Malaria is a preventable and curable – yet life-threatening – disease caused by parasites that are transmitted to people through the bites of infected mosquitoes.
The World Health Organization estimates that 3.4 billion people across the world are at risk of malaria, with children under the age of five and pregnant women being most vulnerable. WHO also estimates that in 2013 there were 198 million cases of malaria, which led to 584,000 deaths, mostly among African children
How malaria works:
- Malaria is caused by Plasmodium parasites, transmitted to people by anopheles mosquitoes.
- Of the four parasites that cause malaria in humans, two (Plasmodium vivax and Plasmodium falciparum) are the most common, and the latter is the most deadly.
- After a period of incubation, malaria presents itself with initial flu-like symptoms that include fever, headache, chills and vomiting. It is often described as an acute febrile (fever-like) illness.
- If not treated within 24 hours, P. falciparum malaria can progress to severe illness, which may lead to death or serious brain damage, especially in children and pregnant women.
We focus on a variety of interventions to improve the availability, affordability and use of effective malaria treatment. Our interventions against malaria include the delivery of long-lasting insecticide-treated nets to prevent malaria, rapid diagnostic tests to diagnose malaria, and artemisinin-based combination therapy to effectively treat malaria. #DefeatMalaria
All of our interventions are accompanied by strategic behavior change communications to increase the appropriate use of these products. We also lead research programs to inform global malaria policy and national programming decisions around the world.
Our network members play a variety of roles. These include managing national programs to support the public sector, and helping grow commercial markets for product delivery to build a more sustainable, self-funded delivery mechanism to reduce the public-sector burden.
Our in-country offices and experts work with national malaria control programs to assess the total need or market for malaria prevention and treatment. Once the market is defined, we work with partners to facilitate the delivery of approved evidence-based interventions using a tailored combination of public- and private-sector delivery channels. This holistic approach, with differing levels of subsidy for groups with different abilities to pay (free for the poorest, varying levels of subsidy for those who can afford to pay), maximizes health impact in a sustainable way at the best possible value.
We also contribute to global efforts to contain the spread of artemisinin resistance in Southeast Asia. Malaria parasites resistant to artemisinin has emerged in the Greater Mekong sub-region, with a focus in Vietnam, Cambodia, Thailand and – more recently – Myanmar. The spread of these resistant parasites would threaten recent successes in malaria control and jeopardize the gains made to date across the malaria endemic world, particularly in sub-Saharan Africa. We are working with national malaria control programs and within national and global strategic frameworks to prevent and treat malaria in the region.
Donate to support PSI’s efforts to #DefeatMalaria this #WorldMalariaDay.
To date, we have delivered more than 215 million insecticide-treated mosquito nets and more than 65 million artemisinin-based combination therapies for malaria treatment. In 2011 alone, we delivered 43 million nets, representing roughly half of all nets delivered in Africa that year.
To date, we have delivered more than 215 million insecticide-treated nets in 38 countries. We also stimulate markets to increase private sector delivery of this key malaria prevention commodity at no cost to the public sector.
- Long-Lasting Insecticide-Treated Nets: We are the largest distributor of long-lasting insecticide-treated nets in the world, and we use a variety of strategies in tandem with distribution to reach and protect vulnerable populations.
Diagnosis and Treatment
Alongside rapid diagnostic test kit distribution programs, we deliver and promote artemisinin-based combination therapy, all in conjunction with tailored health communication campaigns, to ensure that people suffering from malaria are properly diagnosed and started on treatment within 24 hours of the onset of symptoms.
- Integrated Case Management: Our integrated case management programs reduce death and severe disease through prompt and effective diagnosis and treatment where and when people need it.
- Rapid Diagnostic Tests (RDTs): We promote the use of quality assured RDTs to confirm suspected cases of malaria before supplying appropriate malaria treatment, thereby decreasing wastage of artemisinin-based combination therapy and preventing the development of dangerous drug resistance.
- Artemisinin-based Combination Therapy: We are working to ensure that children with confirmed cases of malaria receive quality-assured and effective antimalarial treatment.
- Towards Subsidized Malaria Rapid Diagnostic Tests. Lessons Learned from Programmes to Subsidise Artemisinin-Based Combination Therapies in the Private Sector: a Review
Private sector subsidy programmes of ACTs have been effective in increasing availability of ACTs in the private sector and driving down average prices but struggled to crowd out antimalarial monotherapies. A subsidy of rapid diagnostic tests (RDTs) in the private sector has been recommended by governments and international donors to cope with over-treatment with ACTs and to delay the emergence of resistance to artemisinin. In order to improve the cost-effectiveness of co-paid RDTs, we should build on the lessons we learned from almost 10 years of private sector subsidy programmes of ACTs in malaria-endemic countries.
- Oral Artemisinin Monotherapy Market Still Maintains a Foothold in Myanmar, 2015
A 2015 outlet survey was conducted in the private sector within 4 domains: intervention and comparison areas in eastern/central Myanmar for the Artemisinin Monotherapy Replacement Project (AMTR) in operation since 2012; western border areas with India; and the Bangladesh border / Rakhine region. Availability and distribution of oral AMT is a serious problem throughout Myanmar, with particularly urgent need to address this problem in India border areas. It’s distribution, especially at sub-optimal dosing is likely to further exacerbate the spread of artemisinin resistance in Myanmar. There is urgent need for rapid national scale-up and strengthening of strategies, including those used by the private sector AMTR program, to rid oral AMT from the market, and increase access to QA ACT. Policy changes that ban the full import, distribution, and sale of oral AMT would create a far more conducive environment for the support of these activities.
- Private Sector Readiness and Performance for Malaria Case Management in Uganda
In a nationally-representative 2015 outlet survey, 1 in 4 private sector outlets had both confirmatory testing and QA ACT treatment available. Among outlets with testing and treatment available, study results suggest positive private sector performance with respect to testing all fever patients, particularly in health facilities and drug stores, however testing was very low in pharmacies. However, not all patients seeking treatment in the private sector can or will be tested for malaria. There is need to further promote confirmatory testing and first-line ACT treatment among patients and private sector providers, as well as discourage the use of non-artemisinin therapies and inappropriate use of injectable artemisinin monotherapies for uncomplicated cases.
- What Happened to the Malaria Market in Tanzania after the AMFm?
Key strategies have been implemented in Tanzania to ensure access to confirmatory testing and appropriate treatment for malaria cases. To extend quality case management services to the community level, a drug store accreditation program was recently taken to scale across much of the country.
- What Happened to the Malaria Market in Nigeria after the AMFm?
AMFm continuation under the private sector co-payment mechanism (CPM) has been successful in further improving access to quality assured ACTs in the private sector, where the majority of antimalarials are distributed in Nigeria. High QA ACT price relative to nonartemisinin therapies including SP and chloroquine is likely still a barrier to uptake. Furthermore, the very low availability of confirmatory testing in the private sector suggests that presumptive treatment remains common.
- ￼Trends in Public and Private Sector Readiness to Manage Malaria in Madagascar, 2010-2015
Stronger private sector strategies are needed to improve malaria case management in Madagascar. In the vast majority of cases, people seeking malaria treatment
in both public and private sectors of Madagascar are treated with non-artemisinin therapies including SP and chloroquine. The majority of antimalarials in Madagascar are distributed in the private sector. 2015 findings also highlight widening gaps in public sector readiness and performance for appropriate malaria treatment.
- What Happened to the Malaria Market in Kenya after the AMFm?
The AMFm continuation under the private sector copayment mechanism has maintained strong QA ACT availability in the private sector, where nearly 90% of antimalarials are distributed. However, QA ACTs accounted for only half of antimalarial distribution, and 1 in 5 antimalarials distributed were non-QA ACTs. Furthermore, QA ACT price increased following the AMFm pilot to more than double that of SP. Availability of confirmatory testing has improved in the public and private sectors, however availability remains low in the private sector and only 1 in 4 antimalarial-stocking outlets were equipped to test. This result suggests that presumptive treatment remains common.
- ACT Availability, Price and Market Share in Kinshasa & Katanga, DRC, 2013-2015
QA ACT availability improved in the public and private sectors of Kinshasa and Katanga between 2013-2015, however, substantial gaps in availability remain in both sectors. In addition to sub- optimal availability, QA ACT high price relative to cheaper antimalarial alternatives is likely a barrier to uptake. Distribution of QA ACT relative to SP and non-QA ACTs remains low. Ensuring that malaria is managed appropriately in DRC with quality-assured ACT requires working with the private sector to address current gaps in availability, affordability and distribution of QA ACTs.
- Malaria Testing and Treatment Markets on the Thai-Myanmar and Thai-Cambodia Borders
A 2016 outlet survey was conducted in Thailand with 2 study domains: Thai-Myanmar and Thai-Cambodia border areas. Availability of malaria blood testing was high in the public sector, but antimalarial availability was variable. Overall, over half of malaria clinics/posts and hospitals had ASMQ or DHA PPQ, CQ, PQ and malaria blood testing available, indicating moderate readiness to test for and treat both P. falciparum and P. vivax malaria. The gap in readiness in the public sector suggests that patients may need to be referred to a different facility to receive appropriate care.
- The Malaria Testing and Treatment Landscape in Benin
Readiness to test and treat malaria is high in Benin's public health facilities, but with gaps in readiness for IPTp. However, the private sector is responsible for the majority of antimalarial distribution in the country, and general retail outlets are the most common distributor of anitmalarial medicines. Strategies to improve malaria case management in the private sector are critical to improve overall coverage of appropriate malaria case management in Benin.