Malaria and children: Progress in intervention coverage - Unicef

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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 2
20 BASF AG Public Health/MENTOR/VOICES/Benoist Carpentier UNICEF/HQ07-0127/Giacomo Pirozzi 2 Figure 12 Only about a third of febrile children receive antimalarial medicines across sub- Saharan Africa—and only 23 per cent receive them within the recommended time period Comoros a (2000) 63 Gambia, The (2006) Uganda (2006) Ghana (2006) Cameroon (2006) Tanzania, United Rep. of (2004–2005) Zambia (2006) Central Africa Republic (2006) Benin (2006) Congo, Dem. Rep. of the a (2001) Sierra Leone (2005) Sudan a (2000) Equatorial Guinea a (2000) Burkina Faso (2006) Congo (2005) Togo (2006) Guinea-Bissau (2006) Guinea (2005) Côte d’Ivoire (2006) Madagascar a (2003–2004) Nigeria (2003) Mauritania (2003–2004) Niger (2006) Chad a (2000) Burundi (2005) Kenya (2003) Senegal (2005) Swaziland a (2000) São Tomé & Principe (2006) Malawi (2006) Mozambique (2003) Namibia a (2000) Rwanda (2005) Djibouti (2006) Somalia (2006) Zimbabwe (2005–2006) Eritrea (2002) Ethiopia (2005) Sub-Saharan Africa average b 26 25 24 15 14 12 10 8 5 4 3 34 63 62 61 58 58 58 57 54 52 52 50 49 48 48 48 46 44 36 34 34 33 33 32 30 27 27 Roll Back Malaria (Abuja) target for 2005 Roll Back Malaria target for 2010 0 20 40 60 80 100 Timing of malaria treatment Percentage of febrile children under age five that receive any antimalarial medicine, sub-Saharan Africa, 2000–2006 Children under age five with fever that receive any antimalarial medicine promptly (within 24 hours) Children under age five with fever that receive any antimalarial medicine Note: Some sub-Saharan African countries have a significant population share living in nonmalarious areas. National-level estimates may obscure higher coverage in endemic subnational areas targeted by programmes (see annex A). a. Data on prompt antimalarial medicine use not available. b. Includes only countries with data for 2003–2006. Source: UNICEF global malaria database, based on 38 Multiple Indicator Cluster Surveys, Demographic and Health Surveys and Malaria Indicator Surveys for 2000–2006. antimalarial medicines promptly (within 24 hours of the onset of fever). 22 This indicates that of the 35 per cent of children in sub- Saharan Africa treated for malaria symptoms about two-thirds are treated promptly (figure 12). Several countries perform well above this regional average, with around half of all children with fever treated with antimalarial medicines within
Page 1 and 2: Malaria & children Progress in inte
Page 3 and 4: Copyright © 2007 by the United Nat
Page 5 and 6: Acknowledgements This report was pr
Page 8 and 9: 1 Executive summary An estimated 3
Page 10: 3 30 25 20 15 10 5 0 Figure 2 Globa
Page 13 and 14: 6 Bonnie Gillespie/Voices for a Mal
Page 15 and 16: 8 Background on malaria Where is th
Page 18 and 19: 11 Progress in the fight against ma
Page 20 and 21: Large increases in funding and atte
Page 22 and 23: The number of nets procured by UNIC
Page 24 and 25: Although data are limited, more tha
Page 28 and 29: Since 2003 nearly all sub- Saharan
Page 30 and 31: Many countries still treat a large
Page 32 and 33: Since around 2005 both production o
Page 34 and 35: Coverage of intermittent preventive
Page 36 and 37: Countries are now accelerating thei
Page 38 and 39: New medicines are urgently needed t
Page 40: 33 2000 2006 Figure 3 Togo has seen
Page 43 and 44: 36 2005 Alfredo L. Fort/Courtesy of
Page 45 and 46: 38 M. Hallahan/Sumitomo Chemical-Ol
Page 47 and 48: 40 Malaria intervention coverage da
Page 49 and 50: 42 spraying rather than insecticide
Page 51 and 52: 44 Republic, Ecuador, Egypt, El Sal
Page 53 and 54: 46 26. Gazsi 2007. 27. Novartis Int
Page 55 and 56: 48 on Morbidity, Mortality, CD4-Cel
Page 57 and 58: Contents Statistical annex Statisti
Page 59 and 60: 52 Statistical table 1 (continued)
Page 63 and 64: 56 Statistical table 2 Household av
Page 65 and 66: 58 Statistical table 3 Household av
Page 73 and 74: 66 Statistical table 8 Children wit
Page 75 and 76: 68 Statistical table 9 Pregnant wom
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This report assesses progress in ma
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Malaria and children: Progress in intervention coverage - Unicef

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