Africa's Malaria Death Toll Still "Outrageously High"

Afshin Molavi
for National Geographic News

June 12, 2003

As international attention is riveted by fears over Severe Acute
Respiratory Syndrome (SARS), an older and far more deadly disease
quietly ravages Africa: malaria. Malaria kills more than a million
people worldwide each year—90 percent of them in Africa; 70 percent
children under the age of five.

A recent report by two United Nations agencies—the World Health Organization (WHO) and the United Nations Childrens Fund (UNICEF) #151;outlines the enormity of Africa's malaria problem and calls on the global community to step up its efforts to combat the disease.

Noting that the death toll remains "outrageously high," The Africa Malaria Report says that sub-Saharan Africa faces continued malarial devastation unless swift action is taken. Malaria, the report noted, is the single biggest killer of children under five and a serious threat to pregnant women and their newborn.

"New analyses confirm that malaria is a principal cause of at least one-fifth of all young child deaths in Africa," the report said. "No country in Africa south of the Sahara for which data are available shows a substantial decline."

Though there is no single cure for malaria and an effective vaccine is considered years away, the keys to prevention, the causes, and clinical responses are well understood but poorly implemented, the report says. Patients also suffer because of increasing drug and insecticide resistance and underfunded health care systems, resulting in a malaria resurgence that has led to a more virulent disease today than in the 1960s.

The report also noted that new effective anti-malarial drugs are not yet accessible to the majority of those who need them—children and pregnant women, in particular—and only a small proportion of children are protected by highly effective insecticide-treated bed nets (ITNs).

The simple act of sleeping under an ITN would halve the number of children who die of malaria. Currently, 15 percent of African children sleep under a net, but only 2 percent sleep under nets that are regularly treated with insecticide, the report says.

The WHO-UNICEF report also describes malaria as "a brake on development." The World Bank, which contributed a chapter to the report, estimates that malaria costs Africa more than U.S. $12 billion annually and has slowed economic growth in African countries by 1.3 percent a year. Sub-Saharan Africa's GDP is 32 percent lower than it would have been by now had malaria been eradicated in 1960, the World Bank says.

Mosquito Bite

Malaria is transmitted from person to person through the bite of a female Anopheles—a species of mosquito prevalent throughout sub-Saharan Africa and considered to be the most dangerous.

Only a small proportion of malaria infections are fatal, but children under five and pregnant women are particularly vulnerable due to their weaker immune systems. Brian Greenwood, a world authority on malaria and director of the Malaria Center at the University of London School of Hygiene and Tropical Medicine, estimates that 1 to 2 percent of cases lead to fatalities.

The high overall number of deaths from malaria reflects the regularity with which Africans—particularly the poorest segments of society—contract malaria. While the majority of healthy adults—who might be bitten up to twice a day by malarial mosquitos in the rainy season—withstand the malaria parasite, many children are hospitalized. In fact, says Greenwood, "malaria is the commonest cause of admission into pediatric wards."

In the cases that lead to fatalities, the microscopic parasite invades and destroys red blood cells, leading to severe anemia. The parasite may also stick to the lining of small blood vessels in the brain causing cerebral malaria.

The parasite has developed a resistance to the commonly used and cheapest drug, chloroquine, according to Greenwood and the WHO-UNICEF report. Resistance to a common chloroquine replacement has also emerged in eastern and southern Africa. The report described artemisin-based therapy as the most promising new drug on the market, though its high cost remains a barrier.

Greenwood argues that the nearly U.S. $2 billion a year needed to "get everyone under a net and ensure access to artemisin is a small amount of money when compared to, say, the costs of the war in Iraq."

Global Response

The Tanzanian malaria researcher Wen Kilama offers a sobering analogy, famous in the malaria research community: If seven Boeing 747s full of children crashed into a mountain every day, would the world take measures to prevent it?

The number of children killed each day by malaria is slowly prodding the developed world to do something to mitigate the disaster. More ambitious anti-malarial initiatives have been announced in recent years.

Roll Back Malaria, a global partnership founded in 1998 by WHO, UNICEF, the United Nations Development Programme, and the World Bank, with the goal of halving the world malaria infection rate by 2010, includes a broad coalition of national governments, civil society, non-governmental organizations, research institutions, professional associations, development banks, and the media.

In Abuja, Nigeria, in April 2000, 44 African leaders met to endorse RBMs goal for 2010.

A new organization—The Global Fund to Fight Aids, Tuberculosis, and Malaria—represents another key resource in the fight against malaria. A partnership between governments, civil society, the private sector, and affected communities, the Global Fund seeks to attract and disburse additional resources to prevent and treat AIDS, tuberculosis (TB), and malaria.

The Bill and Melinda Gates Foundation and Rotary International are also active funders of malaria research and prevention.

Still, despite the growing activity, malaria researchers say the world is not doing enough.

Says WHO's David Alnwick, Project Manager of Roll Back Malaria: "While African governments and donors are beginning to take malaria more seriously, there is still far too much complacency. We can certainly do a better job of controlling malaria."

The Africa Malaria Report estimates $1 billion a year is needed to significantly reduce the problem—a conservative estimate, according to some researchers. Thus far, approximately $200 million a year is spent—a significant rise from past years, though still far below what's needed. Meanwhile, 26 African governments continue to tax the import of life-saving devices such as insecticide-treated bed nets, despite promises to WHO that they would discontinue the levies, the report says.

The report challenges the global community and African governments to increase funding for malaria-control programs, accord a higher profile to the disease in health agendas of endemic countries, and ensure the availability of a new generation of the most highly effective drugs.

In a statement accompanying the report, WHO Director-General Gro Harlem Bruntland and UNICEF Executive Director Carol Bellamy describe malaria as "a disease that has been ignored by the world for far too long."

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