Public Health Multitasking: Measles and Malaria     The Measles Initiative is integrating innovative malaria prevention activities into mass measles vaccination campaigns in Africa. Current plans call for Togo to be the first country to achieve nationwide, household coverage of insecticide treated bednets (ITNs) in six days with plans to distribute 730,000 ITNs during the December 2004 campaign. Insecticide-treated bednets (ITNs) are an important tool to fight death and disease due to malaria, especially in Africa south of the Sahara, which accounts for 90% of deaths due to malaria worldwide. One of the goals of the Roll Back Malaria Partnership is that in Africa south of the Sahara, 60% of the people most at risk (young children and pregnant women) will sleep under ITNs. To date this target has not been met, because too often people who are most in need of the ITNs do not know about them, do not have access to them, or cannot afford them (even a unit cost of $5 is high for a rural African family). These obstacles may be overcome by piggybacking the distribution of ITNs with another health intervention: immunization against measles, another major killer of African children. The Measles Initiative, a partnership including the American Red Cross, Centers for Disease Control and Prevention (CDC), United Nations (UN) Foundation, United Nations Children's Fund (UNICEF), World Health Organization, and International Federation of Red Cross and Red Crescent Societies is a five year commitment to eliminate measles in Africa by vaccinating 200 million children, saving 1.2 million lives. The partnership was created in 2001 and as of June 2004 has vaccinated 120 million children. The Measles Initiative strategy consists of mass vaccination campaigns for children ages nine months to 15 years during one week in a country. Such campaigns draw mothers and children from wide areas and offer one-stop shopping for free, much needed life-saving health opportunities. Recently, ITNs have been successfully integrated in these campaigns: In the Lawra district of northern Ghana, the Ghana Red Cross and its local partners, with additional support from other partners, distributed 14,600 ITNs during a one-week immunization campaign in December 2002. The ITNs were given free of charge to any parent who accompanied a child under five years of age coming to the vaccination post. Measles immunization and ITNs were delivered simultaneously to achieve high coverage at a low cost. Prior to the campaign, only 7% of the families in Lawra district had an ITN; after the campaign 80% did. In Zambia, during one week in June 2003, the Measles Initiative vaccinated five million children under five years old while the International Federation and the Canadian Red Cross provided 90,000 ITNs in five districts. In these districts, household ITN coverage increased from 29% (pre-campaign) to 85%, and measles vaccine coverage reached over 95%. In addition to ITNs, the Zambia campaign also delivered vitamin A and mebendazole (to treat intestinal worms), addressing two other major health problems of children in Africa. The logistical cost for delivering an ITN was US$0.32 and US$0.36 in Ghana and Zambia, respectively. The next step will occur in Togo in December 2004. In the largest health intervention of its kind to date, ITNs will be distributed nationwide: each of the 730,000 households in Togo will receive an insecticide-treated bed net (ITN). Vitamin A, albendazole (to treat intestinal worms) and the polio vaccine will also be given. The intervention will be conducted by the Togo Red Cross and partners that include the Canadian International Development Agency and the Norwegian Red Cross. The impact of this integrated intervention on mortality will be measured.