Five years remain to achieve the target of the Millennium Development Goals.Â Malaria is considered within the wider context of development. So how do things look for achieving the target of 50% reduction in malaria mortality in the context of other MDG goals that might influence the success of malaria interventions?
The 2010 MDG progress report by the United Nations was released last month. Female education is one of the key factors that influences a family’s uptake of health innovationsÂ and reductions in child mortality for example in Brazil and in Ghana. School enrollment has increased from 58% in 1999 to 76% in 2008 in Sub-Saharan Africa, a ways to go to reach universal education access. The following gaps have been found:
Household data from 42 countries show that rural children are twice as likely to be out of school as children living in urban areas. The data also show that the rural-urban gap is slightly wider for girls than for boys. But the biggest obstacle to education is poverty. Girls in the poorest 20 per cent of households have the least chance of getting an education: they are 3.5 times more likely to be out of school than girls in the richest households and four times more likely to be out of school as boys in the richest households.
Concerning access of women to employment, which helps the family be able to afford malaria interventions, the UN says that, “Women are largely relegated to more vulnerable forms of employment.” Specifically, “Women are overrepresented in informal employment, with its lack of benefits and security.
Concerning the goal of reducing child mortality, or which malaria is an important contributor, the UN reports that “Child deaths are falling, but not quickly enough to reach the target.” In Sub-Saharan Africa, the most malaria endemic region of the world, the 2008 rate of child mortality is 144/1,000 live births, double that of the developing countries overall.Â Worldwide malaria directly accounts for 8% of deaths among children under age five in 2008. Malaria in pregnancy contributes to low birth weight, which predisposes to many other causes of infant death.
The goal of improved maternal health shows progress in the area of increased attendance at antenatal care with a skilled health worker.Â Even with improved ANC attendance we know that health systems challenges such as procurement and supply chain problems often mean stock-outs for IPTp and ITNs for pregnant women.
Goal 6 – reduction of disease burden – shows progress in world-wide production on ITNs, but even in the best circumstances, most recent surveys show no country in 2008 was close to attaining the 2010 target of 80% of children under five years of age, speeling under nets. Poverty is still a major factor associated with low net ownership and use or inability to get appropriate malaria treatment
Concerning environmental goals, the UN reports that, “The rate of deforestation shows signs of decreasing, but is still alarmingly high.” Recent reports from Brazil show that malaria increases with deforestation.
The goal of partnership looks promising, but while “Aid continues to rise despite the financial crisis, … Africa is short-changed.”
The malaria statistics are certainly not new to us. What is helpful about the 2010 MDG report is that it shows us the context – development, poverty, education, equality – in which we are trying to achieve malaria control targets and makes us realize that an integrated approach is needed.