April 24, 2011—Over the past decade, 11 African countries have reduced confirmed malaria cases or malaria admissions and deaths by more than 50%. In all of them—Algeria, Botswana, Cape Verde, Eritrea, Madagascar, Namibia, Rwanda, Sao Tome and Principe, South Africa, Swaziland, and Zambia—these decreases are linked with intense malaria control interventions.
Since 2005, the World Bank has committed $762.8 million to the fight against malaria in Africa, more than a ten-fold increase since 2000-2005. It has financed 73.8 million insecticide-treated mosquito nets and 25.3 million doses of malaria medication over the past five years.
“Sustained anti-malaria efforts are needed in Africa, which bears about 90 percent of the world’s malaria burden,” said Maryse Pierre-Louis, program leader of the World Bank’s Disease Control Program in Africa. “Recent gains, though significant, are fragile, and the danger of resurgence remains very real.”
In India, following policy reforms, malaria control activities have intensified, while in Latin America, scaled-up malaria control has led to malaria cases falling by more than 50% in nine countries.
Steady progress: Democratic Republic of Congo and Nigeria
In the Democratic Republic of Congo (DRC), 97% of people live in areas where malaria is endemic. In 2007, mass campaigns to distribute treated mosquito nets began, mainly in the rural provinces of Bas-Congo and Sud-Kivu, followed by Equateur and urban Kinshasa in 2008.
Before the first net distribution campaign, the DRC Demographic and Health Survey reported that 19% of children and 20% of women slept under treated nets in 2007. By 2010, a Multiple Indicator Cluster Survey showed corresponding figures of 38% and 43%, respectively.
In urban Kinshasa, a survey by the Kinshasa School of Public Health showed that the mass distribution campaign under the Bank-supported Urban Rehabilitation and Development Project had a positive impact: approximately 79% of households in Kinshasa had at least one net.
In Nigeria, dramatic progress has been reported in seven states where the Bank has supported malaria control activities. In July 2010, 88% of households in these states owned at least one treated net (up from 2.6% in 2006), and 16.6% of pregnant women received two or more doses of intermittent preventive treatment (IPT), double the level in 2006.
Over the past four years, the Bank has supported distribution of 14.1 million treated bed nets in Nigeria. In 2011, the Global Fund to Fight AIDS, TB and Malaria and the U.S. President’s Malaria Initiative will support further distribution.
Zambia takes steps to arrest resurgence
With financial and technical support from partners, including the Bank and the Russian Federation, Zambia has made tremendous progress against malaria. Between 2006 and 2010 an expansion of programs resulted in widespread prevention and treatment of the disease. The share of under-five children who slept under a net increased from 24% to 50%; malaria incidence fell; and the share of children with severe anemia (largely caused by malaria) declined from 14% to 9%.
However, a 2010 Malaria Indicator Survey showed a resurgence in malaria and anemia in certain provinces, largely driven by reduced coverage of nets and indoor residual spraying in some areas. In the Northern Province, for example, parasite prevalence among children increased from 12% in 2008 to 23% in 2010.
World Bank financing of $30 million for malaria in Zambia, approved in December 2010, enabled 800,000 nets to be delivered before the rainy season hit its peak. An additional 2.2 million nets are currently being procured. Funds will also support indoor spraying, diagnostics, and supply chain improvements.
Kenya’s goal: 11 million mosquito nets
In Kenya, where malaria control measures have contributed to a 36% reduction in under-five mortality and a 31% reduction in infant mortality between 2003 and 2009, about 22 million Kenyans will receive nearly 11 million mosquito nets this year. By World Malaria Day (April 25), five million nets will have reached high-burden districts in western Kenya.
The Bank, together with the Global Fund, the U.S. Agency for International Development, and World Vision, has supported purchase of these nets, with the UK’s Department for International Development helping to fund distribution.
In Senegal River Basin, NGOs join fight
In the Senegal River Basin, a Bank water project has a $42 million health component that’s helping to control malaria and schistosomiasis in Mali, Senegal, Mauritania and Guinea. Non-governmental organizations (NGOs) are distributing nets, promoting behavior change, and monitoring impact in the region.
NGOs include Catholic Relief Services in Guinea, Groupe Pivot Santé-Population in Mali, Réseau National de Lutte contre le Paludisme et le Ver de Guinée in Mauritania, and Childfund in Senegal. Together, these organizations are distributing 1.6 million mosquito nets in early 2011.
India focuses on policy change
"Major policy changes in India have paved the way for the adoption of treated mosquito nets, and of community-level case management using rapid diagnostic tests and artemisinin-based combination therapies," said Ramesh Govindaraj, senior health specialist with the World Bank's South Asia Region.
A Bank-supported National Vector Borne Disease Control and Polio Eradication Support Project is part of the government’s latest effort to control malaria, eliminate visceral leishmaniasis, and eradicate polio. The government is working closely with the Bank, the World Health Organization and the Global Fund on its malaria control program.
In 2009, 1.3 million treated nets were distributed under the Bank-supported project, and, by the end of 2011, 7.6 million nets will have been procured for Chhattisgarh, Andhra Pradesh, Madhya Pradesh, Jharkhand and Orissa. In addition, about 3.6 million RDTs were procured by end-2010 and about 1.1 million ACT blister packs will have been procured by end-June 2011.