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Can malaria be controlled where basic health services are not used?

Malaria kills about 1.8 million people each year despite enormous efforts to fight the disease. If there is to be a reasonable chance of successfully controlling malaria, disease control programmes must be integrated into local health facilities. Yet, even if integration is achieved, can malaria be reduced in countries where basic health services are barely used?

Despite a huge increase in international aid to developing countries to control diseases such as malaria, the anticipated reduction in resulting deaths has not occurred. A contributing factor is the ten years old international aid policy which advocates a narrow, disease-based approach within the not-for-profit sector to control priority diseases. Disease control was separated out from health care as a result, yet many believe that to achieve successful disease control, reintegration of the two is crucial.

The World Health Organization promotes a malaria control strategy that emphasises adequate case management. A number of factors suggest that the best method for delivering good case management is through the use of the public-interest sector, that is, state health facilities and non-governmental organisation (NGOs), community and denominational services. Yet in Africa these services are not well used, especially that of government health facilities.

A study by the Prince Leopold Institute of Tropical Medicine, Belgium and the Nuffield Institute for Health, Leeds, UK looked at whether malaria case management can succeed in settings where basic health services are not well used. The researchers estimated malaria cure rates by taking factors that influence home treatment and treatment at health facilities from the most successful African malaria programmes and applying these to the Yanfolila district in Mali, which has a typically low rate of use.

The study reports that:

The cure rate in Yanfolila of 8.4 percent for home treatment without any malaria control intervention would increase to 13 percent if infected people had improved and timely access to treatment.
Another 3.2 percent of infected people could be cured in health facilities offering more sensitive diagnosis of the disease, starting treatment in time, improved compliance and 80 percent chloroquine effectiveness.
If the above two scenarios are applied in a setting where 7.6 percent of infected people seek treatment at a health care institution, the cure rate in the total population would be an unacceptable 16.2 percent.
If the health service user rate in Yanfolila was improved from 0.17 new cases per person per year to 0.95 new cases, this would mean that half of all malaria patients were attending health services and thus the cure rate would jump to 26.1 percent.

The study concludes that basic health services must have an integrated approach to care and must be sufficiently well used by the local population if malaria patients are to receive timely diagnosis and treatment. Improving the user rate of public health facilities and malaria case management would lead to a far greater increase in the malaria cure rate than isolated malaria control interventions, and this has implications for international policies advocating the narrow, disease-based approach.

Source(s):
‘Can malaria be controlled where basic health services are not used?’, Tropical Medicine and International Health 11:3, pp 314-322, by Jean-Pierre Unger, Umberto d’Allesandro, Pierre De Paepe and Andrew Green, 2006
HINARI subscribers can access the full-text article here. Full document.

Funded by: The Belgian Cooperation

id21 Research Highlight: 14 July 2006

Further Information:
Pierre De Paepe
Department of Public Health
Prince Leopold Institute of Tropical Medicine
Nationalestraat 155
2000 Antwerp
Belgium

Tel: +32 3 247 6541
Fax: +32 3 247 6258
Contact the contributor: pdpaepe@itg.be

Department of Public Health, Prince Leopold Institute of Tropical Medicine, Belgium

Nuffield Institute for Health, University of Leeds, UK

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