Malaria is a major public health problem in Ethiopia; it contributes up to 20% of under-five deaths. Tragically, in epidemic years, mortality rates of nearly 100,000 children are not uncommon. In the last major malaria epidemic in 2003, there were up to 16 million cases of malaria - 6 million more than an average year.
Out of an estimated 9 million malaria cases annually, only 4-5 million will be treated in a health facility. The remainder will often have no medical support. It is estimated that only 20 per cent of children under five years of age that contract malaria are treated in a facility.
P. Falciparum and P. Vivax are two common malarial parasites in the region. The former is considered the most severe of the two and almost all deaths occur by infection from this parasite. P. Falciparum can rapidly become resistant to malarial treatment and poses a significant challenge to malarial medicine.
Malaria is prevalent in 75 per cent of the country, putting over 50 million people at risk (out of a countrywide population of 77 million). The disease accounts for seven per cent of outpatient visits and represents the largest single cause of morbidity. Large scale epidemics tend to occur every 5-8 years in certain areas due to climatic fluctuations and drought-related nutritional emergencies.
Children and pregnant mothers are among the most vulnerable. Drought related malnutrition, poor health and no sanitation can leave a weak immune system open to attack from malaria. It can also worsen the effects of malnutrition through malaria-related diarrhea and anemia.
Malaria is also known to speed up the onset of AIDS in anyone who is HIV positive. Those living with HIV in high-risk areas are also amongst the most vulnerable.
A red blood cell infected with the malarial parasite P. Vivax.
The situation is exacerbated by the vast distances rural Ethiopians must cover in the countryside to find a clinic or other health facility with reliable medical supplies. With day to day survival preoccupying the minds of most parents, walking more than a day for anti-malarial supplies is a daunting task.
The map below shows malaria transmission periods in Ethiopia. Epidemics tend to occur in the parts of the white and pink areas below 2,200 meters, where people have not acquired immunity to malaria. Areas above 2,200 in the white areas are malaria free. Red and green areas are subject to seasonal malaria with transmission of more than three months, leading to acquired immunity among people. Only exceptionally do epidemics occur in these areas.
Action
UNICEF is currently working with the Ethiopian Government and other bodies to create the Roll Back Malaria or RBM programme, the largest anti-malaria campaign in Ethiopia's history.
Roll Back Malaria, launched in 1998 by WHO, UNICEF, UNDP and the World Bank, is a "social movement supported by a global partnership". It aims to reduce morbidity and mortality of malaria by half by the year 2010.
The Government of Ethiopia held its Roll Back Malaria inception meeting in 2000 and in 2001 finalized a five-year strategic plan for malaria control.
The Ministry of Health and Roll Back Malaria partners in Ethiopia are determined to achieve an 80 per cent coverage and utilization rate of insecticide-treated mosquito nets in all regions by 2010. Linked with this is the goal of, by 2010, having 60% of malaria cases in Ethiopia treated successfully within 24 hours with effective anti-malaria drugs.
Mosquito net distribution
The RBM initiative has taken crucial steps in providing millions of families with Insecticide-Treated Mosquito Nets (ITNs). A well made ITN is a vital tool for combating malaria.
ITNs have been shown to decrease under-5 mortality by up to 50%. They also help to reduce re-infections after people have been cured. Preventing re-infections with ITNs saves money and reduces illness. The infection “pool” is also rapidly reduced by preventing mosquitoes from transferring the disease from already infected individuals
UNICEF hopes to cover 10 million malaria affected families with 20 million ITNs by 2008 (or two nets per household).
More than 4.5 million ITNs have been distributed in Ethiopia so far. RBM partners, such as UNICEF, The Global Fund to Fight AIDS, Tuberculosis and Malaria and the government, paid for their distribution.
UNICEF has also been providing assistance to the Ethiopian government for all malaria supplies. In 2006, UNICEF will help the Ethiopian government by importing a further 6.9 million ITNs using the Global Funds programme.
Private donations are also having a dramatic impact; supplying another 2 million ITNs by June 2007.
Another 7 million nets are expected to be distributed in the next six months – one of the largest ITN distributions ever. The Enhanced Outreach Strategy (EOS ), combined with other channels, is planning for a rapid distribution of the nets within high risk areas.
Rolling out malaria drugs
The fight against malaria can not be won with the use of ITNs alone. The distribution of anti-malarial drugs is also essential to combat the disease. As part of UNICEF’s strategy, over 3 million treatments of the new anti-malaria drug Coartem (Artemether-Lumefantrine) will be distributed, with priority given to those areas affected by epidemics.
Coartem is now on the World Health Organization’s essential drug list after tests proved it has a 95% success rate.
UNICEF and WHO are assisting the government with distribution of Coartem as a first line of treatment drug, while also supporting supervision and coordination- dramatically helping to make correct diagnoses alongside prompt and effective treatment.
Social Communication
In collaboration with the Ethiopian Government and partners in the Roll Back Malaria Programme, UNICEF supports other areas of malaria prevention and control. This includes: community-based interventions, control of malaria in pregnancy as well as Information, Education and Communication (IEC) programmes. UNICEF focuses on areas most at risk and those most vulnerable- particularly pregnant women and under-five children in rural areas.
UNICEF is continuously working to strengthen partnerships and increase resources for Ethiopia’s Roll Back Malaria Programme from donors, government, NGOs and the private sector.
In August 2006 the Government of Japan handed a much needed boost to the campaign by donating $4.7 million to combat both malaria and polio in Ethiopia. The donation proved to be timely as severe flooding affected many parts of the country.
In the 2002-2006 Country Programmes, UNICEF combined its malaria and Integrated Management of Childhood Illnesses (IMCI) projects. The combined resources make a much better force for combating illness in children,
UNICEF is now better equipped to deal with childhood diseases; such as acute respiratory infection (ARI), diarrhoeal diseases, measles, malaria and malnutrition. Together, they are responsible for 70 per cent of childhood morbidity and mortality.
WHAT CAN FUNDING SUPPORT DO
UNICEF is completely reliant on donations and does not have a guaranteed budget. We need the continued support of all our benefactors.
US$0.50 Tests a child for malaria infection and then determines the correct drugs for a complete cure (Note: When used correctly, Artemether-Lumefantrine was found to have a 100 per cent cure rate in trials undertaken in Ethiopia and elsewhere).
US$2 Allows one child access to the latest, most effective anti-malarial drug - Artemether-Lumefantrine - that prevents death from falciparum malaria.
US$3 Provide social communication campaigns to double the probability that a child will use an ITN correctly and be treated with anti-malaria drugs.
US$6.5 Provides one ITN for malaria protection of a mother (and during her pregnancy), and her two children, for three years.
US$30 Provides ITNs, anti-malarials (e.g. quinine, glucose solutions etc.) and test kits to save the life of one child with a severe attack of malaria during a major malaria epidemic, and reduces transmission of the disease to other children.
