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Analytical summary - Malaria

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Malaria remains a major cause of morbidity and mortality in Malawi, especially among pregnant women and children aged under 5 years. The Health management information system annual bulletin 2009[1] indicates that malaria accounts for 30% of all outpatient visits. In addition, 52% of all children aged under 5 years in inpatient departments are admitted due to malaria and anaemia and nearly 60% of all hospital deaths in children aged under 5 years are due to malaria and anaemia. The number of presumptive cases of malaria increased from 3.7 million in 2005 to 6.1 million in 2009. Death rates due to malaria have decreased from 5.6% to 3.4% in 2004 and 2009, respectively.[2]

The Malawi National Malaria Control Programme developed a Malaria Policy (2009) that covers the main intervention areas of malaria control and prevention, namely effective case management, use of long-lasting insecticide nets, indoor residual spraying as well as operational research and information, education and communication. The policy also addresses cross-cutting issues such as management, financing and human resources. Without improvement in these areas, enhanced malaria control and prevention efforts will not succeed. The policy was developed within the context of the Essential Health Care Package and the sector-wide approach.

In 2004, 27% of households owned an insecticide-treated net (ITN) and this increased to 56.8% by 2010 with more households in urban areas (64.3%) owning such nets compared with rural areas (45.2%). In 2004, 14.8% of children aged under 5 years slept under an ITN and this increased to 55.4% in the Malawi national malaria indicator survey 2010.[3] The Malawi demographic and health survey 2010 estimates that 59.1% of children aged under 5 years slept under an ITN and this percentage was higher in urban areas (68.6%) compared with rural areas (57.5%).[4]

The percentage of pregnant women sleeping under an ITN increased to about 50% in 2010 from 24% in 2006.[1] On the other hand, the Malawi demographic and health survey 2010 shows that 56.7% of pregnant women slept under an ITN.[4] This shows that the targets set in 2004 have not been achieved, especially with regard to net utilization. In terms of intermittent preventive treatment, 47%and 60% of pregnant women took the recommended two or more doses of intermittent preventive treatment in pregnancy in 2006 and 2010, respectively. This proportion is still low.

Some of the challenges that have affected the implementation of malaria interventions in Malawi include:

  • poor diagnostic capacity
  • abuse of nets
  • low coverage of second dose of sulfadoxine–pyrimethamine in pregnancy
  • artemisinin-based combination therapy not being available in the private sector
  • poor adherence to treatment guidelines and policies.

The Ministry of Health's National Malaria Control Programme recognizes the behavioural communication change/information education and communication approach as one of the important strategies to address the malaria burden in Malawi. The approach addresses areas of advocacy for change, creating demand for malaria services and giving information that is necessary for changing people’s behaviour.

The three key areas for scaling-up malaria control activities are:

  • case management for treatment of malaria cases
  • intermittent preventive treatment in pregnancy
  • mosquito vector control (ITNs and indoor residual spraying).

The goal of malaria vector control is to maximize reduction of malaria through appropriate use of ITNs and other vector control measures. The main strategies include:

  • scaling-up of ITN distribution
  • introduction of indoor residual spraying in selected rural areas
  • efficacy of insecticides
  • effective monitoring of malaria vectors.

For correct diagnosis and treatment of malaria cases according to the existing guidelines, the main strategic areas that were identified for the scale-up of malaria control activities include malaria case management and intermittent preventive treatment of pregnant women with sulfadoxine–pyrimethamine.

Through the National Malaria Control Programme, Malawi has established malaria sentinel surveillance systems. The malaria programme has maintained six sentinel sites for monitoring drug efficacy, six sites for insecticides susceptibility tests and four for monitoring malaria intervention coverage. The sites for monitoring drug efficacy were established in the early 1980s to monitor resistance of malaria parasites to antimalarial drugs and have been maintained throughout the years.

Based on drug efficacy studies, the country changed its treatment policy in December 2007 from sulfadoxine–pyrimethamine to artemisinin-based combination therapies, in particular artemether–lumefantrine, as the first-line treatment, with artesunate–amodiaquine as the second-line treatment for uncomplicated malaria with quinine for severe malaria. However, there are some challenges, such as quality of data generated and inadequate supplies, as well as finding funding to sustain the operation of the sites.

References

  1. 1.0 1.1 Health management information systems (HMIS) annual bulletin, July 2009–June 2010 (Word 1.51Mb). Lilongwe, Government of Malawi, Ministry of Health, 2010
  2. Malawi malaria program performance review (pdf 1.08Mb). Lilongwe, Government of Malawi, Ministry of Health, National Malaria Control Programme, 2010
  3. Malawi national malaria indicator survey 2010 (pdf 1.31Mb). Lilongwe, Government of Malawi, Ministry of Health, National Malaria Control Programme, 2010
  4. 4.0 4.1 Malawi demographic and health survey 2010 (pdf 823.48kb). Zomba, National Statistical Office and Calverton, MD, MEASURE DHS, ICF Macro, 2011