Malaria and children: Progress in intervention coverage - Unicef

Rapid gains have been made in insecticide-treated
net use by children across all sub- Saharan African
countries with available trend data in a short
period of time and from a very low baseline
19
Malaria and children
region’s under-five population (excluding Nigeria)
increased from 2 per cent to 13 per cent. Despite
this major progress, though, overall insecticidetreated
net use still falls short of global targets. 19
While trend data for around 2000–2005 are available
for these countries, large-scale distribution
programmes in many countries actually started
much more recently than in 2000. Therefore, for
most countries these large gains occurred in an
even shorter timeframe than the trend analysis
implies—less than three years for many countries.
For example, insecticide-treated net use in
Cameroon remained low at around 1 per cent
between 2000 and 2004, with a sharp thirteenfold
increase in coverage between 2004 and 2006,
as a result of large-scale distribution efforts (see
statistical table 5).
Disparities in insecticide-treated net use
These high coverage rates at the national level,
however, often hide important within-country
disparities. For example, although boys and girls
are equally likely to sleep under an insecticidetreated
net, children with the highest risk of
malaria—those living in rural areas and in the
poorest households—are much less likely. Across
sub- Saharan Africa children living in urban
areas are around 1.5 times as likely to be sleeping
under an insecticide-treated net as those living in
rural areas—and children living in the wealthiest
households are three times as likely as their poorest
counterparts (figure 11). 20
Some countries, however, show little difference in
the use of insecticide-treated nets by residence or
household wealth. For example, 2006 data from
Togo show relatively equitable coverage between
rural (40 per cent) and urban (36 per cent) children
as well as between children living in the
poorest (41 per cent) and richest (35 per cent)
households. Such coverage likely resulted from
Togo’s large-scale insecticide-treated net distribution,
an integrated part of its child health campaign,
which targeted all children throughout
Figure 11 African children living in rural areas and
poorest households are less likely to use
insecticide-treated nets
Male 8
Female
Urban
Rural
Richest
Fourth
Middle
Second
Poorest
6
7
7
8
9
10
11
the country (see feature on recent successful
malaria interventions in sub- Saharan Africa).
Further analyses of data are needed to better
understand how equitable coverage was achieved
in certain countries so that these lessons can be
applied to other countries with less equitable
coverage.
Malaria treatment coverage
Data collected on antimalarial medicine use
refer to all children with fever, whether or not the
malaria diagnosis is confirmed, which reflects
World Health Organization treatment recommendations
for children living in malaria-endemic
areas (see Background on malaria). Across sub-
Saharan Africa some 34 per cent of children with
fever receive antimalarial medicines. 21 Several
countries have much higher treatment rates, some
have achieved the Roll Back Malaria (Abuja) target
of 60 per cent coverage by 2005, and 11 others
have come close, with more than 50 per cent coverage.
However, many children in these countries
are still using less effective medicines.
In addition, nearly one child in four with fever
(23 per cent) in sub- Saharan Africa receives
19
0 5 10 15 20
Percentage of children
under age five sleeping
under insecticide-treated
nets, sub-Saharan Africa,
by gender, residence and
wealth index quintiles,
2003–2006
Source:
UNICEF global malaria
database, based on 24
(gender), 27 (residence)
and 23 (wealth) Multiple
Indicator Cluster
Surveys, Demographic
and Health Surveys and
Malaria Indicator
Surveys for 2003–2006.
Progress in the fight against malaria
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