The malaria burden and the need for research and capacity strengthening in Africa.

Abstract

The Intolerable Burden of Malaria: A New Look at the Numbers supplement highlights the malaria scourge in subSaharan Africa, where the disease has recently attained unprecedented dimensions. The eleven articles included herein make it clear that the malaria burden on the African continent has been grossly underestimated across the board, whether considering rates of infection, causes of acute febrile and chronic illness, adverse outcomes of pregnancy, effects on early childhood, toll from anemia, impact of chloroquine resistance, long-term neurological and related sequelae, or economic consequences of infection. Economist gurus have concluded that malaria is a cause of poverty in sub-Saharan Africa and not vice-versa. Previous underestimates of the effects of malaria have undoubtedly hampered efforts to marshall greater resources for malaria research and disease reduction. Effective malaria control is essential for Africa’s renaissance. Crucial information on the burden of malaria in African communities has been widely dispersed and much of it is brought together in this supplement. This will greatly benefit malaria researchers, particularly epidemiologists, and those planning malaria control programs. This new compilation will also aid decision makers in both endemic and donor countries. The supplement provides crucial evidence to support increased investment in capacity strengthening in malaria research and operations and indicates why it is important for scientists and control specialists to work closely together. Emphasis in malaria epidemiology has undergone tremendous transformation in the recent past. The current emphasis on malaria chemotherapy and chemoprophylaxis during pregnancy has aroused great interest in malaria as a cause of morbidity and mortality. This emphasis is in stark contrast to the past, when malaria control and eradication strategies relied virtually entirely on vector control. Malaria epidemiology was then focused on entomological factors tied to transmission. At that time, Anopheles spp vectors of malaria were at center stage; humans now occupy that position and with good reason. However, if we forget the vector, it is at our peril. The recent neglect of research on malaria vectors, their role in transmission, and their control is apparent— there is not one article in this issue that covers malaria transmission, although it has a direct bearing on the malaria burden. Other important areas of malaria research that deserve increased attention are the impact of environmental changes, human behavior, and socioeconomic and demographic trends including urbanization, on transmission and disease patterns. It is true that considerable investment in capacity building for research and control of tropical diseases, especially malaria, has occurred over the past quarter-century. There is, however, greater need for increased investments in developing more African (and non-African) epidemiologists and other scientists interested in quantifying the malaria burden. The paucity of indigenous expertise is obvious from the authors’ analyses reported in this supplement. National experts are badly needed to enable each African country to understand its own health problems, to inform health policy and operational programs, to enhance the impact of limited funds and personnel, and to form a solid health research base. Moreover, there is a pressing need to develop expertise in institutional leadership so that findings from clinical and field research can influence policy and be deployed effectively in national health systems. I hope that the major legacy of this supplement will be the engagement of more Africans in malaria research, particularly that related to defining more precisely all of the factors bearing on the disease burden, including transmission dynamics. At the same time, it is to be expected that the institutions in which these scientists work will become true centers of excellence—focused on research, teaching, and service, in order to reduce the terrible impact of malaria and other tropical diseases.