a model for interventions against malaria is a risk that funding flattens and disease incubates on.
a worker sprayed the inside a hut with insecticide in the province of Lusaka, Zambia. Indoor spraying is one of the main interventions used to curb the spread of malaria in the country
PHOTO :. © JOHN Stanmeyer / VII / CORBIS
in battle and the death of life against malaria, success is easily measured for Philip Thuma, doctor Macha, in the southern region of Zambia. Here on the hills of this gentle rural outback, where the poorest of the poor live off the corn they grow, the parasitic disease used to be devastating. A little over a decade ago, the small district hospital that works Thuma, up to 1,500 children were admitted with malaria each year. About 60 young patients died. Now there are about 30 admissions per year, and two or three deaths, said Thuma.
These gains are impressive for a country where malaria has long been rampant. Soon after the rains begin around October Anopheles gambiae, Anopheles arabiensis and Anopheles funestus -the three mosquito species that transmit malaria here to breed. The cases are increasing, reaching a peak in April and May. The marshy areas in the north are particularly affected.
Between 06 and 2011, however, the World Bank, the initiative against malaria US President, the Global Fund to Fight against AIDS, Tuberculosis and Malaria, and other donors directed more than $ 300 million in the country to fight against the disease, which makes it a benchmark for prevention and treatment. "One of the goals of early investment in the fight against malaria in Zambia was to establish a proof of concept," says Kent Campbell, director of the program against malaria PATH, a non-profit-making organization international case study in how malaria disease and death "could be quickly and significantly decreased. "
In 03, Zambia was the first African country to adopt artemisinin combination therapy to treat malaria. From 06 to 2011, over 24 million insecticide-treated nets were distributed . the indoor spraying with long-lasting insecticide has covered more than 6 million households at the same time. in some areas, whole communities have been selected for malaria and all those who tested positive, even if they do not feel sick, was treated.
the efforts have paid off. in a recent analysis, Nancy Fullman of the Institute for health Metrics and evaluation at the University of Washington, Seattle, and colleagues found that malaria cases decreased by about 7% per year between 00 and 2013, reducing deaths by about 60% during this period. "this is great news for the country", they say it.
Now that donor commitments flatten, those responsible for public health in Zambia and those who help them concentrate on consolidating their success. Worrisomely, the gains are uneven, with the southern part of the country are better than the north. "There are parts of the country where malaria transmission has not changed at all or increased in recent years, despite all efforts," says William Moss, an epidemiologist at the Institute of Malaria Johns Hopkins in Baltimore, Maryland. and the overall progress is showing signs of erosion. malaria cases nationwide, after falling nearly 5 million cases in 06 to about 3 million in 09, of increased again to about 4.5 million in 2011, responsible for health reasons still struggling to explain.
to maintain the status of Zambia a poster child for progress against malaria, most agree are continued commitment of donors and the national government renewed efforts in the north, a rapid response to new cases of malaria in the south, and attention to neighboring countries. If this is not done, experts warn the disease could return in force.
More than 24 million treated nets insecticide were distributed in Zambia from 06 to 2011.
PHOTO: KIM © Ludbrook / EPA / CORBIS
A THUMA SUMMER iN ZAMBIA long enough to see all malaria but disappear and then come back big. In 1976, when the son of medical missionaries came to southern Africa to work as a doctor, malaria was not a big problem. In each district, there was a health inspector who coordinated campaigns against malaria, for example spraying of homes with insecticides every year.
Then, in the late 1970s, the price of copper, an important export for Zambia, fell and tanked Zambian economy. Investments in malaria control have been reduced. "The entire infrastructure kind of fell apart," said Thuma. In addition to this, in the 1980s, resistance to chloroquine, the main drug against malaria at the time, emerged. "In 190-1995 there was malaria in the country again, "said Thuma." it was terrible. "
other countries have had a similar experience. a 2012 study evaluated 75 cases since 1930, when malaria resurged in a country after being pushed to varying degrees. the civil wars, natural disasters, and resistance against chloroquine or the insecticide DDT have fueled some setbacks. But Richard Feachem, director of the group global health at the University of California, San Francisco, said at the end, "the reason is almost always the same: the budget has been cut back, the malaria team have been partially or completely laid off ".
donor money for the fight against malaria interventions still circulating in Zambia, and the country also spent $ 24 million of its own budget for malaria in 2013 and $ 27 million that year are unprecedented in sub-Saharan Africa, according to Campbell. So why are some of its gains fought hard erosion
Even a short blip can disrupt financial gains of a country: In 2010, Campbell said, the money to replace the mosquito-who start lose effectiveness after 3-years ran short temporarily, and which immediately led to a resurgence of malaria. It is also possible that natural variation played a more important role in past earnings of Zambia as many thought. A drought in southern Zambia ten years ago killed a large number of A. funestus mosquitoes, Moss notes. "They have not really recovered and now it is A. arabiensis a less efficient vector."
In the north, on the other hand, A. funestus and A. gambiae are still spread the disease, and they have developed resistance to pyrethroid insecticides. A new indoor spraying campaign with Actellic, a more costly chemical that kills insects yet, is expected to start soon and can help roll back malaria, says Moss. But more research is needed to understand why the North has not enjoyed the same success as the south, said Ubydul Haque, Emerging Pathogens Institute at the University of Florida in Gainesville.
To maintain the gains in the south, officials of Public Health deployed a strategy called reactive detection of cases. If a new case of malaria is diagnosed, a group of doctors is sent to the patient's home, and anyone living in a radius of 140 meters is tested for malaria and treated if found to be infected. "It's almost as outbreak detection" for a fast-spreading virus, said Moss. The long-term goal of these efforts is to get malaria transmission to zero in this part of Zambia.
Even if this effort succeeds, nobody should rest easy, Feachem said. "Donors tend to go where there is most diseases and malaria, which is a mistake," he warns. After stopping transmission, prevention of reintroduction should become the new home, he added. Zambia borders eight other nations, more than any other African country. To keep malaria to recover, health officials will identify groups of people most likely to bring the parasite back into the country, to focus detection and, if necessary, treatment on them.
In the long term, however, the neighbors will reflect the gains of Zambia. "The success of Zambia can not be sustained by the success of the riparian countries," Feachem said. So perhaps Thuma can have some confidence that the roller-coaster history of Zambia with malaria is not repeated.
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