USAID's Malaria Programs

Background

As many as 900 million cases of malaria occur every year, directly and indirectly causing up to 2.7 million deaths. Ninety percent of these deaths occur in Africa, and most of the victims are young children. Malaria affects the health and wealth of nations and individuals alike. In Africa, it is both a disease of poverty and a disease that causes poverty. It is a major constraint to economic development, with significant direct and indirect costs. As a result, over the past few years, the international community has remobilized to develop and implement sustainable actions against malaria.

USAID has been a key partner in the global Roll Back Malaria (RBM) initiative since its inception in 1998. The Agency has assisted 22 national malaria programs and three regional initiatives, building malaria control networks and developing new technologies and approaches. USAID provided significant support to "going to scale" efforts in national malaria control programs in Africa and to cross-border initiatives addressing the problem of drug resistance.

USAID is reducing malaria morbidity and mortality by focusing on six key areas:

• Preventing malaria infection and illness
• Promoting effective treatment of malaria illness, and drug resistance
• Protecting pregnant women from malaria
• Developing new tools and approaches for malaria prevention and control
• Malaria vaccine development
• Addressing the needs of populations in complex humanitarian emergencies

Preventing malaria infection and illness. Access and use of insecticide-treated mosquito nets is one of the key intervention strategies for RBM. Proper use of insecticide-treated bednets (ITNs) can reduce overall child mortality by up to 30 percent and significantly reduce morbidity in children and pregnant women. However, less than 10 percent of African children are covered by an ITN. USAID has launched NetMark, an innovative program that has formed partnerships with the United Nations International Children's Fund (UNICEF), major commercial firms, and local distributors to expand the availability of affordable ITNs in Africa. In addition, a number of USAID missions are working with various partners to expand access and availability of ITNs.

Promoting effective treatment of malaria illness. Recognition of malaria symptoms and prompt, effective treatment are critical to saving the lives of children infected with malaria. USAID programs aim to increase the proportion of children with fever who receive prompt treatment with an effective drug within 24 hours. This approach involves improving symptom recognition and treatment-seeking behaviors at the household level, improving case management at health facilities, and developing national capacity to set appropriate policies and monitor antimalarial drug efficacy.

Antimalarial drug resistance is one of the major challenges to malaria control worldwide. To help address this issue, USAID fully endorses the recommendation of the World Health Organization (WHO) and the RBM partnership that: "treatment policies for falciparum malaria in all countries experiencing resistance to monotherapies should be combination therapies, preferably those containing an artemisinin derivative (ACT)."

USAID has also supported studies necessary in proving the safety and efficacy of ACTs. At the country level, USAID has worked to help countries enact policies that allow for the use of more effective malaria treatment. With USAID support, an Institute of Medicine panel is developing guidance for the RBM partnership on the most efficient means of financing these newer, more effective treatments.

Protecting pregnant women from malaria. Each year, 22 million pregnancies in Africa are at risk of malaria. Placental malaria infection increases the risk of low birthweight and other adverse birth outcomes. Intermittent preventive treatment of malaria as part of regular antenatal care can significantly reduce this risk to the newborn, as well as reduce the mother's risk of anemia. USAID programs, particularly the Malaria Action Coalition, promotes partnership between malaria and reproductive health to deliver effective malaria control interventions to pregnant women in Africa.

Developing new tools and approaches for malaria prevention and control. Malaria control in the future will be strengthened by new tools and approaches. USAID supports the development of such innovations and methods through funding of the Centers for Disease Control and Prevention (CDC), the Special Programme for Tropical Disease Research and Training (TDR), Medicines for Malaria Venture, and the Multinational Initiative on Malaria (MIM). USAID also supports the development of tools for the targeting and cost-effective deployment of vector management interventions.

Malaria vaccine development. USAID's sustained commitment to malaria vaccine development is widely recognized as having significantly contributed to the advancement of the field to its current promising status, with several vaccine candidates in or nearing clinical field trials. USAID's objective is to develop a vaccine to protect residents in malaria endemic areas, primarily children and pregnant women, the most vulnerable groups. The strategy to meet this objective is to create and maintain a pipeline of the most promising approaches and vaccines that are tested in field trials as soon as possible. USAID has established formal and informal partnerships and working arrangements with a number of institutions including: the U.S. Department of Defense (Walter Reed Army Institute of Research (WRAIR) and Navy Medical Research Institute (NMRI)); National Institutes of Health; CDC; the Malaria Vaccine Initiative (MVI) at PATH; the European Malaria Vaccine Initiative; and, the World Health Organization (WHO).

Addressing the needs of populations in complex humanitarian emergencies. There is a growing recognition that African populations in areas of war and conflict are at particular and increased risk of malaria. RBM has estimated that countries affected by complex emergencies account for more than 30 percent of the world's annual malaria mortality. USAID is supporting a five-year World Health Organization effort to roll back malaria in complex emergency situations, with a particular focus on Sudan, Angola, the Democratic Republic of Congo, and Liberia.