Some 660 million Africans—almost 70 percent of  the population—remain at risk of  malaria. It is the continent's biggest public health problem. In the words of  former pharmaceutical giant GlaxoSmithKline's Chief Executive, JP Garnier, “with malaria, the battle is colossal: three million people die each year because of  the disease—mostly infants, young children and pregnant women. One child every 30 seconds, with malaria, it's 9/11 each and every day.” The cost in Gross Domestic Product (GDP) terms is an estimated US$ 12 billion annually.

Fifty years ago, the continent-wide strategy to fight the problem was spraying the pesticide DDT (Dichloro Diphenyl Trichloroethane ). It checked the population of  mosquitoes that carry the malady. The hugely successful campaign came to a halt when the environmental consequences of  DDT came under scrutiny, with only South Africa holding on to the measure.

South Africa succumbed in 1996—and witnessed a resurgence of  malaria, its worst in a quarter-century. Further, the malaria situation in Africa worsened with Research Unit: “Twice in the past,

South East Asia has the advent of  drug resistance. Says Prof Nick Day, Director of  Mahidol-Oxford Tropical Medicine made a gift, unwittingly, of  drug resistant parasites to the rest of  the world, in particular to Africa. We've had chloroquine and SP (sulfadoxine pyrimethamine) resistance, both of  which have caused major loss of  life in Africa.”

ACTs will see us through? In 1948, the World Health Organisation began malaria control programmes, spraying mosquito-breeding sites
with insecticides and administering anti-malarial drugs. For a while, it appeared that the disease might be eliminated, or at least brought under control. But by the late 1970s malaria resurfaced, seemingly with new-found vengeance.

Mosquitoes developed resistance to insecticides, as did the malaria parasites to traditional chloroquine-based anti-malarial drugs. Urban malaria began spreading
fast, largely as a result of  the growth of  squalid shanty towns that provide numerous pools of  standing water where mosquitoes can breed. Civil conflict and natural disasters such as floods (later compounded by weather phenomena  such as El Niño) contributed to malaria's lightning spread with deadly ease.  The seriousness of  the problem 50 years later prodded the WHO, acting

in concert with other international groups, to launch Operation Roll Back Malaria (RBM). It aimed to intensify monitoring, prevention, and treatment efforts, the ultimate objective being the development of  an anti-malarial vaccine. The best experimental vaccine so far has demonstrated efficacy only 30 percent to 50 percent of  the time. The urgent need for an all-inclusive effort to count and quantify progress and the impact in the fight led the leadership of  the  RBM Partnership to propose a theme for the 2009 World Malaria Day (April 25), packed to reverberate till the following year: “Counting Malaria Out”.

The first part has seen a massive scale-up in anti-malaria programmes. Apart from an already approved US$1 billion, there's a pledge of  a staggering $2.9 billion. The US President's Malaria

Initiative and the World Bank's Booster programme have scaled-up operations; substantial malaria reductions have been achieved in Zambia. There has been increase in private sector investment in places like Angola, Nigeria and Ghana.

One decade after, in November 2009, the Multilateral Initiative on Malaria (MIM) Pan-African Malaria Conference is bringing together 1,500 leading

researchers, activists, health workers, public health officials and policymakers—the world's largest gathering of  the malaria community-- to Nairobi, Kenya. The conference would feature plenary sessions and presentations and unveil new findings in malaria research and address major challenges in the field on the road ahead.

Me a nwhi l e,  Wor l d He a l t h Or g a ni s a t i on recommended measures for controlling malaria now consist in prompt and effective treatment with artemisinin-based combination therapies (ACTs), use of  insecticidal nets by people at risk and indoor residual spraying with insecticide to control mosquitoes.

Infection-based tests for malaria now exist which can be quickly carried out even in settings where a well-resourced laboratory is not available. It has been estimated that 730 million long lasting nets and 228 million treatments will be needed over the next two resources. years. But challenges remain that impede progress, likebureaucracy and lack of  financial and human resources.