A current article by Ye et al. in Malaria Journal stresses that while malaria may be a national problem, there are important local variations in malaria risk in an area of northwestern Burkina Faso. Ecological and economic factors may likely play a role and include seasonal rice farming, cattle rearing, irrigation, and living in a semi-urban area. They conclude that, â€œmalaria control strategies should be designed to fit location-specific contexts.â€ Just because a community has a different ecological setting or requires a different malaria control strategy does not mean it is not part of the global fight against malaria. One size does not fit all.
This brings to mind discussions over the past year whether intermittent preventive treatment for pregnant women (IPTp) is considered a major strategy by WHOâ€™s Global Malaria Control Program (GMP). As of this date (20 April 2007) right in the center of the GMP web page one finds the following statement: â€œIRS is now one of three main interventions promoted by WHO to control malaria.â€ This refers to a 2006 document on Indoor Residual Spraying (IRS), which on page 1 recommends the following three â€˜primaryâ€™ interventions for the control of malaria:
- diagnosis of malaria cases and treatment with effective medicines;
- distribution of insecticide-treated nets (ITNs) to achieve full coverage of populations at risk of malaria; and
- indoor residual spraying (IRS) as a major means of malaria vector control to reduce and eliminate malaria transmission including, where indicated, the use of DDT.
People have taken this to mean that IPTp is no longer considered to be a primary intervention. Recent discussions with colleagues revealed that there is a school of thought that says since IPTp is a key tool for the African Region, it is not a â€˜globalâ€™ strategy. They explained that pregnant women are a focus when it comes to ITNs. They note further that there are links to a fact sheet on malaria in pregnancy at the Roll Back Malaria Website that lists IPTp as part of a three-pronged approach to malaria control, as well as a link to WHOâ€™s Regional Office for Africa and its Strategic Framework for Prevention and Control of Malaria During Pregnancy, which also lists IPTp as a major strategy.
While these links to other organizations are helpful, they do not dispel the uncomfortable feeling that pregnant women in Africa do not rate the status of being part of the â€˜globalâ€™ malaria control effort. One also wonders about their sisters in Papua New Guinea or Brazil where falciparum malaria also is of concern.
If one wants to be particular, one can even question whether the GMP is actually global. What are its strategies for controlling malaria in Norway or New Zealand, for example? Obviously what makes the fight against malaria global is the fact that people and agencies in both endemic and non-endemic countries are joining together to do whatever it takes to control the disease.
Excluding IPTp from the ‘global’ arsenal presents a false distinction and reinforces the perceptions of neglect, which Africa and womenâ€™s health have suffered on many fronts for too long. As Ye et al. have found, there is no single global malaria context, and while we have a variety of tools to fight malaria, there is no one magic global bullet to eliminate malaria in every situation. Letâ€™s form a global alliance that recognizes a wide arsenal of malaria tools but adapts them to the local ecology and local needs.