Malaria in sub-Saharan Africa

Abstract

The papers by Serign Ceesay and colleagues from The Gambia (Nov 1, p 1545) and by Wendy O’Meara and colleagues from Kenya (Nov 1, p 1555) contribute to the growing evidence of the eff ectiveness of wider rollout of the existing malaria control interventions in sub-Saharan Africa. Such evidence supports the revived optimism about global malaria elimination or eradication. However, most of the successful African examples are from islands, fringes of endemic areas, or smaller coun tries with substantial external sup port. Whether progress can be expected to be comparable in most sub-Saharan African countries under the existing scenario of prevailing poverty, weak infrastructure and management capa city, unreliable donor funding, and high-intensity malaria transmission remains doubtful. This doubt is illustrated by our experience from the Nouna Health District in rural Burkina Faso. Insecticide-treated bednets (ITNs) were introduced to Nouna Health District in 2000, and chloroquine remained the prevailing drug for fever treatment until 2007. Although ITN house hold coverage in Nouna reached 28% by 2007, the number of malaria cases and severe malaria cases diag nosed in governmental health centres increased threefold over the period 2000–07. This pattern is most likely to be explained by rapidly increasing resistance to chloroquine. With support from the World Bank and the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Ministry of Health in Burkina Faso has now started to distribute subsidised artemisinin-based combination therapies and ITNs through all governmental health facilities. The eff ects of such a combined approach, the sustainability of which still needs to be shown, are awaited. We declare that we have no confl ict of interest.