World malaria report 2013 shows major progress in fight against malaria, calls for sustained financing

11 December 2013 | Geneva/Washington DC - Global efforts to control and eliminate malaria have saved an estimated 3.3 million lives since 2000, reducing malaria mortality rates by 45% globally and by 49% in Africa, according to the "World malaria report 2013" published by WHO.

An expansion of prevention and control measures has been mirrored by a consistent decline in malaria deaths and illness, despite an increase in the global population at risk of malaria between 2000 and 2012. Increased political commitment and expanded funding have helped to reduce incidence of malaria by 29% globally, and by 31% in Africa.

The large majority of the 3.3 million lives saved between 2000 and 2012 were in the 10 countries with the highest malaria burden, and among children aged less than 5 years – the group most affected by the disease. Over the same period, malaria mortality rates in children in Africa were reduced by an estimated 54%.

But more needs to be done.

“This remarkable progress is no cause for complacency: absolute numbers of malaria cases and deaths are not going down as fast as they could,” says Dr Margaret Chan, WHO Director-General. “The fact that so many people are infected and dying from mosquito bites is one of the greatest tragedies of the 21st century.”

In 2012, there were an estimated 207 million cases of malaria (uncertainty interval: 135 – 287 million), which caused approximately 627?000 malaria deaths (uncertainty interval 473?000 – 789?000). An estimated 3.4 billion people continue to be at risk of malaria, mostly in Africa and south-east Asia. Around 80% of malaria cases occur in Africa.

Long way from universal access to prevention and treatment

Malaria prevention suffered a setback after its strong build-up between 2005 and 2010. The new WHO report notes a slowdown in the expansion of interventions to control mosquitoes for the second successive year, particularly in providing access to insecticide-treated bed nets. This has been primarily due to lack of funds to procure bed nets in countries that have ongoing malaria transmission.

In sub-Saharan Africa, the proportion of the population with access to an insecticide-treated bed net remained well under 50% in 2013. Only 70 million new bed nets were delivered to malaria-endemic countries in 2012, below the 150 million minimum needed every year to ensure everyone at risk is protected. However, in 2013, about 136 million nets were delivered, and the pipeline for 2014 looks even stronger (approximately 200 million), suggesting that there is real chance for a turnaround.

There was no such setback for malaria diagnostic testing, which has continued to expand in recent years. Between 2010 and 2012, the proportion of people with suspected malaria who received a diagnostic test in the public sector increased from 44% to 64% globally.

Access to WHO-recommended artemisinin-based combination therapies (ACTs) has also increased, with the number of treatment courses delivered to countries rising from 76 million in 2006 to 331 million in 2012.

Despite this progress, millions of people continue to lack access to diagnosis and quality-assured treatment, particularly in countries with weak health systems. The roll-out of preventive therapies – recommended for infants, children under 5 and pregnant women – has also been slow in recent years.

“To win the fight against malaria we must get the means to prevent and treat the disease to every family who needs it,” says Raymond G Chambers, the United Nations Secretary General’s Special Envoy for Financing the Health MDGs and for Malaria. "Our collective efforts are not only ending the needless suffering of millions, but are helping families thrive and adding billions of dollars to economies that nations can use in other ways.”

Global funding gap

International funding for malaria control increased from less than US$ 100 million in 2000 to almost US$ 2 billion in 2012. Domestic funding stood at around US$ 0.5 billion in the same year, bringing the total international and domestic funding committed to malaria control to US$ 2.5 billion in 2012 – less than half the US$ 5.1 billion needed each year to achieve universal access to interventions.

Without adequate and predictable funding, the progress against malaria is also threatened by emerging parasite resistance to artemisinin, the core component of ACTs, and mosquito resistance to insecticides. Artemisinin resistance has been detected in four countries in south-east Asia, and insecticide resistance has been found in at least 64 countries.

“The remarkable gains against malaria are still fragile,” says Dr Robert Newman, Director of the WHO Global Malaria Programme. “In the next 10-15 years, the world will need innovative tools and technologies, as well as new strategic approaches to sustain and accelerate progress.”

WHO is currently developing a global technical strategy for malaria control and elimination for the 2016-2025 period, as well as a global plan to control and eliminate Plasmodium vivax malaria. Prevalent primarily in Asia and South America, P. vivax malaria is less likely than P. falciparum to result in severe malaria or death, but it generally responds more slowly to control efforts. Globally, about 9% of the estimated malaria cases are due to P. vivax, although the proportion outside the African continent is 50%.

"The vote of confidence shown by donors last week at the replenishment conference for the Global Fund to Fight AIDS, Tuberculosis and Malaria is testimony to the success of global partnership. But we must fill the annual gap of US$ 2.6 billion to achieve universal coverage and prevent malaria deaths," said Fatoumata Nafo-Traore, Executive Director of the Roll Back Malaria Partnership. "This is our historic opportunity to defeat malaria."

Notes for editors:

The "World malaria report 2013" summarizes information received from 102 countries that had on-going malaria transmission during the 2000-2012 period, and other sources, and updates the analyses presented in 2012.

The report contains revised estimates of the number of malaria cases and deaths, which integrate new and updated under-5 mortality estimates produced by the United Nations Inter-agency Group for Child Mortality Estimation, as well as new data from the Child Health Epidemiology Reference Group.

For more information, please contact:

In Geneva
Fadela Chaib
WHO Communications Officer/Spokesperson
Telephone: +41 22 791 3228
Mobile: +41 79 475 5556
E-mail: chaibf@who.int

In Washington DC
Phil Coticelli
Telephone: +1 301 801 5801
E-mail: phil@coticelligroup.com

View the original article here

WHO hand hygiene strategy feasible and sustainable for health-care settings around the world

23 August 2013 | Geneva - WHO’s strategy for improving hand hygiene is easy for health-care workers to practise, according to a new study published today in "Lancet Infectious Diseases". Health care-associated infections are a major threat to patient safety worldwide and transmission in these settings is mainly from the hands of health-care workers.

Strategy shown to increase hand hygiene compliance

In six sites in Costa Rica, Italy, Mali, Pakistan and the Kingdom of Saudi Arabia, the research team implemented WHO’s strategy in 55 departments in 43 hospitals. During the two-year period between December 2006 and December 2008, compliance with best practices increased from 51% before the study to 67% and infrastructures and staff knowledge were also significantly improved in all sites. The study also demonstrated that this change in practices and safety culture was sustained up until at least two years since the conclusion of the testing phase.

“The WHO strategy was based on a multimodal approach previously proven to have a dramatic effect in reducing the number of health-care related infections at the WHO Collaborating Centre on Patient Safety at the University of Geneva Hospitals, but now for the first time we have evidence of its feasibility and successful effect to improve hand hygiene in a variety of different geographical and income settings, with even greater impact in low-income and middle-income countries than in high-income countries,” said Dr Benedetta Allegranzi, Programme Manager, Clean Care is Safer Care, WHO Patient Safety Programme and lead author of the paper.

Hand contact the leading cause of infections

Health care-associated infections usually occur when germs are transferred by health-care providers’ hands touching the patient. The most common infections are urinary tract and surgical site infections, pneumonia and infections of the bloodstream and are often caused by multi-drug resistant germs such as methicillin-resistant S. aureus (MRSA). Of every 100 hospitalized patients, at least seven in developed and 10 in developing countries will acquire a health care-associated infection. Among critically ill and vulnerable patients in intensive care units, that figure rises to around 30 per 100. Practising good hand hygiene during health care reduces the risk of these infections and the spread of antimicrobial resistance.

“As resistance to antibiotics and other key medicines becomes more common, it is more essential than ever to reduce the number of avoidable infections in hospital,” said Edward Kelley, Coordinator of the Patient Safety Programme at WHO. “The best way of reducing the number of people contracting antimicrobial resistant infections is to protect them from cross-transmission of germs through health-care workers’ hands in the first place.”

Infection prevention and control is one of the key policy pillars identified by WHO to combat the growing problem of antimicrobial resistance. The other pillars include: appropriate national policies and plans, improving surveillance of these resistant pathogens; uninterrupted access to good quality essential medicines; proper use of medicine, and more research and development of new treatments.

The WHO hand-hygiene compliance strategy

WHO’s hand-hygiene compliance strategy consists of five main components:

• ensuring health-care workers have access to alcohol-based handrub at the point of patient care;
• training and education of health-care workers on the most important times in patient care for hand hygiene;
• monitoring and feedback on compliance;
• visual reminders at the point of care in the workplace;
• creation of a culture of attention to patient and health-care worker safety within the institution.

A simple, cost-effective intervention

“Sometimes the simplest and most cost-effective interventions can have the greatest impact,” said Sir Liam Donaldson, WHO Envoy for Patient Safety. “We now have the effective methods to eliminate millions of avoidable sicknesses and death, and reduce the growing problem of antimicrobial resistant infections.”

According to the WHO Clean Care is Safer Care Programme, when working with patients, hand hygiene should be performed at 5 key moments, preferably by using an alcohol-based rub or by handwashing with soap and water if hands are visibly dirty. The five moments for hand hygiene are:

• before touching a patient;
• before clean and aseptic procedures (e.g., inserting devices such as catheters);
• after contact with body fluids;
• after touching a patient;
• after touching patient surroundings.

“WHO’s hand-hygiene improvement strategy is recommended by both the US and European Centres for Disease Control, the Joint Commission International and accredited bodies, and almost all professional organizations worldwide,” said Professor Didier Pittet, Director, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, and senior author of the paper.

The strategy has been implemented so far in more than 15 700 health-care settings in 168 countries worldwide and more than 50 governments have based their national hand hygiene campaigns on it. The current study validates its use as a universal gold standard of patient care.

For more information please contact:

Tarik Jasarevic
WHO Communications Officer
Telephone: +41 22 791 5099
Mobile: +41 793 676 214
E-mail: jasarevict@who.int

View the original article here

WHO hand hygiene strategy feasible and sustainable for health-care settings around the world

23 August 2013 | Geneva - WHO’s strategy for improving hand hygiene is easy for health-care workers to practise, according to a new study published today in "Lancet Infectious Diseases". Health care-associated infections are a major threat to patient safety worldwide and transmission in these settings is mainly from the hands of health-care workers.

In six sites in Costa Rica, Italy, Mali, Pakistan and the Kingdom of Saudi Arabia, the research team implemented WHO’s strategy in 55 departments in 43 hospitals. During the two-year period between December 2006 and December 2008, compliance with best practices increased from 51% before the study to 67% and infrastructures and staff knowledge were also significantly improved in all sites. The study also demonstrated that this change in practices and safety culture was sustained up until at least two years since the conclusion of the testing phase.

“The WHO strategy was based on a multimodal approach previously proven to have a dramatic effect in reducing the number of health-care related infections at the WHO Collaborating Centre on Patient Safety at the University of Geneva Hospitals, but now for the first time we have evidence of its feasibility and successful effect to improve hand hygiene in a variety of different geographical and income settings, with even greater impact in low-income and middle-income countries than in high-income countries,” said Dr Benedetta Allegranzi, Programme Manager, Clean Care is Safer Care, WHO Patient Safety Programme and lead author of the paper.

Health care-associated infections usually occur when germs are transferred by health-care providers’ hands touching the patient. The most common infections are urinary tract and surgical site infections, pneumonia and infections of the bloodstream and are often caused by multi-drug resistant germs such as methicillin-resistant S. aureus (MRSA). Of every 100 hospitalized patients, at least seven in developed and 10 in developing countries will acquire a health care-associated infection. Among critically ill and vulnerable patients in intensive care units, that figure rises to around 30 per 100. Practising good hand hygiene during health care reduces the risk of these infections and the spread of antimicrobial resistance.

“As resistance to antibiotics and other key medicines becomes more common, it is more essential than ever to reduce the number of avoidable infections in hospital,” said Edward Kelley, Coordinator of the Patient Safety Programme at WHO. “The best way of reducing the number of people contracting antimicrobial resistant infections is to protect them from cross-transmission of germs through health-care workers’ hands in the first place.”

Infection prevention and control is one of the key policy pillars identified by WHO to combat the growing problem of antimicrobial resistance. The other pillars include: appropriate national policies and plans, improving surveillance of these resistant pathogens; uninterrupted access to good quality essential medicines; proper use of medicine, and more research and development of new treatments.

WHO’s hand-hygiene compliance strategy consists of five main components:

ensuring health-care workers have access to alcohol-based handrub at the point of patient care;training and education of health-care workers on the most important times in patient care for hand hygiene;monitoring and feedback on compliance;visual reminders at the point of care in the workplace;creation of a culture of attention to patient and health-care worker safety within the institution.

“Sometimes the simplest and most cost-effective interventions can have the greatest impact,” said Sir Liam Donaldson, WHO Envoy for Patient Safety. “We now have the effective methods to eliminate millions of avoidable sicknesses and death, and reduce the growing problem of antimicrobial resistant infections.”

According to the WHO Clean Care is Safer Care Programme, when working with patients, hand hygiene should be performed at 5 key moments, preferably by using an alcohol-based rub or by handwashing with soap and water if hands are visibly dirty. The five moments for hand hygiene are:

before touching a patient;before clean and aseptic procedures (e.g., inserting devices such as catheters);after contact with body fluids;after touching a patient;after touching patient surroundings.

“WHO’s hand-hygiene improvement strategy is recommended by both the US and European Centres for Disease Control, the Joint Commission International and accredited bodies, and almost all professional organizations worldwide,” said Professor Didier Pittet, Director, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, and senior author of the paper.

The strategy has been implemented so far in more than 15 700 health-care settings in 168 countries worldwide and more than 50 governments have based their national hand hygiene campaigns on it. The current study validates its use as a universal gold standard of patient care.

Tarik Jasarevic
WHO Communications Officer
Telephone: +41 22 791 5099
Mobile: +41 793 676 214
E-mail: jasarevict@who.int

View the original article here