USAID in Africa
Summer 2004
Page(s) : 3-4
International Development Agency (USAID)
International Development Agency (USAID)

Fighting One of Africa's Biggest Killers

The Method to Treat Mosquito Net with Insecticide

     The World Health Organization estimates that 3,000 people die of malaria every day, one every 30 seconds. Worldwide, an estimated 300 to 500 million cases of malaria are contracted every year, resulting in up to 2.5 million deaths. In Africa--where 90 percent of malaria deaths occur--malaria is the leading cause of death for children under five years of age.

     To combat this life-threatening illness, USAID has nearly quadrupled funding for malaria programs over the past six years, from $22 million in fiscal year 1998 to $83 million in FY 2004. In addition, USAID has contributed $398 million to the Global Fund to Fight AIDS, Tuberculosis, and Malaria since the fund's inception in 2001, and will contribute up to $398 million more in FY 2004.

     As part of the Roll Back Malaria partnership (RBM), which is led by the World Health Organization, UNICEF, UNDP, and the World Bank, USAID is working to ensure that by the year 2005:

     • At least 60 percent of those suffering from malaria have prompt access to and are able to use correct, affordable, and appropriate treatment within eight hours of the onset of malarial symptoms;

     • At least 60 percent of those at risk of malaria, particularly pregnant women and children under five years of age, benefit from the most suitable protective measures such as insecticide-treated mosquito nets and other materials to prevent infection; and

     • At least 60 percent of all pregnant women who are at risk of malaria, especially those in their first pregnancies, have access to chemoprophylaxis or intermittent presumptive treatment, a proactive and effective intervention that prevents and controls the effects of malaria on mothers and their unborn children.

     The primary focus of USAID's expanded response to malaria is on preventing malaria infection and illness. Even though research has shown that sleeping under an insecticide-treated net (ITN) can reduce mortality by up to 63 percent, particularly among children under age 5 and pregnant women, fewer than 10 percent of Africa's children sleep under a net, and even fewer sleep under an insecticide treated one. To help stimulate commercial investment in ITNs and therefore expand the availability of affordable ITNs, USAID launched NetMark, an innovative partnership with 13 major firms (representing over 80 percent of the global capacity to produce and distribute ITNs) to develop ITN markets in Ghana, Mali, Nigeria, Senegal, Uganda, and Zambia.

     In order to ensure access to ITNs by all segments of the population on a sustainable basis, the participation of the private commercial sector is critical. By engaging the commercial sector in promoting and selling ITNs to those who can afford to pay, the limited resources available from the public sector can then be used to subsidize ITNs for those who truly cannot afford to pay full costs. Competition is encouraged among these commercial partners to ensure customer access to higher quality and more affordable products. Sales of nets topped 1 million in the first year of activity.

     NetMark also brought together key RBM partners to target subsidized nets to pregnant women and infants. Models for targeted subsidies are being widely implemented in Ghana, Malawi, Mali, Senegal, Tanzania, Uganda, and Zambia. In FY 2004, NetMark expects to expand into Ethiopia and Cameroon and generate total sales of 3.5 million ITNs through the commercial sector.

     Another USAID focus is on expanding the reach of medical services. USAID/Benin, for example, is training community-based health agents to administer anti-malarials and other basic medications, which had previously only been dispensed at official hospitals and clinics. Community-based agents in the program area have not only successfully administered the products and information, but have also developed important links with health centers, increasing the number of serious and complicated cases referred to clinics and other health facilities. The program required a change in the national health policy, but has now been expanded nationwide.

     Reducing malaria infection of women during pregnancy is another USAID priority. Placental infection is a significant contributor to low birthweight and subsequent neonatal death. Only 10 percent of women at risk of complications from placental infection during pregnancy have access to the recommended two to three doses of intermittent preventive treatment (IPT), despite the availability of a cheap but effective drug, sulfadoxine-pyrimethamine. USAID is working with several African governments to encourage delivery of known effective therapies. USAID/Tanzania, for example, initiated a project under the Maternal Neonatal Health Program to revise the national guidelines for treating malaria during pregnancy and to strengthen health services for pregnant women. The program uses a comprehensive antenatal care approach for pregnant women, which provides services in early detection and management of diseases including malaria and syphilis, counseling on health promotion, birth preparedness, complication readiness, and individualized birth planning. The new guidelines, which have been adopted nationwide, include the practice of IPT. According to the Tanzania National Malaria Control Program, the coverage of women receiving IPT during antenatal visits increased from 29 percent in 2001 to 65 percent in 2003.

     In Africa as elsewhere, growing resistance to antimalarial drugs, including chloroquine, and sulfadoxine-pyrimethamine, is challenging malaria control. New drugs exist but are significantly more costly than current therapies. USAID and the RBM partnership are exploring the most efficient means of financing these newer, more effective treatments to ensure their wide availability. USAID is also supporting operations research to study issues affecting the introduction of combination drug therapies in Africa.

     There is a growing recognition that African countries experiencing complex emergencies account for a rapidly growing percentage of the total deaths due to malaria in the region. This is especially true for the Democratic Republic of the Congo (DRC) where recent studies have shown malaria accounting for over 40 percent of the total deaths of internally displaced populations. As a result, USAID is providing expanded support for malaria control activities in the DRC.

     In addition to prevention and control programs, USAID also funds a malaria vaccine development program and operations research on behavioral, community, drug use, and treatment regimen compliance issues. Support for potential community approaches to environmental management of malaria is a final important component in USAID's fight against this deadly disease.

• For more information, visit www.usaid.gov/our_work/global_health/id/malaria or contact Dennis Carroll, infectious disease specialist in USAID's Global Health Bureau, at dcarroll@usaid.gov or 202-712-5009.

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