Anti-Malaria Efforts Yield New Success

In Ethiopia, the drugs and nets were introduced in 2005, with each household getting one net for every two people. Hospitalized malaria cases in young children fell 60 percent and deaths 51 percent.

Indoor spraying with DDT or other insecticides -- used in Rwanda at the end of the study period, and before and during it in Ethiopia -- did not appear to be a factor in the steep, sudden declines.

Improvements were less dramatic in Ghana, where cases fell 13 percent and deaths 34 percent. That country could afford to give nets only to households with children younger than 2. It also had a new medical insurance program that had already given more people access to medical care, possibly dampening the decline in malaria deaths compared with previous years.

Zambia, where cases fell 29 percent and deaths 33 percent, did not finish distributing nets until late last year, and hospitals and clinics there frequently ran out of the artemisinin-containing drugs.

Data on cases and deaths came from the records of hospitals and outpatient clinics. The sites studied were widely scattered throughout the countries but not chosen at random. In Rwanda, for example, the researchers sampled two districts in each province, examining a total of nine hospitals and 10 clinics.

Overall, the differences in results "reflect the scale of coverage of the intervention," said Wilson Were, a WHO researcher. "If we do this rapidly, we can save more lives than doing it slowly," he added.

The study was done at the request of the Global Fund, an independent organization headquartered in Geneva that collects money from governments, foundations and individuals, and distributes it to needy countries.

Since its founding in 2002, the fund has provided $3.6 billion for malaria programs in 85 countries. It commissioned the research to learn the effects of some of the interventions it financed. Its officials deferred commenting on the findings until they have studied them further.

While cheap, the items in the malaria tool kit are still out of reach for many high-burden countries, which are among the world's poorest. The insecticide-treated nets cost about $5.50 each, plus $2 to $3 for shipping and distribution. Artemisinin-containing drugs -- generally taken twice a day for three days -- cost about $2.50 for a course of treatment. The common alternative, chloroquine, costs about 20 cents but is less effective.

For a while, ACTs were reserved for severe cases, because of expense and fear that resistant strains of the parasite would emerge. There is now consensus that the drugs should be used in virtually all cases. Resistance to artemisinin is reportedly emerging on the Thailand-Cambodia border -- the historical nursery for drug-resistant malaria strains -- and WHO is looking into the matter.

Cutting malaria mortality by 50 percent is a goal of the President's Malaria Initiative, started by the Bush administration in 2006. As with its global AIDS program, the administration is targeting specific countries with its malaria effort, starting with three the first year, adding four more last year (including Rwanda) and eight more this year. It plans to spend $1.2 billion between 2005 and 2010.

Worldwide, spending on malaria has tripled in the past three years, according to the New York-based nonprofit group Malaria No More. WHO estimates that about $4.5 billion a year is needed to control and treat the disease. At the moment, about $1 billion is spent yearly by donor countries and about $600 million by countries where malaria is prevalent.