The global community is committed to cutting by half the number of deaths worldwide from malaria by 2010. In Africa, progress has been slow towards achieving the objectives set by the continent’s leaders in April 2000 to help reach this goal. Programmes to reduce malaria could be far more effective if they are linked to existing initiatives to prevent other diseases.

The African heads of state who met at a summit in Abuja, Nigeria in 2000 set three targets to be achieved by 2005: affordable, appropriate and prompt (within 24 hours) treatment for 60 percent of people with malaria; access to anti-malarial treatment for 60 percent of pregnant women; and insecticide-treated mosquito nets to be supplied to 60 percent of all children under five and 60 percent of all pregnant women. While the items needed for fighting malaria in Africa – bed nets, insecticides and highly effective drugs - already exist, they are not being provided fast enough.

If malaria is to be tackled successfully, the donor community, African governments and pharmaceutical companies will need to intensify their efforts. A study by the Liverpool School of Tropical Medicine and the Global Fund to Fight AIDS, Tuberculosis and Malaria argues that the most effective approach would be to control the mosquito. This would decrease the pressure when selecting from available drug treatments to determine and avoid drug resistance. The researchers suggest how progress towards meeting the Abuja goals could be speeded up by linking malaria control programmes with already operational initiatives for disease control and elimination.

The paper reports that:

• A measles vaccination programme in rural areas of Zambia and Ghana was used as an opportunity to also distribute mosquito nets to all families with children under five years old. In one week, the campaign reached the Abuja target for net coverage. 
• Linking malaria control programmes with programmes that tackle lymphatic filariasis - especially where they are both present in rural communities - works particularly well.
• The use of the drug 'albendazole', donated by Glaxo SmithKline, in the filariasis programme decreases anaemia resulting from hookworms and Trichuris (whipworm) infections. This influences the anaemia-associated maternal, infant and child morbidity and mortality which are related to malaria.
• Morbidity and mortality from malaria and helminth infections may be decreased by control programmes that use donated drugs for river blindness and lymphatic filariasis. Worm-free children have been reported to have many fewer malaria episodes than those with worms.

The researchers suggest that:

• In rural populations, the acceptance of insecticide-treated mosquito nets given out with treatment for eliminating lymphatic filariasis is likely to increase if the nets are given out for free.
• The rate of mosquito net re-treatment would increase if this took place at the same time as mass drug administration programmes for diseases such as lymphatic filariasis, schistosomiasis, trachoma and others.
• Linking up programmes that control a number of different diseases increases overall health benefits at a reduced cost to the heath care system. 
• Those in charge of programmes that tackles single diseases should ensure that the programme links up with other disease-reducing programmes at the level of the community, district and nationally.
• Community workers who are trained in complementary treatments of diseases – for instance, polio eradication – could be used in drug programmes tackling a number of different diseases.

Source(s):
‘Linking disease control programmes in rural Africa: a pro-poor strategy to reach Abuja targets and millennium development goals’, British Medical Journal 328: 1129-1132, by D.H. Molyneux and V.M. Nantulya, 2004

id21 Research Highlight: 18 March 2005

Further Information:
David Molyneux
Lymphatic Filariasis Support Centre
Liverpool School of Tropical Medicine
Liverpool L3 5QA
UK

Tel: +44 (0) 151 7053291
Fax: +44 (0) 151 7090354
Contact the contributor: david.molyneux@liv.ac.uk

Lymphatic Filariasis Support Centre, Liverpool School of Tropical Medicine, UK

Other related links:
'Editorial: Thinking about deworming', The Lancet 364(9450): 1993-1994, by D.H. Molyneux, 2004

'Achieving the Millennium Development Goals', The Lancet 365(9464): 1029-1030, by A. Fenwick et al, 2005

'Strengthening the link between research and practice: an Indian leprosy NGO'

See id21's collection of links relevant to infectious diseases.