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Rolling Back Malaria: a Multi-Sectoral Challenge

Obreniokibo I. Amiesimaka


Rebranded RBM logo ©RBM


October 2018 marked the 20th anniversary of the now-rebranded RBM Partnership to End Malaria. Originally called Roll Back Malaria, RBM was founded by the World Health Organisation (WHO), the United Nations Children's Fund (UNICEF), the United Nations Development Programme (UNDP) and the World Bank.
With its foundation build on collaboration, it was charged with building a partnership of stakeholders in order to spearhead the global effort in combatting malaria.

The RBM Partnership has brought together over 500 partners from diverse fields; ranging from the academia and malaria-endemic countries to the donor, public and also private sectors, amongst many others. This collaborative approach – and work in line with Millennium Development Goal (MDG) 6: “combat HIV/AIDS, malaria and other diseases” – yielded fruits. In the 17 years from its inception to 2015, the WHO records that more than 6 million lives were saved and there was a significant reduction of about 18% in the global burden of malaria.

Its technique is succinctly described in the Stanford Social Innovation Review thus: “RBMhas never treated a patient; nor has it delivered a single bed net or can of insecticide. Rather, RBM has worked across the field of malaria eradication by helping to build public awareness, aggregate and share technical information with a system of global stakeholders, and mobilize funding“.

In 2016, RBM underwent a governance overhaul, which led to its rebranding, in order to reposition it to better meet the malaria challenge. With the launch of the Sustainable Development Goals (SDGs) the year previous, RBM and other global health initiatives are adopting more holistic strategies which recognize the linkages between other social factors and health. 

The WHO issued its Global Technical Strategy (GTS) for Malaria 2016 – 2030, which has a similar timeline to the SDGs. Compared to 2015 figures, by 2030, it aims to reduce malaria mortality and incidence rates both by 90%. The elimination of malaria from a minimum of 35 countries and prevention of re-establishment in already malaria-free countries are further targets.

In congruence with the GTS, RBM also published its Action and Investment to defeat Malaria 2016-2030 (AIM) policy. The fulcrum of the AIM document is four-fold: ‘Combine forces to defeat malaria’; ‘Demonstrate continued progress’; ‘Expand partnerships’ and ‘Accelerate efforts’. The AIM document also highlights the importance of malaria eradication to the achievement of the SDGs.


Progress made in the execution of the GTS and AIM documents has been monitored and is explored below.


Great strides but a long way to go

Progress in childhood malaria reduction 2000 – 2015 ©DW

There is no gainsaying that RBM has achieved remarkable success in the fight against malaria. As a result of its work, countries with less than 10,000 malaria cases have risen to an unprecedented 44. Further, whereas 10 countries are poised to completely eradicate malaria by 2020, eight (8) have already done so since 2010; with two joining the ranks after 2016. They include Armenia, Kyrgyzstan, Maldives, Morocco, Paraguay, Sri Lanka, Turkmenistan and United Arab Emirates.

More so, the proportion of the African population with access to long-lasting insecticide treated nets, has increased from a 2001 figure of just 2% to more than 50%. Notwithstanding the progress made, malaria still remains a top-10 killer in low-income countries and a major burden on global health. 

The WHO World Malaria Report 2017 estimates that there was an unfortunate rise in the number of people with malaria of 5 million between 2015 and 2016. Similarly, the number of deaths stagnated at about 445,000 between those two years. Although there was still an overall decrease in malaria cases from 273 million in 2010 to 216 million in 2016, it is worrying to see that the progress made thus far could be reversed.

Africa bears the majority of the malaria burden with 91% of deaths and 90% of cases globally. Even more troubling is the fact that 80% of cases are found in just 15 African countries. Malaria is also a sizeable problem in South-East Asia and South America.

Additionally, inadequate funding continues to hamper the achievement of the GTS goals. An estimated USD 2.7 billion was spent in 2016 on malaria but this is less than half the amount needed annually – USD 6.5 billion by 2020 - as stated in the GTS.

According to the WHO, groups at high risk of malaria infection include: patients with HIV/AIDS, infants, children less than 5 years old and pregnant women, coupled with non-immune migrants, mobile populations and travellers.

Given the impact of malaria on these vulnerable groups, many of whom constitute the future of society, the need for progress in the fight against malaria cannot be overemphasized.

Some social factors which play a role in the spread of malaria, and are thus of substantial importance, are explored below.


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Rolling Back Malaria



The WHO REPLACE Trans Fat Action Package – From Policy to Practice

Obreniokibo I. Amiesimaka



In May 2018, the World Health Organisation (WHO) introduced an action package for the elimination of industrially-produced trans fats globally by 2023. The action package, called REPLACE Trans Fat, is in keeping with the Sustainable Development Goal (SDG) 3.4, which aims to reduce non-communicable diseases (NCDs). 
Here, we consider the action package and some of the potential challenges to its practical implementation.


Trans fats in brief

Trans fats are produced through the addition of hydrogen to unsaturated vegetable oils via the partial-hydrogenation process. This increases the stability of the oils and prevents 'rancidity‘; thus extending their shelf-life. It also modifies the oils into (semi-)solid fats at room temperature, which are used widely in processed and baked foods.

Small quantities of trans fats can be found naturally in meat and dairy, but most trans fats in human consumption come from industrially-produced fat and oil goods e.g margarine, shortening etc.

Trans fats, however, do not have any nutritional benefit. In fact, trans fats have been majorly implicated in causing cardiovascular diseases; especially as they decrease HDL (good) cholesterol whilst increasing LDL (bad) cholesterol in the body.
Further, about 540,000 deaths annually have been ascribed to the consumption of trans fats; with high intake raising the risk of death generally by 34% and specifically deaths from coronary heart disease, by 28%.

The WHO recommends that trans fatty acids (TFAs) constitute below 1% of total energy intake; in other words, for a 2000 Calorie diet, TFA intake should be below 2.2g/day.
There is a dearth of evidence on TFA intake globally. However, available research, shows that the TFA content of diverse street and processed foods considerably exceeds the recommended levels.

The aforementioned evidence necessitated this WHO policy to ban trans fats globally. Trans fat bans/mandatory limits are not entirely novel as up to 20 countries - mainly in the upper middle and high income bracket - have instituted policies regulating the trans fat content of foods. They include: Denmark, Canada, Argentina, South Africa and Iran, amongst others. As most countries without such regulations are Low and Middle Income Countries (LMICs), health equity concerns also formed part of the rationale for the WHO REPLACE Trans Fat policy, discussed below. 

To continue reading please follow the link to the PDF...

WHO Transfat Action Plan


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© Photos: Susanne Dürr, TUM Institute for Medical Microbiology, Immunology and Hygiene



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