FIGHTING MALARIA IN MALAWI Ellen Feig Malaria Griots April 2010

Profile of Malawi  Malawi is one of the 20 poorest countries in the world. More than half of its people survive on less than a dollar a day, and the average Malawian lives only 37 years due to HIV/AIDS, malaria, and malnutrition.

Malaria in Malawi  Malaria is a major public health concern in Malawi, especially among pregnant women and children under the age of five. It is a leading cause of morbidity and mortality in Malawi, accounting for one-third of all outpatient visits and more than a third of visits among children under five years old. The type of malaria most common in Malawi (plasmodium falciparum) can lead to death ;however, the most severe cases are typically limited to those who are not immune or have low immunity. People most at risk are children from age three months, who no longer have the immunity transferred from their mother, to about the age of five years when they have developed their own immunity. Also at particular risk are pregnant women because their natural immunity is reduced. Pregnant women are four times more likely to suffer from complications of malaria than nonpregnant women. Malaria is a cause of pregnancy loss, low birth weight, and neonatal mortality (Jamison et al, 1993).

Malaria in Malawi attacks children more than any other group Children at Lake Malawi, an area with a high rate of malaria (used courtesy of ONE.org)

Malaria and Pregnant Women  Malaria is common in Southern Africa (40% of all deaths in hospitals are malaria- related) and a high risk for pregnant women. Contracting malaria weakens the health of both the mother and child, and may lead to premature birth or even miscarriage.  Statistics from USAID, 2009  (images courtesy of ONE.org)

The Neglected Disease "Malaria is unusual in that it has been neglected by the scientific community," says Dr Fred MacInnes, a retired Canadian pathologist who is one of several overseas medical specialists who travel each malaria season to Queens Hospital in Malawi. "It was the number one killer in the world until HIV came along, but there has never been much political will. It's not sexy, the people who have it are poor and unemployed. I've often thought that if the US Vice President's wife came down with malaria we might get a lot more funding!"

Blantyre Integrated Malaria Initiative  To improve service delivery and quality for malaria, the Ministry of Health and Population (MOHP) began the Blantyre Integrated Malaria Initiative (BIMI) in 1996 to pilot test methods in malaria prevention and treatment for pregnant women and children under five years of age. Blantyre, a largely urban district with a population of nearly 500,000, was chosen as the launch site for the initiative. The BIMI built on prior malaria control work in the country and on new national malaria guidelines developed by the MOHP’s National Malaria Control Programme, as well as the World Health Organization (WHO) algorithm for management of the ill child.

Tactics to Stop the Spread  USAID and the Department of Health and Human Services’ Centers for Disease Control and Prevention began the pilot indoor spraying program in Nkhotakota District two years ago. The district was hard-hit by malaria, and its natural boundaries provided an ideal pilot site.  The program worked closely with the Ministry of Health, Nkhotakota District Health Office, and Illovo Sugar Estates to spray approximately 28,000 houses in 2007 and 25,000 houses in  The spray, a biodegradable insecticide, was applied on walls inside houses to repel and kill malaria-spreading mosquitoes, which are most active late at night when people are sleeping. Nearly 90 percent of the houses in the designated area of the district were sprayed during the first round— coverage high enough to protect even people living in houses that weren’t sprayed.  The study concluded that high coverage with spraying, along with use of long-lasting nets and effective case management, reduces anemia rates.

Spraying Inside Walls with Insecticide ( image courtesy of MalariaNoMore.com )

President’s Malaria Initiative  PMI also worked with the Ministry of Health to procure a national supply for 18 months— over 9 million doses—of artemisinin-based combination therapy, the country’s new firstline malaria treatment; and approximately 1.2 million longlasting nets, used as protective barriers when people are asleep.  “On the basis of this successful pilot,” Wolf said, “the Malawi Ministry of Health is planning to scale up the [spray] program to include six additional highly malaria endemic districts.”  PMI is working with the National Malaria Control Program and the University of Malawi’s Malaria Alert Center to evaluate the effect of the scale-up of these malaria prevention and treatment programs

PMI Funding  In support of Malawi’s NMCP, PMI backs four key intervention strategies to prevent and treat malaria: - Insecticide-treated mosquito nets (ITNs) - Indoor residual spraying with insecticides (IRS) - Intermittent preventive treatment for pregnant women (IPTp) - Diagnosis of malaria and treatment with artemisinin-based combination therapy (ACT)  In fiscal year 2009, PMI allocated $17.7 million for malaria prevention and treatment in Malawi. Of this amount, 27 percent will support malaria diagnosis and procurement of ACTs, 42 percent ITNs, 10 percent IRS, 3 percent IPTp, and 5 percent monitoring and evaluation activities. Approximately 48 percent of the total will be spent on commodities.

Results  In the areas in Nkhotakota District, where PMI supported indoor residual spraying in October–November 2007, surveys found a dramatic 44 percent reduction in the prevalence of anemia, which is closely associated with malaria infections in children six to 30 months of age.  Malawi is one of the first countries to have distributed insecticide treated mosquito nets (ITNs) through antenatal clinics (ANCs) and has been a leader in 2009 sub- Saharan Africa in making ITNs available and accessible to vulnerable populations. The national policy calls for free distribution of ITNs to pregnant women through ANCs and to children under five who attend clinics for immunization or illness. In addition, children under five living in rural areas should receive a free net at least once every three years through an ITN campaign.

A Malaria Lab in Malawi (image used courtesy of MalariaNoMore.com)

Literature on Malaria  “Malaria – A handbook for health professionals” via Malaria consortium -- Consortium/dp/ X/ref=sr_1_8?ie=UTF8&s=books&qid= &sr=1-8 Consortium/dp/ X/ref=sr_1_8?ie=UTF8&s=books&qid= &sr=1-8  MNM”s Youtube page (various videos) --  “Malaria: The Vaccine Challenge” (BBC Documentary)  “Malaria: Fever Wars” (PBS 2006 Documentary) -- Provided/dp/B000EOTV48/ref=sr_1_6?ie=UTF8&s=dvd&qid= &sr=8-6http:// Provided/dp/B000EOTV48/ref=sr_1_6?ie=UTF8&s=dvd&qid= &sr=8-6  “The Making of a Tropical Disease: A Short History of Malaria (Johns Hopkins Biographies of Disease)” by Randall M. Packard -- Biographies/dp/ /ref=sr_1_1?ie=UTF8&s=books&qid= &sr=8-1http:// Biographies/dp/ /ref=sr_1_1?ie=UTF8&s=books&qid= &sr=8-1  “The Malaria Capers : More Tales of Parasites and People, Research and Reality” by Robert S. Desowitz -- Reality/dp/ /ref=ntt_at_ep_dpi_2 Reality/dp/ /ref=ntt_at_ep_dpi_2  "Shrinking the Malaria Map: A Prospectus on Malaria Elimination" Edited by Richard G.A. Feachem, Allison A. Phillips, and Geoffrey A. Targett. (April 2009, the Malaria Elimination Group)  "Shrinking the Malaria Map: A Guide on Malaria Elimination for Policy Makers" by Richard G.A. Feachem (April 2009, Malaria Elimination Group)

Sources  7_malawi html 7_malawi html  phy/dhs/main_report/Chapter13.pdf phy/dhs/main_report/Chapter13.pdf   malawi_profile.pdf malawi_profile.pdf