A World Health Organization evaluation of West African countries’ progress in controlling malaria has recommended that donors allocate more funds to indoor spraying and to helping countries purchase the latest anti-malarial drugs.

“For the control of malaria vectors, we had previously recommended the use of mosquito nets,” said Stephan Tohon, WHO focal point on malaria in West Africa, speaking to IRIN on the sidelines of the UN agency’s malaria evaluation meeting in the Burkina Faso capital Ouagadougou.

“But today the experience of some countries in southern Africa with indoor house spraying – containing the once-banned insecticide DDT – has yielded positive results. This is very important to beat malaria and it is going to contribute to controlling mosquitoes not only in bedrooms, but in houses and verandas,” Tohon explained.

International donors to date have mostly focused on providing insecticide-treated bed nets. According to a report from the UN Children’s Fund (UNICEF) released on 17 October, annual production and distribution of nets more than doubled between 2004 and 2006.

According to WHO officials DDT is effective because it stays for a long time on the walls and kills mosquitoes efficiently. The powerful insecticide was decommissioned 30 years ago because of environmental fears but recent reports by specialists have found the risks to be exaggerated.

“If countries want to use DDT we’ll assist them,” pledged Wilson Were, medical officer with the malaria case management office at WHO-Africa in Congo-Brazzaville.

Drugs

WHO has also expressed concerns that a number of countries in the region do not have resources to buy the latest Artemisin-based Combination Therapy (ACT) drugs to treat malaria patients, even though all of them have in theory agreed to make the switch from the older, less effective drug chloroquine.

So far only 11 of the 17 countries WHO covers in West Africa have started effective implementation of ACT.

“We need partners to come on board and support some of these countries and mobilise these resources because they cannot continue using drugs which are not working,” Were said.

Funding

According to WHO, the region is currently expected to receive around US$400 million of international aid earmarked for malaria prevention and treatment over the next three years. But WHO officials say this will not be enough.

“With the support of the international community, we could bring the cost of medicine down and we are even encouraging countries that this medicine should be given for free because malaria is a disease of the poor and it is important to note that people are not getting medicine because they do not have money,” WHO’s Were said.

Health centres

West African government officials that participated in the evaluation said that while they agree with the urgency of dealing with the killer disease, the biggest obstacle to tackling malaria is weak or even non-existent health facilities.

“One of the main challenges regarding treatment in Liberia is the lack of health facilities, which forces the government to depend on private facilities which are in turn reluctant to distribute the tablets free of charge,” said Yah Zolia, deputy coordinator of Liberia’s malaria program.

WHO estimates that 42 percent of in-patient deaths in Liberia are caused by malaria and 500,000 children under five and 100,000 pregnant women are infected each year.

“We call on partners and especially the Global Fund to which we have applied to give us a positive reply,” Zolia said.

“Health clinics are far from the poor people, so by moving medicine nearer to the people we would expect them to get treatment earlier and to not die of malaria,” WHO’s Tohon said.

Some 80 percent of the one million malaria deaths recorded annually worldwide occur in Africa. The West African sub-region represents 45 percent of Africa’s population and malaria is endemic in 15 of the 17 countries covered by WHO there.