Sustaining the Gains

Efforts to eradicate smallpox and guinea worm have taken generations.  In both cases there was a very clear and focal transmission pattern. Smallpox spread only among people and could be stopped with a very effective vaccine. Guinea worm again only infects humans and transmission can be stopped through safe water.

Unlike these other diseases malaria has no one silver bullet and transmission dynamics vary across many different environment types.  At present case containment that was successful in ending smallpox and is effective in guinea worm, is out of the question for malaria.  Malaria must deal with huge health systems challenges ranging from weak procurement and supply management systems to health workforce shortages.  Peak efforts at malaria control have also unfortunately coincided with a world economic downturn.

uganda-malaria-indicators-from-2006-11.jpgDocumentation of malaria control progress is ongoing, if not perfect. A look at indicators from three national DHS/MIS surveys in Uganda make it possible to show how difficult it is to achieve and sustain coverage of the interventions we do have. To date the Roll Back malaria targets of 80% have not been achieved for any indicator, and in the cases of using insecticide treated nets (ITNs) and intermittent preventive treatment in pregnancy (IPTp), there have been drops.

There are a number of ways to measure indicators.  For example, the figures for people who slept under any kind of net are better than those using only ITNs. On the other hand, if we used the data on taking Artemisinin-based combination therapy (ACT) within 24 hours of fever onset, then the figures would be worse.  Of course these figures do not even include whether treatment occurred after a positive rapid diagnostic test.

What we can see is that even with a little more positive nudge, the data are not encouraging.  The guinea worm eradication effort has shown that stakeholders do tire of maintaining disease control efforts year after year.  Many endemic countries are still much too dependent on external assistance to go it alone in eliminating malaria. What will it take to get malaria control and elimination back on track so we can achieve zero malaria deaths by 2015?

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