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Analytical summary - Malaria

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Malaria is endemic in Ethiopia, with differing intensities of transmission. The disease is prevalent in areas below 2000 m altitude and is seasonal, with irregular transmission patterns. Areas below 2000 m altitude cover three quarters of the country’s land mass, with an estimated population of 52 million.[1] An epidemic occurs every 5–8 years in these areas, with frequent outbreaks within short periods. The last epidemic occurred in 2003 and recent outbreaks have been reported in consecutive years from 2006 until early 2010. With an average of more than 3 million clinical cases per year, malaria remains the biggest health problem in Ethiopia.

Although malaria is a major cause of child mortality, only 33% of children under the age of 5 years sleep under an insecticide-treated bednet.[2] The disease burden is broad, going beyond the substantial health concerns it creates. The population may be forced to abandon productive areas and to concentrate in malaria-free areas that are exposed to constant food insecurity. As a result, substantial environmental and ecological degradation and loss of productive land has left a significant proportion of the population threatened by recurrent droughts and famine. In addition, malaria affects the learning capacity of schoolchildren due to constant non-attendance of school in the absence of treatment.

The Malaria Prevention and Control Programme is guided by the national 5-year (2006–2010) strategic plan, developed in line with the objectives of the Health Sector Development Programme. Ethiopia is one of the first countries to embrace the scaling-up for impact concept for malaria control.

The 2006–2010 National Strategic Plan aimed to rapidly scale-up malaria control interventions to achieve a 50% reduction of malaria burden. In August 2008, Ethiopia signed a Compact Agreement with development partners on scaling-up for reaching the health-related Millennium Development Goals through the Health Sector Development Programme as part of the International Health Partnership. A three-pronged approach was implemented, consisting of early diagnosis and effective treatment, selective vector control, and epidemic prevention and control with the integration of malaria control activities into the basic health service delivery system.[3]

The Government of Ethiopia has launched two vector control activities in the country, namely indoor residual spraying and insecticide-treated nets. Indoor residual spraying is applied in malaria epidemic prone areas, whereas insecticide-treated nets are practical in areas with longer periods of transmission. Although areas at altitude 2000 m and below are generally considered to be at malaria risk, transmission has also been detected at altitudes as high as 2500 m.[4] Thus, to support the implementation of malaria prevention and control strategies, the Government has developed two consecutive 5-year plans: 2001–2005 and 2006–2010.

During the first 5-year plan, annual indoor residual spraying coverage was between 20% and 30%.[4] The household-level insecticide-treated net coverage rate in malaria-prone areas increased from 3.5% in 2005 to 100% in 2009–2010. Over 39.5 million bednets were procured and distributed in 2009–2010 and 2010–2011. In addition, artemisinin combination therapy was implemented as a first-line treatment for Plasmodium falciparum malaria, to complement the distribution of insecticide-treated nets to households in malaria-prone areas.

To enhance the effective utilization of insecticide-treated nets, educational information has been broadcasted by radio and training has been given to media professionals, who are expected to play a major role in educating the public.[5]

Trend in the cumulative number of insecticide-treated nets distributed by region (Ethiopian Fiscal Year 1998–2003). Source: Federal Ministry of Health

If the epidemic peak of 2003 is excluded, the annual numbers of malaria admissions and deaths in 2007–2009 was lower by 31% and 50% than the rate for 2002 and 2004, respectively. Annual average malaria cases have fallen from 3 million during 2000–2005 to an average of 1.7 million in 2009. The lower levels of malaria admissions and deaths after 2004 are associated with an expansion of the malaria control programme targeting 40 million people at high risk. The malaria prevention and control programme is financed by the Government along with external financing from development partners.[2]

References

  1. Ethiopian national malaria indicator survey, 2007. Technical summary (pdf 173.25kb). Addis Ababa, Government of Ethiopia, Ministry of Health, 2008
  2. 2.0 2.1 World malaria report, 2010 (pdf 9.85Mb). Geneva, World Health Organization, 2010
  3. Health Sector Development Program IV, Annual performance report. Addis Ababa, Government of Ethiopia, Ministry of Health, 2010
  4. 4.0 4.1 Health Sector Development Program IV, 2010/11–2014/15. Final draft. Addis Ababa, Government of Ethiopia, Ministry of Health, 2010
  5. National Monitoring and Evaluation Plan for Malaria 2010–2015. Addis Ababa, Government of Ethiopia, Ministry of Health, 2011