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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 October 27; 335(7625): 848.
PMCID: PMC2043447

More effort is needed to tackle malaria in sub-Saharan Africa, says Unicef

Important advances have been made in recent years to reduce the malaria burden in sub-Saharan Africa through greater use of treated bed nets and better treatment, says a report by Unicef.

But despite this progress the report concludes that overall use of bed nets treated with insecticide still falls short of global targets and that a large number of children with fever are still being treated with weaker drugs and not with the more effective artemisinin based combination treatments.

More “enhanced commitments and bolder efforts” are needed, it says, by donors and governments to help meet the anti-malaria goals.

Actions needed include further strengthening of political and financial commitments and integrating malaria control into existing programmes for improving maternal and children's health, it says.

“In sub-Saharan Africa malaria kills at least 800 000 children under the age of 5 each year,” said Ann Veneman, Unicef's executive director. “Controlling malaria is vital to improving child health and economic development in affected countries. Studies show that malaria disproportionately affects the poorest people in these countries.”

The report, prepared by Unicef on behalf of the Roll Back Malaria Partnership, says that sub-Saharan African countries are the hardest hit of the 107 countries and territories in tropical and sub-tropical regions where malaria is endemic. Sub-Saharan Africa accounts for more than 80% of the estimated one million deaths each year from the disease.

Awa Marie Coll-Seck, executive director of the partnership, said that its goal is to “achieve 80% coverage with all antimalarial interventions by 2010.”

She added, “We are moving in the right direction, but we need to do much more.”

The partnership, which was launched in 1988 to coordinate the international fight against malaria, includes the World Health Organization, Unicef, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank, the United Nations Development Programme, research and academic institutions, advocacy and community based organisations, and private sector bodies.

The report says that from 2004 to 2006 the supply of insecticide treated bed nets more than doubled from 30 million to 63 million and that another big increase is expected by the end of this year.

It notes that 16 of the 20 sub-Saharan countries for which trend data are available have “at least tripled” their coverage of treated bed nets since 2000, but it admits that the high coverage hides large disparities within countries.

The proportion of children sleeping under treated bed nets reached 54% in the Gambia in 2006, up from 15% in 2000; in Togo the figure was 38% (up from 2%) and in Guinea-Bissau it was 39% (up from 7%). A total of 18 million nets have been distributed in Ethiopia since 2005 and more than 10 million in Kenya since 2003.

Nevertheless the report estimates that an extra 130 million to 264 million bed nets are needed to achieve the partnership's target of 80% coverage among African children aged under 5 and pregnant women who are at risk of malaria.

Similarly, it notes that a survey of 22 sub-Saharan countries with trend data for 2000 to 2005 showed that the percentage of children with fever who were given antimalarial drugs fell from 41% in 2000 to 34% in 2005.

The study also notes that although nearly all sub-Saharan countries have changed their national drug policies to support the use of artemisinin based combination treatments, many countries still treat a large proportion of children with fever with less effective traditional monotherapies, such as chloroquine, which it says are no longer recommended because of increasing levels of resistance and risk of treatment failure.

About 60% of children receiving antimalarials were taking chloroquine, it notes.


Malaria & Children: Progress in Intervention Coverage is available at

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