Winning the fight against malaria
It is estimated that in 2010 there were 216 million cases of malaria, resulting in 655,000 deaths. 81% of these cases and 91% of deaths happened in Africa. Across the globe, 86% of victims were under 5 years old.
Thanks to the efforts of communities in affected areas and their international partners, malaria deaths have fallen by 25% since the year 2000. As the world’s largest donor of development assistance, the EU is at the forefront of ensuring that this progress continues. In the Democratic Republic of Congo (DRC) for example, notable results have been achieved.
In the DRC, malaria accounts for nearly 30% of deaths of children who die before their fifth birthday. The disease kills 10% of infants before their first birthday. One study suggests that at any one time in the DRC, 42% of children under five have malaria and according to the country’s National Malaria Control Programme, 35% of visits to public health facilities are caused by malaria and 30% of hospital beds are occupied by malaria cases.
Moreover, economically, malaria drains the wealth of nations and households. The World Health Organisation (WHO) estimates that malaria costs Africa alone €8.7bn a year. In countries where the disease is endemic, such as the Democratic Republic of Congo, it grinds down the per capita economic growth rate by at least 1.3% yearly. Poor households can spend up to 34% of their total income fighting malaria. Nationally, in some heavy-burden countries, such as the DRC, the disease accounts for up to 40% of public health expenditure, up to 50% of inpatient admissions and up to 60% of outpatient health clinic visits.
Yet with minor changes, these terrible figures could be drastically reduced. Anti-malarial mosquito nets are key – indeed it is estimated that if at least 80% of all households in sub-Saharan Africa were to use them, the number of malaria cases could be reduced by up to 50%. An EU-UNICEF partnership to distribute insecticide treated mosquito nets in the DRC, Ethiopia, Mozambique and Niger that began at the end of 2007 is making a major impact on the number of people sleeping under nets.
Committing to a net increase
In 2007, as part of its commitment to fighting malaria, the EU pledged €5 million over three years from the European Development Fund to support the distribution of nets by UNICEF in the DRC, Ethiopia, Mozambique and Niger. The amount earmarked for the DRC alone was €1.8m.
In the first three years of the project, which had been initiated by UNICEF in December 2007, the campaign focused on distributing nets to households with children under three (Bas-Congo in 2008) and under five (Sud-Kivu and Équateur, in 2009 and 20010). Since 2008, the policy in the country has been adapting and changing, and nets are now given in sufficient numbers to reach universal coverage.
Thanks to the Project funded under the EDF and other contributions from UNICEF, in total, at least 14.5 million nets have been distributed between 2006 and 2011 in DRC. The campaigns in the DRC continue, with distributions having taken place in 2009 and 2010 in Oriental and Maniema, in 2011 in Kasai Oriental, Kasai Occidental, Bas Congo and parts of Bandundu.
In 2012, campaigns aiming at universal coverage are taking place in Nord-Kivu, Sud-Kivu, Katanga, and to finish covering Banduna. The replacement of nets which were distributed earlier is also planned for Équateur and Kinshasa and again in Maniema and Province Orientale in 2013 (anti-malaria nets have a lifespan of approximately three years).
In order to reach universal coverage throughout the DRC, at least 39.8 million nets are needed across the country. Thanks to joint programmes like this, the DRC is coming ever closer to reaching this target.
“To us, UNICEF is a natural partner as the organisation focuses on women and children, who are those most affected by malaria. The European Union backs a wide range of projects in the DRC – including for example providing infrastructural support to make the Congo river navigable – but what the country really needs is to develop economically. That will be the task of the people and we need to help them to be free from this awful illness.”
Vincent Dowd, Head of Operations, EU Delegation to the DRC
Overcoming the challenges
The DRC is the 11th largest country in the world and the largest in Sub-Saharan Africa. It also unfortunately also has the second highest number of malaria cases in the world. Much of the country is inaccessible even with 4x4 vehicles and when nets reach distribution points, they often have to be taken further by motorcycle, bicycle, boat, canoe or sheer human effort.
The ongoing civil war in parts of the country has also wreaked havoc with its already sparse infrastructure. The country's administrative capacity is weak and many members of Congo's public sector have not received a salary from the state in years - police, army, health workers, teachers, administrators are therefore forced to effectively privatise their services.
As a consequence, people often avoid seeking medical treatment due to the expense of going to the doctor. This adds extra importance to preventing people from being infected with malaria in the first place.
“Our logistical challenges are huge. Funding from the European Union, World Bank, Global Fund and others has presented us with the opportunity to carry out the biggest distribution of insecticide-treated malaria nets the DRC has ever seen. In 2007, in terms of usage, less than eight per cent of pregnant women were sleeping under nets. Our recent surveys show that figure has risen to 43 per cent. Similarly with children, we have gone from seven per cent to 38 per cent.”
Jean-Bosco Hulute, UNICEF malaria specialist
Education is key
Informing people on how to use the nets is also crucial. Alongside the distribution of nets, health workers also setting up workshops so that the primary users of the nets - usually women - are taught how to protect themselves and their children. These workshops moreover teach communities how to clear the dark corners of their homes and the greenery outside where mosquitoes can congregate.
In Djuma, Bandundu Province for example, a four day campaign of distribution and education took place recently amid a carnival atmosphere of music, dancing and most importantly, theatre sketches on how to detect and prevent malaria. A team of 65 specialists drawn from a pool of more than 700 health extension workers carried out house to house surveys of net requirements and issued vouchers to beneficiaries. They elicited the support of local communities, including the influential Kimbanguista church.
In Djuma, the distribution of nets was also coupled with a UNICEF polio vaccination campaign. Some people in rural areas are reluctant to have their children vaccinated and the much sought after nets act as an incentive for people to obtain the polio vaccine.
“International studies have shown that if 80 per cent of households use mosquito nets, you register a 50 per cent drop in cases of malaria and an 18 per cent decrease in deaths. In the context of the DRC, where malaria is endemic virtually everywhere, that is a huge impact.”
Dr Aimé Yiyi Mantempa, Bandundu Province medical coordinator
Between the abandonment of the WHO malaria eradication programme in Africa in 1976 and the end of the 1990s, a sense of resignation had set in amongst many health professionals that wiping malaria out in Africa was an impossible task. After all, the vastness of the continent with its largely tropical climate and fertile breeding grounds for mosquitoes made and continues to make fighting the disease a challenging task. Added to the extremely high number of African mosquitoes, as well as their strong preference for biting humans over animals, it is no surprise that over 80% of global malaria cases happen in Africa.
A renewed sense of optimism and vigour in the fight against malaria was perceptible in the late 1990s, when the Roll Back Malaria partnership was formed and then the Millennium Development Goals (MDGs) were drawn up. The EU has repeatedly affirmed its commitment to the MDGs including MDG Goal 6C, which is to have halted and begun the reversal of the incidence of malaria by 2015.
The EU is at the forefront of the fight against malaria. Between 2004 and 2009 there was a tenfold increase in global funding to fight malaria, much of that coming from the EU budget or from EU Member States. In the same period, there was a fivefold increase in the production of insecticide treated nets.