|Millennium Development Goals
Reversing incidence of malaria – one of the great success stories of the MDGs
Malaria death rates have plunged by 60% since 2000, translating into 6.2 million lives saved, the vast majority of them children, according to a joint WHO-UNICEF report released in September.
The report – “Achieving the malaria MDG target” – shows that the malaria Millennium Development Goal (MDG) target to “have halted and begun to reverse the incidence” of malaria by 2015, has been met “convincingly”, with new malaria cases dropping by 37% in 15 years.
“Global malaria control is one of the great public health success stories of the past 15 years,” said Dr Margaret Chan, Director-General of WHO. “It’s a sign that our strategies are on target, and that we can beat this ancient killer, which still claims hundreds of thousands of lives, mostly children, each year.” An increasing number of countries are on the verge of eliminating malaria. In 2014, 13 countries reported zero cases of the disease and 6 countries reported fewer than 10 cases. The fastest decreases were seen in the Caucasus and Central Asia, which reported zero cases in 2014, and in Eastern Asia.
Journey not over
Despite tremendous progress, malaria remains an acute public health problem in many regions. In 2015 alone, there were an estimated 214 million new cases of malaria, and approximately 438,000 people died of this preventable and treatable disease. About 3.2 billion people – almost half of the world’s population – are at risk of malaria.
Some countries continue to carry a disproportionately high share of the global malaria burden. Fifteen countries, mainly in sub-Saharan Africa, accounted for 80% of malaria cases and 78% of deaths globally in 2015.
Children under 5 account for more than two-thirds of all deaths associated with malaria. Between 2000 and 2015, the under 5 malaria death rate fell by 65% or an estimated 5.9 million child lives saved. “Malaria kills mostly young children, especially those living in the poorest and most remote places. So the best way to celebrate global progress in the fight against it is to recommit ourselves to reaching and treating them,” said UNICEF Executive Director Anthony Lake. “We know how to prevent and treat malaria. Since we can do it, we must.”
A surge in funding – but not enough
Global bi-lateral and multi-lateral funding for malaria has increased 20-fold since 2000. Domestic investments within malaria- affected countries have also increased year by year.
A number of donor governments have made the fight against malaria a high global health priority. In the United States of America, the President’s Malaria Initiative has mobilized hundreds of millions of dollars for treatment and prevention, while the government of the United Kingdom tripled its funding for malaria control between 2008 and 2015.
Many governments have also channelled their investments through the Global Fund to Fight AIDS, Tuberculosis and Malaria, or directly to countries.
“A healthy, prosperous world is in all our interests and the prevention of deadly diseases is one of the smartest investments we can make.” said Justine Greening, Secretary of State for International Development of the United Kingdom. “That is why, working with malaria-affected countries and partners like the Global Fund, Britain will continue to provide bednets to millions, tackle resistance to life saving medicines and insecticides, and boost health systems across Africa to help bring an end to this terrible disease.”
The surge in funding has led to an unprecedented expansion in the delivery of core interventions across sub-Saharan Africa. Since 2000, approximately 1 billion insecticide-treated bednets (ITNs) have been distributed in Africa. The increased use of rapid diagnostic tests (RDTs) has made it easier to distinguish between malarial and non-malarial fevers, enabling timely and appropriate treatment.
Artemisinin-based combination therapies (ACTs) are highly effective against Plasmodium falciparum, the most prevalent and lethal malaria parasite affecting humans, but drug resistance is a looming threat which must be prevented.
New research demonstrates the impact of core interventions
New research from the Malaria Atlas Project – a WHO Collaborating Centre based at the University of Oxford – shows that ITNs have been by “far the most important intervention” across Africa, accounting for an estimated 68% of malaria cases prevented since 2000. ACTs and indoor residual spraying contributed to 22% and 10% of cases prevented, respectively. The research, published 16 September 2015 in the journal Nature, provides strong support for increasing access to these core interventions in post-2015 malaria control strategies.
The way forward
In May 2015, the World Health Assembly adopted the WHO Global Technical Strategy for Malaria – a new 15-year road map for malaria control. The strategy aims at a further 90% reduction in global malaria incidence and mortality by 2030. The WHO-UNICEF report notes that these targets can only be achieved with political will, country leadership and significantly increased investment. Annual funding for malaria will need to triple – from US$2.7 billion today to $8.7 billion in 2030.
Other key findings from the report
In 2015, 89% of all malaria cases and 91% of deaths were in sub-Saharan Africa.
• Of the 106 countries and territories with malaria transmission in 2000, 102 are projected to reverse the incidence of malaria by the end of 2015.
• Between 2000 and 2015, the proportion of children under 5 sleeping under an ITN in sub-Saharan Africa increased from less than 2% to an estimated 68%.
• 1 in 4 children in sub-Saharan Africa still lives in a household with no ITN and no protection provided by indoor residual spraying.
In 2015, only an estimated 13% of children with a fever in sub-Saharan Africa received an ACT.
Child mortality plummets, but target not met
Child mortality rates have plummeted to less than half of what they were in 1990, according to a new report released in September. Under-five deaths have dropped from 12.7 million per year in 1990 to 5.9 million in 2015. This is the first year the figure has gone below the 6 million mark.
New estimates in “Levels and trends in child mortality report 2015,” released by UNICEF, WHO, the World Bank Group, and the Population Division of UNDESA, indicate that although the global progress has been substantial, 16,000 children under 5 still die every day. And the 53% drop in under-five mortality is not enough to meet the Millennium Development Goal of a two-thirds reduction between 1990 and 2015.
“We have to acknowledge tremendous global progress, especially since 2000, when many countries have tripled the rate of reduction of under-five mortality,” said UNICEF Deputy Executive Director Geeta Rao Gupta. “But the far too large number of children still dying from preventable causes before their fifth birthday – and indeed within their first month of life – should impel us to redouble our efforts to do what we know needs to be done.
We cannot continue to fail them.” The report notes that the biggest challenge remains in the period at or around birth. A massive 45% of under-five deaths occur in the neonatal period – the first 28 days of life. Prematurity, pneumonia, complications during labour and delivery, diarrhoea, sepsis, and malaria are leading causes of death for children under 5 years old. Nearly half of all under-five deaths are associated with undernutrition.
However, most child deaths are easily preventable by proven and readily available interventions. The rate of reduction of child mortality can speed up considerably by concentrating on regions with the highest levels – sub-Saharan Africa and Southern Asia – and ensuring a targeted focus on newborns.
“We know how to prevent unnecessary newborn mortality. Quality care around the time of childbirth including simple affordable steps like ensuring early skin-toskin contact, exclusive breastfeeding and extra care for small and sick babies can save thousands of lives every year,” noted Dr Flavia Bustreo, Assistant Director General at WHO. The Global Strategy for Women’s, Children’s and Adolescents’ Health, to be launched at the UN General Assembly this month, will be a major catalyst for giving all newborns the best chance at a healthy start in life.”
The report highlights that a child’s chance of survival is still vastly different based on where he or she is born. Sub- Saharan Africa has the highest under-five mortality rate in the world with 1 child in 12 dying before his or her fifth birthday – more than 12 times higher than the 1 in 147 average in high-income countries. In 2000-2015, the region has overall accelerated its annual rate of reduction of under- five mortality to about two and a half times what it was in 1990-2000. Despite low incomes, Eritrea, Ethiopia, Liberia, Madagascar, Malawi, Mozambique, Niger, Rwanda, Uganda, and Tanzania have all met the MDG target.
Sub-Saharan Africa as a whole, however, continues to confront the immense challenge of a burgeoning under-five population – projected to increase by almost 30% in the next 15 years – coupled with persistent poverty in many countries.
“This new report confirms a key finding of the 2015 Revision of the World Population Prospects on the remarkable decline in child mortality globally during the 15- year MDG era,” said UN Under-Secretary-General for Economic and Social Affairs Wu Hongbo. “Rapid improvements since 2000 have saved the lives of millions of children. However, this progress will need to continue and even accelerate further, especially in high-mortality countries of sub-Saharan Africa, if we are to reach the proposed child survival target of the 2030 Agenda for Sustainable Development.”
“Many countries have made extraordinary progress in cutting their child mortality rates. However, we still have much to do before 2030 to ensure that all women and children have access to the care they need,” said Dr Tim Evans, Senior Director of Health, Nutrition and Population at the World Bank Group. “The recently launched Global Financing Facility in Support of Every Woman Every Child with its focus on smarter, scaled and sustainable financing will help countries deliver essential health services and accelerate reductions in child mortality.”
Among the report’s findings:
• Roughly one-third of the world’s countries – 62 in all – have actually met the MDG target to reduce under-five mortality by two-thirds, while another 74 have reduced rates by at least half.
• The world, as a whole, has been accelerating progress in reducing under-five mortality – its annual rate of reduction increased from 1.8% in 1990-2000 to 3.9% in 2000-2015.
• 10 of the 12 low-income countries that have reduced under-five mortality rates by at least two-thirds are in Africa.
• 5 in 10 global under-five deaths occur in sub-Saharan Africa, while 3 in 10 occur in Southern Asia.
• 45% of all under-five deaths happen during the first 28 days of life. 1 million neonatal deaths occur on the day of birth, and close to 2 million children die in the first week of life.
Date of upload: 16th Nov 2015
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