The number of people who die from malaria each year fell by nearly half, from 839,000 in 2000 to 438,000 in 2015, according to the World Health Organization. While the 214 million new cases in 2015 mean there is a long way to go to achieve global elimination, more than half of the 106 endemic countries in the world saw cases fall by more than 75 percent over the past 14 years.
“As the global burden of malaria declines, new challenges have emerged,” said Pedro Alonso, director of the WHO Global Malaria Program, in a statement. “In many countries, progress is threatened by the rapid development and spread of mosquito resistance to insecticides. Drug resistance could also jeopardize recent gains in malaria control.”
Resistance is not the only problem. From bad data collection to problematic water projects, different forces are making malaria control difficult. It is particularly a problem in Africa, the region with the greatest malaria burden. Here are three examples that illustrate the new challenges to malaria control and elimination, and a new study showing how the distribution of bednets and food can address both hunger and malaria.
Outbreak in South Sudan
The number of malaria cases in South Sudan exploded over the past year. Reports from hospitals treating people with malaria show that the number of cases grew by as much as four times as last year. And it is not slowing down.
“For sure the malaria season has been huge this year,” said Claire Nicolet, project manager for Doctors Without Borders in Aweil, South Sudan, to Al Jazeera. “Last year was huge already, but this year has been even worse. Usually around December we would be reaching the end of the malaria season but we are still treating about 130 patients a week who have severe malaria.”
Civil war in South Sudan has both forced people to flee from their homes and reduced the supply of basic goods, including malaria medicines. It makes for a worse situation when parts of South Sudan are experiencing what the U.N. characterizes as an “unprecedented” malaria outbreak.
The U.N. said is working with the Ministry of Health in South Sudan to increase the supply of anti-malarials and distribute bednets. An estimated $4 million is needed to cover the cost.
A big dam problem
Giant hydropower dams are a great way to harness water and produce electricity in African countries that struggle to deliver enough on a daily basis. They also have the potential of creating environmental benefits (better irrigation) and harms (increased flooding or restricted water flow) to the communities living along the waterways. One group definitely benefits from the dams – mosquitoes.
More than 1 million people will have contracted malaria in 2015 because they live near a large dam, according to a study published in Malaria Journal. Sixty of the planned dams to be built across sub-Saharan Africa would be located in malaria-prone areas and cause 56,000 more cases of malaria per year.
“Whilst recognizing the importance of dams for economic development, it is unethical that people living close to them pay the price of that development through increased suffering and, in extreme cases, loss of life due to disease. Those building dams must invest effectively in measures to prevent malaria transmission,” said Solomon Kibret and his co-authors in the study.
That means distributing insecticide treated bed nets to people who live within five miles of the reservoir caused by the dam.
India cooking the books?
Amid the good news about falling malaria deaths and cases is an important question: how reliable is the data available? For some countries it is great and for others it is terrible. With the case of India, there may be some funny business going on that leads the government to grossly under-report the country’s malaria burden, according to a recent report in Al Jazeera.
An independent study of malaria in India published in the medical journal The Lancet in 2010 came up with a very different set of numbers than the official government figures. By looking at the causes of death for 122,000 people across the country between 2001 and 2003, the group was able to estimate the rate of malaria deaths for various age groups. They estimated that between 125,000 and 277,000 Indians died from malaria each year, much higher than the 15,000 malaria deaths estimated by the WHO.
The Al Jazeera report builds on the evidence of the study, showing that the problems persist and India’s malaria death estimates may still be too low. The estimates are even lower, according to the Indian government. Only 561 deaths were attributed to malaria in 2014, despite 1.1 million total cases.
Many health officials privately acknowledge this systemwide failure but say they are helpless. In a review of hundreds of pages of program records, medical supply contracts and village health registers – as well as interviews with dozens of insiders – reporters found that the most serious failures often persist for years in plain sight. But because most victims are poor villagers like the Raasas, hidden from the public eye, this crisis causes little outrage.
Nets and food for undernourished kids
Despite individual challenges and holes in data, there is no doubt that fewer people are contracting malaria and dying of it that a decade ago. One of the major reasons behind that improvement is the distribution of insecticide treated bed nets. Even aid skeptic Bill Easterly willingly concedes that bed nets are a very successful and life-saving intervention.
Those nets can have an even greater impact for children suffering from undernutrition. Providing insecticide-treated bed nets and supplementary food for children that are undernourished can prevent malaria deaths, shows a new study. The argument is rather simple, children with malnutrition are at a greater risk of dying from malaria, as compared to their healthier counterparts.
Targeting areas with a higher rates of undernutrition can lead to a greater reduction in deaths, as opposed to random distribution, argue the authors. For areas where the malaria burden is already high and bed nets are being distributed, supplementing with food is an effective way to buoy child survival.
Evidence connecting nutrition and malaria is not consistent. One study showed micronutrient deficiencies put children at greater risk of malaria deaths and another said it was anemia that posed the greatest risk. But both show that health problems linked to nutrition makes malaria more deadly for children. Putting greater emphasis on that link may be one of the ways to further reduce malaria deaths.