News Release

Much of malaria burden alleviated in the Gambia

Peer-Reviewed Publication

The Lancet_DELETED

Malaria incidence and mortality has fallen substantially in The Gambia between 1999 and 2007, largely thanks to huge increases in malaria funding and interventions to pregnant women and young children since 2003. This should encourage consideration of policies to eliminate malaria as a public-health problem. These are the conclusions of authors of an Article in this week's edition of The Lancet, written by Dr David Conway, Medical Research Council Research Laboratories, Banjul, The Gambia, and London School of Hygiene and Tropical Medicine, UK, and colleagues.

The authors did a retrospective analysis of original records to establish numbers of malaria inpatients, deaths, and blood-slide examinations at one hospital over 9 years, and at four health facilities in three different administrative regions over 7 years. They found that from 2003-07, at four sites with complete slide examination records, the proportion of malaria-positive slides decreased by 82%, 85%, 73%, and 50%. At three sites with complete admission records, the proportions of malaria admissions fell by 74%, 69%, and 27%. Proportions of deaths attributed to malaria in two hospitals decreased by 100% (seven of 115 in 2003 to none of 117 in 2007) and 90% (22/122 in 2003 to one of 58 in 2007).Since 2004, mean haemoglobin concentrations* increased by 12 g/L (85 g/L in 2000-04 to 97 g/L 2005-07). Mean age of child malaria admissions also increased from 3.9 years to 5.6 years.

The authors conclude: "During the past few years, efforts to control malaria in Africa have expanded to a level that has not been seen since the time of the malaria eradication programme 50 years ago…we noted a progressive reduction in the proportions of ward admissions and deaths attributed to malaria, and of positivity rates of outpatient malaria slides."

"The most substantial change in measures to prevent malaria has been the increase in coverage of insecticide-treated bednets, with MICS** data showing a more than three-fold increase to 49% reported coverage of children younger than five years between 2000 and 2006. This initiative was possible because of support from the Global Fund…These findings support the proposal that increased investment in malaria interventions in Africa can have a major effect on reducing morbidity and mortality from this disease."

They add***: "Despite these encouraging trends, malaria is still a risk in The Gambia and remains a cause of significant numbers of deaths. If elimination is to be possible in the long term in this part of Africa, it will take sustained investment in delivering available interventions, and will also need the development of new weapons such as a vaccine to give people immunity, or further tools to attack the mosquito vector."

In an accompanying Comment, Professor Peter Byass, Umeå Centre for Global Health Research, Umeå University, Sweden, says: "It seems that 21st century malaria can only be tackled effectively with a globally integrated approach that will enable action on health information, determinants, and interventions. As The Lancet has already commented, this unprecedented opportunity needs to be grasped firmly by all parties. Malaria-research groups, in terms of formulating research agendas that bring particular findings of direct relevance to the global situation, are included here, as is the commitment of programmes to make systematic use of available evidence."

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Dr David Conway, Medical Research Council Research Laboratories, Banjul, The Gambia (temporarily in UK) T) + 44 (0) 7757 866846 E) dconway@mrc.gm

Professor Peter Byass, Umeå Centre for Global Health Research, Umeå University, Sweden (also temporarily in UK) T) +44 (0)7711 077808 E) peter.byass@epiph.umu.se

Notes to editors:

For full Article and Comment, see: http://press.thelancet.com/malariagambia.pdf

*Malaria causes levels of haemoglobin (the oxygen carrying compound in the blood) to decrease; thus increased haemoglobin levels are associated with decreased malaria incidence.

**MICS = Multiple Indicator Cluster Surveys

*** This is a quote direct from the author and cannot be found in the text of the article.


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