World Malaria Day 2013: Sigue la Lucha---Continue the Fight

World Malaria Day 2013: Sigue la Lucha---Continue the Fight

World Malaria Day 2013 {Photo credit: UNHCR/S. Hoibak.}Photo credit: UNHCR/S. Hoibak.

To me, malaria is a very personal disease.

I first came face to face with malaria during the war of my time: Vietnam. I was plucked out of residency after my first year, with only an internship under my belt, and sent as a Navy Medical Officer to war. Medical school and residency prepared me well for much of the trauma I encountered medically, but I was totally unprepared for the large-scale emotional trauma, and for the tropical diseases I had encountered only in books.

I was overwhelmed by the young children with malaria, some of whom literally died in my arms while treating them.  Yet, I also witnessed bona fide miracles: children at death’s door, comatose and unresponsive, who responded dramatically to treatments, and ultimately went home to their families.

To address malaria, I focused on promoting prevention (long-lasting insecticidal nets [LLINS] for families and intermittent preventive treatment [IPT] for pregnant women), early detection, and early treatment in the community—what is now called community case management.

That was 40 years ago.

Despite decades of effort addressing malaria and reductions in disease and death rates over the past ten years, malaria remains a major killer around the globe---especially in Africa.

Each year, there are approximately 219 million malaria cases and about 660,000 people die from malaria-related causes. Sixty-eight percent of malaria-related deaths occur in the world’s ten high-burden countries---nine of which are in Africa.

We know that investing in fighting malaria is money well spent.

Since 2000, these investments have helped to save over 1.1 million lives and reduce Africa’s malaria-related mortality rates by one-third.

The principles I learned in Vietnam still hold true today.

Addressing malaria in pregnancy is critical for reducing both maternal and newborn malaria-related mortality.

Malaria in women contributes significantly to miscarriages, premature birth, labor complications, low birth weight babies, maternal anemia, chronic anemia, and maternal and newborn death. By integrating malaria prevention and treatment into existing maternal health programs, we ensure that pregnant women receive the care and information needed to keep themselves and their babies healthy.

Countries have committed to eradicating malaria, and MSH is helping them to implement evidence-based tools and develop new approaches. Specifically, we work with local, national, and global partners to:

  • Train community health workers in integrated community case management of malaria, diarrheal diseases, and pneumonia in countries such as Afghanistan, South Sudan, Democratic Republic of the Congo, Haiti, and many others;
  • Improve tools for distributing LLINs through integrated primary health care services, such as antenatal care and expanded program on immunization (EPI) services;
  • Introduce artemisinin combination therapy (ACT) into malaria programs worldwide (a strategy that has contributed to significant reductions in incidence and mortality from malaria during the last decade);
  • Develop innovative monitoring and evaluation approaches to ensure progress is measured and activities adjusted to meet the ever-changing epidemiology of malaria; and
  • Build community outreach and behavioral change communications strategies to enlist active community participation in malaria control.

All our gains could be wiped out in a few years if we do not maintain our vigilance, invest in the future, and support active malaria detection and treatment interventions in both health facilities and communities.

April 25 is World Malaria Day. Please join me, MSH, Roll Back Malaria Partnership, and the World Health Organization (WHO) in calling for an investment in the future to defeat malaria.

We must prioritize integrated programming for malaria, particularly in the face of the current economic crisis and funding cutbacks.

Malaria is always lurking, waiting to seize any opportunity to spring back, even in areas where we have controlled the disease.

Let us learn from history and “sigue la lucha”---continue the fight.

A. Frederick (Fred) Hartman, MD, MPH, is MSH’s global technical lead for communicable diseases and epidemic preparedness, and the regional portfolio director for the Center for Health Services’ projects in East Africa.


Najibullah Safi
Dear Dr. Frederick, Many thanks for comprehensive and timely note on malaria. This is to highlight that malaria eradication seems impossible with existing tools. However, countries could set elimination as target. Regards
Pierre Claquin
Fred During the 5 years I worked in the Chittagong Hill Tracts of Bangladesh (where 80% of all malaria cases come from) we were able to bring down the case/fatality from 520 cases a year to 11 and the morbidity by: a) creating a network of female community workers residing in very remote areas, using rapid test and treating immediately with Coartem; b) disseminating impregnated mosquito nets; and backing up the community workers with weekly interactions by mobile clinics.
A. Frederick Hartman, Jr.
Dear Pierre, Merci for your insightful comments that reinforce the value of a community-based approach that combines prevention with case management. Your results speak for themselves. Best regards, Fred
A. Frederick Hartman, Jr.
Thank you all for the thoughtful comments!
A. Frederick Hartman, Jr.
Dear Onen, Thank for your comments; yes, environmental controls are important for effective malaria control. Regards, Fred
A. Frederick Hartman, Jr.
Dear Tenaw: As you know, Ethiopia is very close to my heart, having worked there for the last seven years. You reinforce the value of a community-based approach. Our Ethiopia HIV & AIDS program integrates malaria control activities into comprehensive HIV & AIDS services, a very effective approach as well. Bettam amaseganalleu, Fred
A. Frederick Hartman, Jr.
Dear Sarki, Many thanks for your comments. While much progress has been made in the past decade, government ownership of the program is essential for sustained achievements. Thus, we need to work very closely with National Malaria Programs in each country and develop approaches which stimulate this ownership and promote sustainability. Best Regards, Fred
A. Frederick Hartman, Jr.
Dear Chinonyerem, Happy to have someone with your experience as part of the MSH family. You outline a comprehensive approach needed to sustain the gains over the past decade. It is good to have experienced public health professionals willing to continue the fight. Best Regards, Fred
A. Frederick Hartman, Jr.
Dear Najibullah, Malaria eradication may be difficult with existing tools, but malaria control is certainly possible with the approaches outlined in the blog and responses above. Many thanks for continuing the fight. Best Regards, Fred
Njoku, Chinonye...
May I express my sincere, heartfelt gratitude for being accepted as part of the MSH family. I am so grateful to be working on the mission and vision of the founding father and MSH as a family. I am so fascinated with your story on malaria on this occasion of World Malaria Day. However, in the Sub-Saharan part of the world, malaria prevention and control has continued to pose a serious public health challenge as the disease burden has continued to rise. We appreciate the efforts of NGOs and donor agencies like MSH working assiduously in this area. Please accept my humble suggestions on the way forward towards reducing this disease burden in terms of morbidity, mortality and severity with special emphasis on the at-risk populations and most vulnerable groups (under-fives): - Increase in the timely distribution of ITNs and LLINs in very remote and hard to reach communities and thorough coverage - Effective and wider coverage of malaria chemoprophylaxis in these communities and villages -Effective community mobilization and awareness o the socioeconomic and health burden due to malaria and the need for effective action. The concept of "community ownership and participation" as stipulated in the Alma Ata 1978 convention on PHC should be effectively incorporated in the prevention and control of malaria. - Training and mobilization of change agents (volunteers) in the management of malaria. -Effective public health research on better and resistant malaria drugs and awareness on ACT as the most effective drug of choice for resistant species of Plasmodium in this area. I want to say a big thank you for the piece. Sincerely, Njoku, Chinonyerem J. BSc, MPH Intern MSH-Imo State, Nigeria.
Onen Omenka
The fight against malaria should not be done only with treated nets but also through fulmigation of gutters and standing water.
Tenaw Andualem
Dear Fred, Thank you for the informative piece of writing. Yes, you are right. I would like to share a similar story about malaria. In the 1990’s there was a high malaria epidemic in Ethiopia which took a number of lives much worse in some areas. Out of great concern and touched by the catastrophe; we organized a local anti-malaria association which flexibly tried to contribute to contain the epidemic from further damage. To make long story short; we mobilized the local the communities through trained university students for prevention and control efforts and provision of medicine, that time sulfadoxine+pyrimethamine through volunteer healthcare providers. This has helped families to continue intact, the people had expressed these with surprise.
sarki othman
Thanks for the incite full write up. The fight against Malaria should be a global approach where all stakeholders cutting across managers of environment, water resources, education and women/children affairs should be on board. i say this because with my experience working in one of the USAID funded programmes where we have been working in the area of prevention (through LLINs) and IPT (using SP), diagnosis utilizing RDTs and the gold standard (microscopy), case management using ACTs, BCC and community mobilization, i have realized that with all the efforts the donor agencies are making towards malaria control, the government agencies in these high burden countries do very little in the above mentioned area of malaria prevention and control. Nigeria being a high burden country will not eradicate Malaria at the present pace the Country is going.

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