Posted by: lbenjamin | 11/04/2009

Malaria and the MDGs

Global Health Council Research Associate Lillian Benjamin is at the 5th MIM Pan-African Malaria Conference in Nairobi, Kenya. This is the second of her posts from the conference.

NAIROBI, Kenya — While Millennium Development Goal Six (MDG 6) is dedicated to malaria, it is not the only MDG that is impacted by the disease.

MDG 1 Eradicate extreme poverty: Malaria contributes to approximately 1 percent of gross domestic product (GDP) loss. It also accounts for 40 percent of health spending and 30 percent of household health expenditures in endemic countries.

MDG2 – Achieve universal education: Malaria contributes to absenteeism in Africa. Cognitive damage from cerebral malaria prevents many children from attending schools.

MDG 4- Reduce childhood mortality: Malaria is one of the leading causes of childhood death worldwide.

MDG 5- Improve maternal health: Pregnant women are at increased risk for contracting malaria because of their immunocomprised status. Malaria also contributes to maternal anemia, which can lead to hemorrhage, spontaneous abortion, neonatal death and low-birth weight.

MDG 6Combat HIV/AIDS, malaria and other diseases: The Global Malaria Action Plan calls for several actionable targets to achieve malaria elimination.

MDG 8Develop global partnerships: Malaria has benefited from assistance of private-public partnerships to improve access to affordable malaria interventions.

All six of these MDGs are impacted by the malaria burden, but one of the take home messages here at the MIM conference has been the benefit of malaria control on childhood survival, MDG 4. Researchers Rowe and Steketee predict that if malaria mortality is reduced by 50 percent in high transmission areas, all-cause childhood mortality is also likely to decrease (Am. J. Trop. Med. Hyg., 2007; 77: 48–55).  The reduction of all-cause child mortality through malaria control interventions has been demonstrated in several studies,  however one of the most talked about success stories this week was the Bioko experience (Am. J. Trop. Med. Hyg., 2009; 80: 882–888).

Dr.  Immo Kleinschmidt presented the results of the study during the third plenary session of the conference. Bioko, Equatorial Guinea is an island located off the coast in the Gulf of Guinea. The government, along with private industry (Marathon Oil Corporation) and researchers conducted an expanded containment project on the island (the Bioko Island Malaria Control Project).  During the initial phase, a four-year period, the campaign consisted of vector control, indoor residual spraying (IRS) and long-lasting insecticide treated nets (LLIN) intermittent preventive treatment for pregnant women (IPTp) and artemisinin-based combination therapy (ACT).  

The study noted a decrease in malaria-infecting mosquitoes in the area, but the most exciting news was the impact of the intervention on childhood morbidity and mortality. After the intervention, the mean prevalence of malaria infection for children two to five years old dropped from 42 percent to 18 percent, and prevalence of anemia decreased from 15 percent to less than two percent. The all-cause under-5 mortality fell from 152 deaths per 1,000 births to 55 deaths per 1,000.

This study, as well as others, demonstrates the need for an integrated approach to improve health and increase in child survival.

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