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SOURCE: J. A. OMUMBO ET AL. PHOTOGRAMM. ENG. REM. SENSING 68, 161–166 (2002) malaria

30′ 35′ 40′ given that the relevant questions are buried in a effectiveness can be measured.
Uganda Kenya national-health survey questionnaire the size More money won’t be enough. Donors,
5′ 5′
of the Oxford English Dictionary. governments and international initiatives
Similarly, RBM’s target of providing bed- must take on board the concerns of scientists
nets to 60% of children is not framed scien- in the field, and back political goals with hard
tifically to ensure that these reach the most science.Without a greater appreciation of the
vulnerable. The distribution often correlates importance of creditable baseline data, and
0′ 0′
more closely with wealth than areas of high the need for adequate funding and resources
malaria risk7. to gather such data, in a decade or so we will
In 2001, the UK government granted one not be celebrating the rolling back of malaria
non-governmental organization US$22 mil- —we will be scratching our heads wondering
lion to market nets in Kenya. But it focused whether we made any difference at all. ■
–5′ –5′ on urban rather than rural areas. The out- Robert W. Snow is at the Kenya Medical Research
come: a mere 1.5% increase in children Institute/Wellcome Trust Collaborative Programme in
Ocean protected — hardly a stunning success. Nairobi, Kenya.
The best way to measure the impact of 1. Snow, R. W., Trape, J. F. & Marsh, K. Trends Parasitol. 17,
interventions would be to use rigorous, 593–597 (2001).
2. The Abuja Declaration on Roll Back Malaria in Africa (2000);
–10′ –10′ longitudinal demographic and epidemio- available at
logical studies, such as those provided by malaria/publications/docs/abuja.pdf.
Tanzania the INDEPTH network of sentinel sites 3. United Nations Development Programme Human Development
Report 2003. Millennium Development Goals: A Compact Among
( But such Nations to End Human Poverty (Oxford Univ. Press, New York,
30′ 35′ 40′ sites are few — there are only 11 in Africa.We 2003); available at
urgently need a properly funded, science- 4. Rogers, D. J., Randolph, S. E., Snow, R. W. & Hay, S. I. Nature
Satellite sensor model of malaria based strategy to evaluate the use of both 415, 710–715 (2002).
transmission in East Africa 5. Hay, S. I., Guerra, C. A., Tatem, A. J., Noor, A. M. & Snow, R. W.
existing and future malaria control tools. Lancet Infect. Dis. 4, 327–336 (2004).
Malaria free Clinical trials of new vaccines and drugs 6. Snow, R.W., Craig, M. H., Newton, C. R. J. C. & Steketee, R. W.

Malaria near water for malaria, such as those planned by the The Public Health Burden of Plasmodium falciparum Malaria in
Africa: Deriving the Numbers DCPP Working Paper 11 (DCPP,
Moderate malaria transmission
recently launched European and Developing
Bethesda, Maryland, 2003); available at
Countries Clinical Trials Partnership, will wps/wp11.pdf.
Intense malaria transmission
eventually require sites where operational 7. Monasch, R. et al. Am. J. Trop. Med. Hyg. (in the press).

Struggling to make an impact

Hampered by bureaucracy, politics and Programme and UNICEF, and is now supported ministries make spending decisions.
ineffectual policies, critics claim that the by 90 countries. It has raised the disease’s But critics also complain about the
international Roll Back Malaria (RBM) partnership international profile, says Roger Bate of the programme’s inertia in replacing obsolete drugs
is failing, and is a long way off its goal of halving American Enterprise Institute for Public Policy with more effective, but costlier, artemisinin-
malaria deaths by 2010. Few of the 44 African Research, a Washington-based think-tank. based drugs (see Nature 429, 588; 2004). In
countries that signed up to its main goals, “Unfortunately, I think that’s kind of where the addition, they question its focus on mosquito
including providing immediate access to good news ends,” he says. “If RBM were a nets soaked in insecticides to the exclusion of
treatment for 60% of patients by 2005, have government, it would be voted out of office.” indoor spraying with DDT and other insecticides.
followed up with increased resources. In 2002, an external evaluation panel RBM claims that it promotes DDT wherever
Allan Schapira, RBM coordinator at the World concluded that RBM was failing at regional and appropriate, but argues that nets are safer and
Health Organization (WHO), disputes that the national levels, and was too isolated from local more effective. Spraying is difficult to push
programme is off-course, arguing that it will take health policies (see Nature 419, 422; 2002). It through politically, says Schapira, with pressure
years for the impact of current initiatives to also found the World Bank’s commitment to be from government and other donors. “We have
become apparent. “There’s no basis for the ambivalent. “We are committed to doing a lot had very, very strong lobbying over DDT,” he
contention that deaths from malaria have gone more, to doing much better,” says Olusoji Adeyi, says. “We have had to give up.”
up,” he says, adding that tracking trends in communicable-diseases coordinator at the bank. The biggest issue, says Schapira, is money.
malaria-specific deaths over short periods is RBM has since been reorganized to make Most new funding for African countries is coming
difficult. What is clear, however, is that no data it more accountable to malarial countries, from the Global Fund to Fight AIDS, Tuberculosis
show substantial drops in deaths in sub-Saharan and to have a tighter focus on fewer countries. and Malaria, although it is far short of the billions
Africa, where most cases occur. Mark Young, UNICEF’s senior health adviser needed. “We have the tools and the strategies,
RBM was launched in 1998 by the WHO, the for RBM, points to ‘basket funding’, where but without more money it will be a disaster.”
World Bank, the United Nations Development money is pooled nationally and health Apoorva Mandavilli is news editor of Nature Medicine.

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