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Malaria kills a child somewhere in the world every 30 seconds. The majority of the deaths it causes occur in Africa. Malaria is a major factor in Africa's high rate of infant and maternal mortality, of low birth weight, of school absenteeism, and of low productivity in farming and other work. It afflicts primarily the poor, who tend to live in malaria-endemic areas and in dwellings that offer little or no protection against mosquitoes. By sapping people's health, strength and productivity, malaria further marginalizes and impoverishes them. Malaria affects many of the countries that are also reeling from the HIV/AIDS pandemic. Africa's future development is inextricably linked to the prevention and control of both these diseases. At last there are strong signs of major new international political commitment to tackling both malaria and HIV/AIDS. This is seen in the discussions at the United Nations Security Council in January of this year on HIV/AIDS, at the Abuja Summit on Malaria in April, and the Declaration of the Okinawa G8 Summit in July. Malaria and HIV/AIDS must not be seen as competing priorities. Ways must be found to strengthen efforts to control both of them, so that progress in one area carries over into the other. There is now a real possibility that the resources available to tackle malaria will increase substantially, perhaps tenfold, during the next few years. Some of these new resources must be invested in the search for new and better technologies. An effective vaccine would certainly be a breakthrough, but even in the most optimistic scenario, such a product will not be available for widespread use within the next five years. The question is what to do in the meantime. We have today a number of reasonably effective and cheap technologies which, if widely applied, could result in a major reduction of the burden of malaria. None of them are perfect, but technical limitations are not the main problem. The most pressing need now is for mechanisms which allow the majority of the most affected families to use the available technologies in the near future. When such mechanisms exist, it should be relatively simple to add to the technologies in use or replace them with new ones as they become available. In highly endemic situations found in sub-Saharan Africa, three interventions could be introduced within a year or two, even where the health infrastructure is very poor. These are distribution and use of insecticide-treated bednets, rapid first-line treatment of all suspected malaria cases, and routine intermittent presumptive malaria treatment of all pregnant women. These combined could halve the burden of malaria in the most vulnerable population groups. If they were linked to improvements in mosquito control and in the diagnosis, treatment and referral of complicated malaria cases, the burden of poor health and death due to this disease could be reduced even further. Most of these highly cost-effective interventions have been available for over a decade, but, with the exception of a very small number of countries in South-East Asia and Africa, none of them has yet been applied on a big enough scale to make much difference to malaria incidence, morbidity or mortality. There have been three main obstacles. First, the network of public sector health facilities, largely focused on curative care, has tended to play a conservative and restrictive role rather than empowering the full range of potential actors and partners to take action on a large scale. …

Roll back malaria--what are the prospects?