Malaria Solutions

Mother and Child
Photo: ©MHallahan/Sumitomo Chemical - Olyset® Net

In the 1950s, malaria was eradicated in the United States. Malaria has been brought under control and even eliminated in many parts of Asia, Europe and the Americas. Yet these campaigns never reached sub-Saharan Africa. In Africa, with very efficient mosquito vectors, increasing drug resistance and struggling health systems, malaria infections have actually increased over the last three decades.

Experts agree that a comprehensive approach is needed to effectively control malaria. Such an approach involves the use of insecticide-treated bed nets, spraying the inside walls of houses with insecticides, providing access to diagnosis and antimalarial drugs, and delivering a packet of interventions through strengthened antenatal care services for pregnant women. Underpinning these four is education – empowering families and communities with the knowledge and resources to combat this disease. Additionally, experts encourage continued research into the development of a vaccine.

Bed Nets

Long-lasting insecticide-treated bed nets (LLINs) work by creating a protective barrier against mosquitoes at night, when the vast majority of transmissions occur. The African malaria mosquitoes generally bite late at night or early morning, between 10pm and 4am. Most mosquito nets can accommodate more than one person—a mother and an infant or a few siblings—for up to three to five years. A net treated with special insecticides offers about twice the protection of an untreated net, and through its repellency, can even protect other people in the room outside the net. When enough people (about 70 percent) sleep under LLINs, entire communities, even houses without an LLIN, can be made safer.

Killing Mosquitoes (Indoor Residual Spraying)

While LLINs are generally effective in Africa wherever they can be consistently used, sometimes specialized teams are organized to spray an insecticide on the inside walls of houses (a process known as Indoor Residual Spraying, or IRS). This helps kill the female mosquito after she feeds on a person, reducing malaria transmission to others. In some special circumstances, teams are also organized to eliminate or treat mosquito breeding sites with another type of environmentally-friendly insecticide. However, because the African malaria mosquitoes are so prolific and have such a broad range of breeding habits, this type of "larval control" may only be applicable in some areas, as determined by local assessment.

Spraying and DDT

The fight against malaria requires a full arsenal. To effectively battle against the disease and end malaria deaths in Africa by 2015, it is necessary to adopt an integrated approach. This includes providing access to malaria control interventions, including long-lasting insecticide-treated mosquito nets (LLINs), effective medicines like artemisinin-based combination therapies (ACTs) and intermittent preventative treatment for pregnant women (IPT) and safe indoor residual spraying (IRS). One such example of IRS is dichloro-diphenyl-trichloroethane, better known as DDT.

Because of adverse environmental effects, DDT use was outlawed by most of the world for agricultural use in the 1960s, with exceptions made for malaria control-but it became nearly impossible to procure. However, in 2000, the WHO approved DDT as one of 12 insecticides safe for use in indoor residual spraying. In 2006, it announced a major policy shift when it began actively supporting DDT for use in malaria control.

Malaria No More is not a scientific organization. Our focus is on advocacy, awareness and strategic investments; we are not malariologists-we don't test vaccines, create new medicines or specialize in spraying. However, we do support an integrated approach to fighting malaria-and that includes proven interventions like indoor residual spraying.

The use of DDT-or indeed, any indoor residual spray-is entirely up to each country's National Malaria Control Program. Malaria No More supports the leadership of African countries and the World Health Organization and welcomes anything that will move the world closer to ending malaria deaths.

Anti-Malarial Drugs

Artemisinin-based combination therapies (ACTs) are the most effective drugs currently available for treating malaria. Pregnant women can also be helped by administering at least two monthly treatment doses of sulfadoxine-pyrimethamine (SP) during the second and third trimesters of pregnancy. More than 70 percent of pregnant women in Africa attend antenatal clinics at least once during their pregnancy. A regime of SP helps protect pregnant women from possible death and anemia and also prevents malaria-related low birthweight in infants, which causes about 100,000 infant deaths annually in Africa.

It is widely accepted that more affordable ACTs need to be developed and strategies to deliver them need to be implemented and evaluated to increase access. The Bill & Melinda Gates Foundation and the Medicines for Malaria Venture are helping to develop new drugs; while the President's Malaria Initiative, Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank's Booster Program for Malaria Control in Africa are working with Ministries of Health on delivery and access issues.

Development of a Vaccine

As with any disease, finding a vaccine to protect individuals from malaria would create the best possible defense. Around the world, from Sweden to Kenya, from Australia to the United States, world class physicians are working on this important research. However, the malaria parasites have proven to be remarkably adaptable, meaning they change their characteristics as antibodies are developed. This adaptability has made finding a vaccine especially challenging.

Government and Multilateral Efforts

The President's Malaria Initiative (PMI), announced by President George W. Bush in 2005, is a $1.2 billion, five year initiative. The goal of the PMI is to cut malaria-related deaths by 50 percent in 15 target countries in Africa, eventually benefiting at least 175 million people. This goal will be achieved by reaching 85 percent of the most vulnerable groups – children under five years of age and pregnant women – with a comprehensive approach to prevent and treat malaria, including insecticide-treated bed nets. PMI coordinates with national malaria control programs and international partners, including the World Bank's Booster Program for Malaria Control in Africa, the Roll Back Malaria Partnership, and the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. President Bush has called on other donors, foundations, and private, public, and voluntary organizations to complement this initiative and provide additional funding.