiative was launched, the number of polio-infected countries was reduced from 125 to 7. Widely endemic on five continents in 1988, polio is now found only in parts of Africa and south Asia.
Strategies
There are four core strategies to stop transmission of the wild polio virus
high infant immunization coverage with four doses of oral polio vaccine in the first year of life;
- supplementary doses of oral polio vaccine to all children under five years of age during national immunization days (NIDs)
- surveillance for wild polio virus through reporting and laboratory testing of all cases of acute flaccid paralysis (AFP) among children under fifteen years of age;
- Coalition: The Global Polio Eradication Initiative (GPEI) is spearheaded by WHO, Rotary International, the US Centres for Disease Control and Prevention (CDC) and the United Nations Children’s Fund (UNICEF).
Countries at Risk of Polio
As long as a single child remains infected with polio virus, children in all countries are at risk of contracting the disease. In January 2003, a child was paralysed by polio in Lebanon, the first case seen in that country in nearly ten years. Genetic sequencing confirmed this case was an importation from India. The polio virus can easily be imported into a polio-free country and can spread rapidly amongst unimmunized populations. At the beginning of 2003, seven countries were known still to have ongoing polio virus transmission. The seven polio-endemic countries/areas, from highest to lowest risk of ongoing transmission beyond mid-2003, are northern India, northern Nigeria, Egypt, Pakistan, Afghanistan, Somalia and Niger.
PolioPlus by Rotary International
Rotary’s involvement in polio eradication began in 1979 with a five-year commitment to provide and help deliver polio vaccine to six million children of the Philippines. It was the first project of the new Health, Hunger, and Humanity (3-H) programme. In the next four years, similar five-year commitments were approved for Haiti, Bolivia, Morocco, Sierra Leone, and Cambodia.
Polio cases as on 15 June 2005
Global cases of polio virus: 502
Yemen (importation) 243
Nigeria (endemic) 157
Indonesia (importation) 34
Sudan 25
India(endemic) 18
Ethiopia (importation) 10
Pakistan (endemic) 9
Afghanistan (endemic) 3
Niger(endemic) 2
Cameroun (importation) 1
In the early 1980s, Rotary began planning for the most ambitious programme in its history – to immunize all of world’s children against polio. As the war on polio enters its final phases, adequate funding is the No. 1 obstacle to achieving a polio-free world. The Global Polio Eradication Initiative is recognized worldwide as a model of public and private cooperation in pursuit of a humanitarian goal. In the words of United Nations General Secretary Kofi Annan, “Rotary’s PolioPlus programme is a shining example of the achievements made possible by cooperation between the United Nations and nongovernmental organizations.”
NATIONAL RURAL HEALTH MISSION (NRHM)
In order to meet the key objectives of National Population Policy 2000 and to provide the common man with adequate health care facilities, an ambitious National Rural Health Mission has been launched on April 12, 2005. The mission attempts a major shift in the governance of public health by giving leadership to the Panchayati Raj institutions (PRIs) in all matters related to health at the district and sub-district level. It aims to increase the reach of health system to village and even household level through the provision of a voluntary trained Female Community health activist called ‘ASHA’. The mission will cover all the states with special focus on 18 states which have a weak health infrastructure and demographic indicators.
Vision of NRHM
- Effective health care for rural population especially woman and children throughout the country.
- Health plan for each village through village health committee of the panchayat.
- Special focus on 18 states.
- Effective integration of health with sanitation and hygiene, nutrition and safe drinking water.
- 24 hours functional hospital in each block.
- Community health insurance for the poor.
The goal of NRHM
- Reduced Infant Mortality Rate (IMR).
- educed Maternal Mortality Ratio (MMK).
- Prevention and control of diseases.
- Promotion of healthy life style.
- Promotion of health care at household level through formal health activist (ASHA).
- Full coverage of immunization and access to institutional delivery.
Gaps in the mission
- The slogan ‘Hum Do Hamare Ek’ of the mission needs to be popularized at grassroot level.
- The ultimate objective of the Empowered Action Group in the mission seems to be demographic stabilization and not overall health care.
- Mission’s attempt to facilitate the unregulated entry of the private sector into rural healthcare and by general lack of commitment to the creation and strengthening of public health infrastructure has raised the doubts that the mission has a hidden fertility control agenda.
- The mission does not specify the population to be covered by ASHA. There appears to be some ambivalence in the role and location of ASHA.
- One of the key strategies of the mission is to operationalise the existing 3222 Community Health Centres (CHCs) as 24 hour first referral units with 30-50 beds but a similar emphasis is lacking for primary health centres which is where most people are most likely to go first.
- The responsibilities have been concentrated at district level. So it seems that there has been a neglect of village health samitis and panchayat samitis. District is the care unit of planning. Thus decentralization is only a theoretical notion
- The question of funding is vague. The envisaged united fund of Rs 10000 per annum for each subcentre is to be deposited in a joint bank account of auxiliary nurse, midwife and sarpanch. The fund should have been given directly to the panchayat.
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