In Africa, malaria kills an African child every 30 seconds. Together with HIV/AIDS and TB, malaria is one of the major public health challenges undermining development in the poorest countries in the world
– WHO RBM Infosheet (What is Malaria?)
Since 1976, Canada’s International Development Research Centre (IDRC) has contributed more than CA$15 million to close to 50 projects to combat malaria, one of the leading causes of illness and death in the developing world. These funds have helped researchers in Africa, Asia, and Latin America find solutions to pressing local problems.
The focus of much work in Africa is on testing and increasing access to insecticide-treated nets (ITNs). These nets, impregnated with pyrethroids – the same pesticide used in ordinary anti-lice shampoos—have proven effective in reducing illness and deaths. IDRC began investing in research on ITNs in 1989. The Centre’s first such project was in Tanzania: it explored the possibility of using sacking material manufactured for agricultural products to make impregnated bed curtains. In 1994, Tanzania hosted the first international conference on ITNs, co-organized by IDRC and the World Health Organization (WHO) with support from the Canadian International Development Agency (CIDA). In 1997, IDRC supported the creation of the Net Gain for Africa Task Force, which aimed to increase the availability of ITNs across the continent. Other IDRC/CIDA-supported projects on ITNs included the development of the first “do-it-yourself” dipping kit.
In Tanzania, where research on this kit was pioneered, IDRC has seen its initial investment pay dividends in the work of Population Services International (PSI), an American nongovernmental organization. The kit is one of the key elements of PSI’s Social Marketing of Insecticide-Treated Nets project in Tanzania, launched in 1998. This project, funded by the UK’s Department for International Development, is designed to create demand for mosquito nets and insecticide treatment, particularly in rural areas. With this, Tanzania became the first country in Africa to introduce a national strategy to ensure that more people get a safe night’s sleep under ITNs.
Research supported by IDRC/CIDA and other donors has clearly shown the effectiveness of the nets. In Kenya, for example, controlled trials with 60,000 people, including 11,000 children, showed a 33% reduction in mortality in children under five years of age; a 44% reduction in severe life-threatening malaria; and a 41% reduction in admissions to hospitals of children infected with malaria. Studies in Ghana and Kenya involving about 200,000 people indicated that full scale implementation of treated nets could save 500,000 children each year.
The treated nets are an important component of a vast research and development project in the districts of Morogoro and Rufiji in Tanzania. Called the Tanzania Essential Health Interventions (TEHIP) project, this joint IDRC/Tanzania Ministry of Health initiative seeks to improve health by reforming the health care system: in effect, to improve health, not by spending a lot more money, but by spending the money more efficiently, according to where the needs are greatest.
The research showed that malaria accounted for 30% of the years of life lost to death and disease in the project’s two regions of operation. Yet, in 1996, only 5% of health budgets went toward malaria treatment and prevention. Today this has changed: spending on malaria has increased to 25% of the health budget.
This is only one of a number of measures introduced to address the population’s health problems. Leading the list of new priority interventions is the Integrated Management of Childhood Illnesses, an approach that focuses on the well-being of the whole child. In doing so, it addresses five major childhood diseases: malaria, pneumonia, diarrhoea, measles, and malnutrition. Other interventions also target malaria, such as insecticide-treated bednets and drugs to prevent malaria in pregnancy. The results are significant: child mortality has declined over 40%, from about 35 per 1000 in 1997 to 20 per 1000 in Morogoro District and from 33 per 1000 to 18 per 1000 in Rufiji District.
An integrated approach
Much recent malaria-related research in Africa focuses on improving people’s health by addressing the sources of disease in their environment, a novel method known as ecosystems approaches to human health—ecohealth, for short. And because malaria is thought to have emerged as a virulent disease at the same time as the early practice of agriculture—about 7,000 years ago – the links between agriculture and malaria are particularly important.
In Kenya, for example, IDRC is supporting researchers at the International Centre for Insect Physiology and Ecology (ICIPE) and the International Water Management Institute (IWMI) who are implementing malaria control activities in rice-growing villages in the Mwea region. Some 20% of the population have malaria parasites in their blood at any one time; 75 to 100 children die each day of the disease. Conventional efforts to control the disease have not worked. Working with villagers, the research team identified a number of measures to address the malaria problem. These include improved water management to reduce the time the rice fields are flooded and introduce more nutritious crops. Cattle – a preferred food source for mosquitos – are being used as bait: feeds from rice husks are being developed for the cattle. Other measures include introducing biological control agents into stagnant water to destroy mosquito larvae. And insecticide-treated bed nets are being provided to groups at high risk, particularly young children and pregnant women.
The lessons learned from this project are being carried forward by the System-wide Initiative on Malaria and Agriculture (SIMA), a consortium formed by the Future Harvest Centres of the Consultative Group on International Agricultural Research (CGIAR). SIMA’s goal is to show, through research and training, that communities can adopt agricultural practices to reduce and prevent malaria — in essence, to return to common sense, centuries-old agricultural remedies. IDRC has supported the CGIAR since the 1970s and is collaborating with SIMA in funding research on the complex interactions between the agro-ecosystem and human health.
On the other side of the continent, in Côte d’Ivoire, water-borne diseases such as malaria are also on the rise as irrigation and agriculture expand. In the town of Buyo, researchers from the University of Abobo-Adjamé are attempting to find solutions to a host of health and environmental problems. Supported by IDRC, they have found that children and women may be at greater risk of contracting malaria because of the greater amount of time they spend indoors or in their home. They are thus often the first food source mosquitos encounter as they emerge from the thatch or eaves of houses to feed in the evenings.
Building capacity to address these problems is a large component of IDRC’s support in Africa and elsewhere. During the past few years IDRC has supported a number of training workshops on ecosystems approaches to human health and funded small grants projects.
Other approaches to malaria control supported by IDRC over the years include the evaluation of alternative drugs in areas where the disease parasite has developed resistance against the standard drug (chloroquine); biological control methods using botanical pesticides and bacteria that kill mosquito larvae; developing the first-ever geographic information system for malaria risk for Africa; implementation research on ITNs in a number of countries, including Benin, Ghana, The Gambia, Tanzania, and Kenya. Some of these projects were carried out in collaboration with other donors, such as CIDA and WHO.