African leaders from 26 countries have launched a fresh drive to eliminate malaria using a combination of bed nets, insecticides, and medication,  announced Tanzania’s President Jakaya Kikwete. Almost one million people die annually worldwide from malaria, and 85% of these deaths are in Africa.

“We believe that if we cover everybody in Africa with bed nets, insecticides, and medication by the end of this year, we will have zero deaths or near zero deaths from malaria in Africa by 2015,” said Ray Chambers, U.N. special envoy for malaria. Coverage of all at-risk people from malaria by the end of this year would make this Millennium Development Goal target not only attainable, but probable.

In Zanzibar, the three-pronged approach utilizing bed nets, insecticides and medication cut malaria cases in Zanzibar to less than 1% from previous levels of 40 percent.

U.S. Malaria Coordinator Timothy Ziemer said the U.S. government has made a budget request of $680 million for the fight against malaria in FY2011, including $100 million for the Democratic Republic of Congo and Nigeria, which together account for about half of the world’s malaria cases. Malaria costs Africa over $40 billion each year in treatment and sick days.

A team of Duke University researchers and African colleagues will be performing experiments in 24 villages in the Mvomero district of Tanzania to assess the effectiveness of different intervention strategies individually and in combination to curb the spread of malaria while protecting human and environmental health. Their work will be supported by a $2.2 million four-year grant from the U.S. National Institutes of Health. The study will be lead by principal investigator Randall A. Kramer, a professor of environmental economics at Duke’s Nicholas School of the Environment and the Duke Global Health Institute. 

The participating villages will be randomly assigned one of four malaria control options: no intervention, chemical treatments that kill mosquito larvae, rapid diagnostic testing for malaria by health workers, or both larvicide and rapid diagnostic testing. Kramer explains, “The central objective is to improve malaria control through an approach that integrates health delivery and decision-support modeling, to promote joint optimization of vector control and disease management strategies.” What Kramer and his colleagues learn will be used to refine a model they have developed called the Malaria Decision Analysis Support Tool (MDAST), which scientists and public health officials can use to improve the effectiveness and safety of malaria control strategies in differing localized conditions and circumstances worldwide.

Marie Lynn Miranda, an associate professor of environmental sciences and policy and director of the Children’s Environmental Health Initiative at the Nicholas School, and associate professor of pediatrics at the Duke School of Medicine, is Kramer’s co-principal investigator. Their team includes collaborators from Duke, The University of Pretoria in South Africa, and the National Institute for Medical Research in Tanzania.

The Kupona Foundation was created to gain private support in the U.S. for CCBRT’s (one of Tanzania’s leading disability organizations) new maternity facility, the Baobab Maternity Hospital, which is being developed as part of a public-private sector partnership with the Government of Tanzania. It is planned to open in 2012, provided funding is secured.

Seventeen organizations from Tanzania’s private sector have already pledged a total of $350,000 to help make this hospital a reality. CCBRT CEO Mr. Erwin Telemans thanked all of these companies, commenting: “It is inspiring to see the corporate community coming together to help build a new maternity hospital for Dar es Salaam in this way and my deepest appreciation goes to all of those companies who have supported this initiative so far.” However, the total funding needed for construction and equipping the new hospital is $22 million. “We urgently need the commitment of development partners alongside that of CCBRT, the government, and Tanzania’s corporate sector,” says Mr. Telemans, continuing to point out that each year an estimated 13,000 women die unnecessarily in pregnancy and childbirth.

Mrs. Blandina S.J. Nyoni, Permanent Secretary at the Ministry of Health and Social Welfare, added that the services that will be given in the Baobab Maternity Hospital will help increase the pace of Tanzania reaching Millennium Development Goals 4, 5, and 6 in addition to saving thousands of lives and preventing thousands of women and children from developing disabling conditions each year. It will also offer services to prevent the spread of HIV/AIDS and will be a training center to build expertise in maternal and infant health care.

The Daily Beast has some great coverage of Christy Turlington’s story and work to advocate for maternal health around the globe. Mark Green, along with President Kikwete of Tanzania have promoted her documentary and are actively calling for improved maternal and child health.

At 41, the former supermodel has embarked on a new career as an advocate for maternal health and reproductive rights. Six and a half years ago, after giving birth to her daughter, Turlington started hemorrhaging. It was the sort of common complication that’s easily treated in the first world but often fatal in the developing world. The terror of that moment stayed with her, and inspired Turlington to learn more about maternal mortality.

So two years ago, Turlington enrolled in the masters program at Columbia University’s Mailman School of Public Health, using her married name, as if to separate her celebrity persona from her student one. At the same time, she began working on No Woman No Cry, a documentary about maternal mortality worldwide. This week, she’s screening it at Women Deliver, a huge, star-studded conference about reproductive health taking place in Washington, D.C.

A second “Women Deliver” conference took place in Washington,D.C. from June 7th to 9th of the year 2010. The conference focused on advocating for girls’ and women’s health in the world today as well as attainment of the Millennium Development Goals. The conference participants, which consisted of people of various backgrounds and interests from all over the globe, had a chance to meet, share a wide array of information, and exchange ideas regarding measures to improve girls’ and women’s health worldwide.

According to the conference’s introduction, “every year, between 350,000 and 500,000 girls and women die from pregnancy-related causes”, malaria in pregnancy (MIP) being one of them. I was fortunate enough to attend a very interesting panel which discussed three countries in Africa; Zambia, Tanzania, and Senegal, that have succeeded in achieving high coverage of malaria in pregnancy prevention. What stood out to me during the panel is the fact that each one of the presenters from the three different countries expressed similar concerns regarding the challenges their nation has been facing in the battle against malaria. The common limitations discussed by the panelists in preventing malaria in pregnancy and its complications include lack of skilled providers and services in hospitals, poor infrastructure, inconsistent supply of drugs, lack of financial resources, and inefficient data monitoring.

Many malaria-endemic countries, including Zambia, Tanzania, and Senegal,  depend on foreign donors in order to succeed in the war against malaria. The United States government has been a major source of aid for many countries that have been battling against the parasitic disease. With sufficient support and effort, the prevalence of malaria has significantly declined in areas such as Zanzibar, Tanzania. In order to achieve similar outcomes in areas where the prevalence of malaria is still high, as well as sustain malaria control, prevention, and treatment in regions that have succeeded in reducing malaria rates, leaders from all over the world must work together in efforts to eradicate the disease.

One of the conference’s focuses was to encourage leaders to invest in girls and women in order to “produce far-reaching economic and social benefits,” not just in developing nations, but worldwide. The fact that childbearing girls and women are amongst the most vulnerable populations to malaria complications should encourage leaders to put forth as much effort as possible to not only improve girls’ and women’s health, but to also get closer to achieving the Millennium Development Goals in general. In addition to saving girls’ and women’s lives, investing in these populations would also  significantly decrease neonatal and infant mortality rates. It is therefore pivotal to tackle the common challenges many malaria-endemic regions such as Zambia and Tanzania have been facing in malaria in pregnancy prevention in order to save neonates, children, girls, and women worldwide.

As the Tanzanian Government Malaria Haikubaliki campaign escalates in a three day insecticide-treated mosquito net distribution program, non governmental organization Sikika pleads with both recipients of the nets and authorities in charge of the activities to ensure that the nets are used for their intended purpose.

“This will go a long way in saving life, that is, if the nets are properly used,” in the fight against a disease that kills 291 Tanzanians, mostly children, every day. After reports of abuse from both sides, including recipients using the nets for fishing and leaders selling nets that were meant to be provided free, Sikika urges both the public and leaders of the campaign to direct their efforts to reach the “intended targets,” in the interest of  health and government transparency, and for the general advancement of the country.

The proper use of ITNs has been proved to be an effective method in reducing malaria cases. In a heightened effort to end malaria, Tanzania launched the Malaria Haikubaliki campaign, part of which was the distribution of ITNs in January. If successful, Tanzania will be one of a handful of African countries to achieve universal access to mosquito nets and affordable malaria treatment for its citizens. President Kikwete, also head of the African Leaders Malaria Alliance, leads a malaria awareness campaign. On nets, he said that households with children under five are receiving the nets for free and a final stage goal is to provide every household with a minimum of two ITNs. “It is possible to ensure that we become the last generation to die of malaria.”

Malaria is one of the leading causes of child mortality in Africa and is estimated to cause a loss of US$12 billion in GDP every year in Africa, despite the fact that it could be managed for a fraction of that price. It is a preventable and treatable disease, but many African countries lack the infrastructure and resources needed to launch sustainable campaigns to end malaria cases, and the success that results from collaboration between foreign assistance and African governments, as seen in the example of Tanzania, must be realized.

Today the Malaria Policy Center had the opportunity to speak with Dr. Mohammed Jiddawi, the Principle Secretary of the Minister of Health in Zanzibar, Tanzania. Dr. Jiddawi reported that Zanzibar’s malaria prevalence rate is now less than 1 percent, as opposed to 40% just four to five years ago, pronouncing: “I can confidently say that malaria is very rare in Zanzibar, has been dramatically reduced in a short period.”

Dr. Jiddawi attributes these results to a combined approach of interventions that included indoor residual spraying, bed net usage, establishment of a strong surveillance and response system using mobile phones to report any new malaria cases, and strong communication and education to elicit behavioral changes targeted at establishing malaria as a top priority and maintaining the same level of commitment after achieving such a low prevalence rate to guard against resurgence.

In addressing how mainland Tanzania will be able to achieve the same success as Zanzibar, Dr. Jiddawi points to underdeveloped infrastructure as the main obstacle.

Ensuring continued success in virtually eradicating malaria is a key aspect of Tanzania’s economic development. According to Dr. Jiddawi, “We are already seeing the economic dividents now, and we will continue to see more dividends in the future.”

The World Bank’s Board of Executive Directors has approved US$63.66 million to create a unique regional network of 25 public health laboratories across Kenya, Tanzania, Uganda and Rwanda. The network will operate across country borders, improving access to diagnostic services to vulnerable populations in cross border areas and making optimal use of internet and mobile communications to improve public health.

World Bank Vice President for Africa Obiageli Ezekwesili states: “At a time when the global economic crisis has undermined Africa’s recent economic achievements, regional integration is an essential strategy for restoring medium-term growth, unlocking economies of scale, and sharpening competitiveness in Africa…Laboratories are currently the weakest link in the region’s public health defenses, seriously hindering each country’s ability to confirm and respond in a coordinated manner to disease outbreaks. By bolstering diagnostic and surveillance capacities, the new multi-country laboratory network will help to identify potentially devastating disease outbreaks at an early stage, enabling countries to act quickly to prevent the rapid spread of diseases across borders. Communicating outbreak-related information across national borders in real time is more important than ever before, as labor mobility is likely to increase shortly with the establishment of the East African Community common market and with growing global travel.”

The East Africa Public Health Laboratory Network simultaneously addresses a key weakness in health systems and a critical gap in the continental responses to disease outbreaks, expanding access to services to vulnerable groups.

“With this approach, which will continue throughout the project’s implementation, much can be done to strengthen health systems in a sustainable and coordinated manner,” says Eva Jarawan, Sector Manager in Health, Nutrition and Population for Africa at the World Bank.

William Brieger of End the Neglect: The Blog for the Global Network for Neglected Tropical Diseases, explains astutely that tropical communicable diseases such as malaria are integrated into the environment and human activities, and thus require a holistic and integrated approach as opposed to relying any one intervention. Excerpt below:

“A common critique of the Global Fund to Fight AIDS, TB and Malaria is that there are other major contributors to the burden of disease in tropical countries… From the standpoint of malaria integration makes sense.  From the start, the Roll Back Malaria Partnership made it clear that malaria control (and eventual elimination) could not succeed unless health systems were strengthened. These are the same systems that are supposed to control filariasis, helminthic diseases, diarrheal diseases, and pneumonia as well as promote maternal health, child growth and development as well as immunization programs. It was a weak health system that contributed to the failure of the first effort to eradicate malaria fifty years ago.”

Brieger examines two recent articles that highlight this need for integrated prevention and control services: significant overlapping and negative synergies between malaria and helminth co-infections in outpatients in southern Ethiopia, and similar convergences between lymphatic filariasis and malaria vectors in Tanzania.

Brieger argues: “If basic health services are well funded, staffed, and supplied, no tropical disease needs to be neglected.”

A recent article by William Brieger in Science Daily reports that drainage systems have been critically linked to the development of malaria, as well as lymphatic filariasis. The extensive drain network, mostly with inadequate water flow, in Dar Es Salaam is the most common habitat accounting for over 70% of Anopheles and Cuvex larvae. This is fantastic news – because the drains are manmade, these findings suggest that simple but well-organized environmental management programs aimed at restoring and maintaining the functionality of drains will drastically reduce mosquito-born disease transmission. In addition, such an intervention would promote an overall healthier environment, particularly for those living in slum conditions.

The intervention would also reduce costs of the ongoing Urban Malaria Control Program (UMCP) by eliminating an average of 42% of all potential mosquito larval habitats that are currently treated with larvicides in weekly intervals. This type of vector control is critical to minimize LF transmission when mass drug administration efforts have moderate population coverage or are prematurely ceased.

The authors conclude: “A synergy between efforts to control lymphatic filariasis and malaria, identifying common strategies, combining monitoring activities, optimizing the use of limited financial resources, and carefully evaluating the cost-effectiveness of the joint venture would not only contribute to current goals of lymphatic filariasis and malaria elimination, but also provide important lessons for future integrated control efforts.”