Analytical summary - Malaria
Malaria has remained a major cause of morbidity in the Gambia although it is on the decline. In 2001, 39% of under-five visits and 5% of antenatal consultations at child and reproductive health clinics were due to malaria with mortality rates of 3.6% and 2.3%, respectively. Malaria accounted for 78% of all outpatients visits and 58% of all inpatient admissions in 2003.
Policies on malaria control cover preventive as well as curative aspects of malaria control, with emphasis on partnerships as an important component. The current policy builds on the principle of scaling-up for universal access. Thus all those at risk of the disease, with particular emphasis on young children and pregnant women, will have access to the most suitable combinations of preventive and curative measures against malaria. Implementation of the National Malaria Control Programme is at four levels, namely central, regional, health facility and community levels. Each of these levels has functional structures and responsibilities.
Funding is from two main sources:
- the national health budget funds administration, salary emoluments, logistics and vector control activities;
- external sources, of which the Global Fund to Fight AIDS, Tuberculosis and Malaria contributed 81% of the total funds to the National Malaria Control Programme in the period, 2004–2007 targeting women, children and differentially able people. During the period 2004–2008, other partners such as Catholic Relief Services, United Nations Children's Fund and WHO have also provided financial and technical support to malaria prevention and control.
As part of its strategies to control malaria, the National Malaria Control Programme intends to continue to monitor drug efficacy on a regular basis at selected sites. This has proved useful in the decision to change from chloroquine to artemisinin-based combination therapy. It also plans to regularly monitor insecticide efficacy as well as conduct specialized studies to test the efficacy of proven interventions in the Gambia. This will require capacity-building in research as well as collaboration with other research institutions in the Gambia.
In a retrospective analysis of data from five health facilities (WEC mission hospital in Sibanor; Brikama Major Health Centre; Medical Research Council Keneba Clinic; Farafenni AFPRC District Hospital; Medical Research Council hospital in Fajara) there is evidence that malaria is on the decline from Western, Lower River and North Bank Regions. From 2003 to 2007, the proportions of malaria-positive slides collected from outpatients suspected to have malaria decreased by 50%, 73%, 82% and 85% at the four sites with complete laboratory records.
At the three sites with complete hospital paediatric admission records, the proportions of malaria admissions fell by 74%, 69% and 27%. Proportions of deaths attributed to malaria also declined in the two hospitals with complete records: in Medical Research Council Fajara these decreased by 100% (7/115 in 2003 to 0/117 in 2007) and in WEC Sibanor a 90% decline was recorded (22/122 in 2003 to 1/58 in 2007). With the systematic increased implementation of these highly targeted malaria control activities, in an environment of increased community and stakeholder involvement, malaria appears to be declining in some areas.