Promoting Rational Use of Drugs and Correct Case Management in Basic Health Services Published by UNICEF’s Programme Division in cooperation with the World Health Organization

ROUND THE WORLD, the malaria situation is serious and getting worse. Malaria threatens the lives of 40% of the world’s population – over 2 200 million people. Each year, there are an estimated 300-500 million clinical cases. Malaria is estimated to kill more than 1 million people annually, the majority of whom are young children. Ninety per cent of malaria cases in the world occur in Africa south of the Sahara. Children under 5 years of age and pregnant women are the worst affected by malaria. It is one of the leading causes of death among young children. Together with pneumonia, diarrhoea, measles and malnutrition, malaria is responsible for over 70% of deaths in young children especially in developing countries. Malaria during pregnancy causes severe maternal illness and anaemia, and is also associated with low birth weight among newborn infants, a leading risk factor for infant mortality. Malaria’s cost to human and social well-being is enormous. The mosquito-borne disease typically strikes its victims not once but repeatedly. As a result, workers’ output is diminished, and children miss school, often for periods of a week or more at a time. The economic loss from malaria was estimated at US$2 billion in Africa alone in 1997. Malaria is a major cause of poverty, and poverty exacerbates the malaria situation. Taken together, the effects of malaria on lives and livelihoods are devastating for economic progress in hard-hit countries. The World Health Organization and the World Bank rank malaria as the largest single component of the disease burden in Africa, causing an annual loss of 35 million future life-years from disability and premature mortality. In Africa, malaria is responsible for about 20-30% of hospital admissions and about 30-50% of outpatient consultations. Malaria is also a major public health problem in parts of Asia, Latin America, the Middle East, Eastern Europe and the Pacific. In India, epidemics of malaria are frequently reported from areas that previously were not associated with malaria. In Bangladesh, the malaria situation has been steadily deteriorating since the late 1980s. The number of cases increased fivefold between 1988 and 1994. In Latin America, Brazil is worst affected with over 50% of all malaria cases in the Americas. Malaria is mostly a disease of hot climate. The Anopheles mosquito, which transmits the malaria parasite from one human being to another, thrives in warm, humid climates where pools of water provides perfect breeding grounds. It proliferates in conditions where awareness is low and where health care systems are weak. THIS ISSUE COVERS THE FOLLOWING: