UAB Synopsis, Vol. 27, No. 22, June 9, 2008
In a major tropical medicine journal, two UAB scientists have called for a change of direction in how the world’s malaria control programs are funded. Their editorial in the American Journal of Tropical Medicine and Hygiene (2008;78[4], 536-537) advocates a strategy that protects the community at large rather than putting almost all funding into protecting children younger than 5 years of age and pregnant women.
Most antimalarial funding now goes toward a strategy formulated in 1992 aimed at improved case management, intermittent preventive treatment of pregnant women, and widespread use of insecticide-treated bednets.
The authors are Robert J. Novak, PhD, professor of medicine, and Ephantus J. Muturi, PhD, a postdoctoral fellow, both in the Division of Infectious Diseases and the UAB William C. Gorgas Center for Geographic Medicine, along with economist Peter Burgess, director of The Transparency and Accountability Network: (Tr-Ac-Net) in New York.
“It seems logical to target young children and pregnant women because they experience the greatest morbidity and mortality from malaria,” Dr. Novak writes. “However, we question whether this is the best strategy to help the World Health Organization’s (WHO) Roll Back Malaria (RBM) program realize its goal of halving deaths from malaria by 2010. The disease has burgeoned among teens and adults who are not being protected. We believe tangible socioeconomic value to the family and community can only be realized if older children and all adults also are included and do not suffer from malaria-induced morbidity.”
The authors cite data from the 1999-2003 World Health Reports showing that the annual mortality from malaria is higher today than before the RBM initiative started, “indicating a failing campaign,” they write. They suggest a change in malaria prevention and control philosophy to include an integrated vector management strategy, and say a strategy to include source reduction, indoor residual spraying, and insecticide-treated bednets is now practical with emergence of a renewed interest in vector control and recent WHO approval of DDT use where and when the vectors concentrated inside houses are still susceptible to it.
Dr. Muturi, a native of Kenya who once was stricken with malaria, is frustrated by the current approach to management of the disease. “I have family in Kenya who are at risk every day,” he says. “During the day and early in the evening, when we are not shielded by bednets, protection is minimal. Little funding is directed to help identify and address environmental factors that contribute to malaria’s growth and spread.”
“Relying on drugs and bednets is the same mentality that failed in the 1960s,” Dr. Novak says, “so we need to attack the disease in new and more efficient methods. By properly combining past successful tactics in managing malaria with new technologies in insecticides, surveillance, geographic information systems and remote satellite, molecular characterization of the vectors, and new drugs, malaria can become a minor disease.”