Global Policy Forum

By Barry James

While SARS, or severe acute respiratory syndrome, grabs the headlines, about 3,000 people, mostly children in Africa, are dying every day from an older and more deadly scourge - malaria - according to a United Nations report issued Friday. By any measure, malaria eclipses SARS but has become such a part of life in much of sub-Saharan Africa and other poor countries that it gets relatively little attention.

SARS has so far infected an estimated 4,510 people and killed about 276. This year, between 300 million and 500 million will contract malaria and at least a million of them will die, according to the report by the World Health Organization and the UN Children's Fund, the first assessing malaria across Africa. Children under 5 and pregnant women are hardest hit by the disease, which is caused by a mosquito-borne parasite and costs Africa of billions of dollars a year in direct expenses and lost growth. Many of those who survive a malaria attack are left handicapped.

In Nairobi, Fatoumata Nafo-Traore, who heads Roll Back Malaria, said that the real tragedy was that "malaria is a well-known disease that is not only curable but entirely preventable." "We now have the tools and the knowledge that are needed to slow the progress of malaria," she told The Associated Press. "But we have not yet managed to deploy them on a sufficient scale Africa-wide."

While a vaccine may still be years away, experts say malaria can be slowed by providing families with nets impregnated with insecticide. But the report said that fewer than 5 percent of Africa's children slept under the nets, which are too expensive for most Africans. The report said the nets and drug treatment ought to be provided as prenatal care for the 30 million women who become pregnant in malaria-infested regions each year because research shows that up to 200,000 newborn children die of complications from the disease contracted during pregnancy.

Another dire problem is that the two cheapest and most widely used drugs against malaria - chloroquine and sulfadoxine-pyrimethamine - are becoming increasingly ineffective as the parasite builds resistance. Chloroquine has become almost useless in many parts of Africa, experts say. More effective treatments are not generally used either because they are too expensive or because health care workers are not trained to use them. Health budgets in most African countries provide less than $15 a person a year - leaving little for the treated net or more effective drug treatments at up to $3 a dose, according to the report.

It said more attention should to be paid to forecasting and pre-empting epidemics of the disease that strike populations with little or no immunity to it. Devastating epidemics have recently been reported in Zimbabwe, Botswana, Mozambique, Swaziland and South Africa. Infections can rise sharply because of climate change, natural disasters, wars and civil strife. Incidentally, public-health experts warn that developed countries are also at risk as global warming extends the field of action of malarial mosquitoes. Isolated cases, presumed to be caused by mosquitoes that arrive in cargo from malaria zones, have already been noticed in the richer countries.

Since the Roll Back Malaria campaign began in 1998, spending on prevention and treatment has more than tripled to $200 million a year, and a new Global Fund to fight AIDS, tuberculosis and malaria is expected to distribute $256 million over the next years for malaria control - more nets, new drugs and the clearing of mosquito breeding areas. "Africa has arrived at a critical point in the struggle against a disease that saps its development and kills some 3,000 of its children every day," the report says. "Left to its present course, malaria is a crisis that can only deepen."

Carol Bellamy, the executive director of the UN Children's Fund, said the disease "kills an African child every 30 seconds and remains one of the most important threats to the health of pregnant women and their newborns. "We have the knowledge and potential to achieve our target of reducing the global burden of malaria by half by 2010, but we need much greater investment and political commitment."

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