The issue of malaria and the age long struggle to put it under control is once again brought to the front burner. This time around is not supposed to be business as usual as the World Health Organisation (WHO) is intent on working towards the total eradication of malaria from the planet earth. Editor, MORGAN NWANGUMA takes us into the heart of the renewed battle to put the killer disease in check, but this time, on a permanent basis.
The 25th of April every year is a constant reminder either for good or for bad, depending on the way you choose to look at the case of malaria which has spelt tragedy for many families and communities. The scourge brought on by the tiny annoying flying insect called (anopheles) mosquito is one that the entire globe has for long sought for solutions, and continues to do so.
And as the whole world comes together again to seek new strategies to combat this deadly disease one can only wish that perhaps this time around the World Malaria Day events will be one that wages the war against the killer disease in a way that it had never been fought before. For almost half of the entire world, each day tends to come with its anxiety – it is either you are going to bed with the mosquitoes or you are doing something consistently about them.
Renewing the war against malaria
Until a lasting solution is found however, either by way of a vaccine against malaria or outright eradication of mosquitoes from our world, all we can continue to do is up the ante in raising many more advocacy platforms for civil society groups to further mobilise, with the efforts of various governments to renew the battle against malaria. According to official reports, in 2013 alone there were 198 million cases of malaria, out of which 584,000 deaths were recorded from the attack while about 3.2 billion people of the entire world’s population are said to be at constant risk.
As at today the world is still at a quandary as regards what can be done to totally eradicate the scourge of malaria which is spread through the bite of the plasmodium parasite carrying female anopheles mosquito. And so the world is looking to how we can close up gaps in the treatment and prevention approach to defeating malaria. Last year in Geneva the World Health Organisation called out for as much; the world body is concerned about how agencies and countries as well as the global health community in general can come to urgently address major gaps in the ongoing effort to prevent, diagnose and treat malaria.
Fate might actually be smiling at the clarion call pushed out by the world body; at the heels of it, international donors are squaring up to unleash bigger support towards the malaria elimination struggle. Just in 2015 the British government and Bill Gates Foundation announced an expanded funding partnership to enable further research into the disease.
In the process British chancellor, George Osborne, and the Microsoft founder announced a £3bn funding agreement to fight the ‘world’s biggest killer’; it will run for a period of five years. With such concerted efforts there are high hopes for the near future. In a joint statement the two officials wrote “We are optimistic that in our lifetimes we can eradicate malaria and other deadly tropical diseases, and confront emerging threats, making the world a safer place for all.”
It is important to note that World Malaria Day was instituted by WHO Member States during the 2007 World Health Assembly and is celebrated on 25 April each year. It is an occasion to highlight the need for continued investment and sustained political commitment for malaria control and elimination. For this year we are hoping that it will not just be another time for ‘celebration’ but a time to set new and unique agenda for the final eradication of the disease even if it means killing off all the mosquitoes especially in the tropics where they are very much at home.
Even though malaria (parasite) is said to be naturally endemic mainly in the countries of the tropics, the disease has often been diagnosed and treated in countries outside the endemic regions. For instance, records have it that about 1,500 cases of malaria are diagnosed in the United States of America each year. But it is instructive to note that the vast majority of cases in that country are in travellers and immigrants who are making their way back from parts of the world where malaria transmission is prevalent, including sub-Saharan Africa and South Asia.
It is therefore heart-warming to know that the theme chosen for this year’s World Malaria Day is “End Malaria For Good”. This is in tandem with the hopes and aspirations of billions of people all over the world most of whom reside in Africa and the tropics. As it is, many more hands have to be on deck with more cogent and far reaching approach lined out for the battle ahead in the malaria fight. The malaria menace does not seem to be abating for the basic reasons that mosquitoes still find breeding and hiding places within our neighbourhoods.
Even though malaria is transmitted only through the bite of the (female) anopheles mosquito, there are yet different types of parasites that are transmitted thus. There are four kinds of parasites that cause humans to come down with the malaria disease: Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae.
Apart from these, there is also the Plasmodium knowlesi, a type of malaria that naturally infects macaques (a breed of short-tailed monkey of rocky regions of Asia and Africa) in Southeast Asia; it also infects humans, leading to malaria attack that is transferred from animal to human (“zoonotic” malaria). Plasmodium falciparum is the type of malaria that is most likely to result in severe infections and if not quickly tackled, can be easily fatal. Although malaria can be a deadly disease, illness and death from malaria can usually be prevented.
The cost of cracking down on mosquitoes
Further statistics reveal that in 2014, 97 countries had on-going malaria transmission, but the global malaria mortality rate was reduced by 47% in 2000 – 13, and an estimated 4.2 million lives were saved as a result of a scale-up of malaria interventions. But again, the cost of the malaria war is very expensive and even has to be further scaled up for that matter if the human race is to be on the winning side. For instance WHO estimates that about US$ 5.1 billion is needed every year, which means to meet that requirement the available funding needs to be doubled.
And as a consequence of the malaria scourge, the human race is also incurring an estimated regular and direct annual loss of up to USD 12 billion. Thus the theme for this year’s World malaria Day is one that avails the world community an opportunity, working leverage as well as an enabling common platform to showcase their successes so far in their efforts to control malaria. It also brings about an opportunity to try and harmonise the diverse initiatives in the changing global context.
Suffice it to say that malaria endemic countries have made tremendous strides over the past decade to fight malaria; yet sustaining these laudable efforts will take so much extra efforts for the job to be fully done until that day when we will wake up to discover that we have totally eradicated mosquitoes or malaria from the surface of the earth. While efforts are increasing to deal with the disease worldwide, funding is rather not able to match up with the required scaled up onslaught especially in the malaria endemic countries in Africa where efforts and funding needs redoubling.
These have been some of the major challenging factors so far regarding the three main battle fronts of – diagnosis, treatment as well as prevention of malaria. And unless the world is able to work out a solution towards bridging the funding gaps, and endemic countries are able to access resources and the technical support needed to execute sound malaria control plans, malaria resurgence will likely claim many more lives.
The problems of the tropics and especially Africa continue to pose immense challenge to the effective control of malaria in the world owing to the underlying encumbrances. Statistics still show that for instance, most (about three-quarter) of all malaria related deaths in the world occur in Africa. Majority of the deaths are of course within the children aged five and below; the problem is exacerbated by the fact that an estimated 278 million people in Africa still live in households without a single insecticide-treated bed net owing to the same reasons adduced earlier.
As if the problem of inadequately protecting the toddlers in Africa is not enough, what about the issues relating to protecting pregnant women? Available reports also show that for instance, in 2013, only about 1 in 5 children that had malaria in Africa received effective treatment for the disease. Also, about 15 million expectant mothers were not able to receive a single dose of the recommended preventive drugs; the challenge is that daunting.
Treatment
The World Health Organisation has since 2015 launched its updated “Guidelines for the Treatment of Malaria”. It recommends among other things, that for uncomplicated malaria cases, treatment should involve the use of artemisinin-based combination therapies (ACTs). Worldwide, up to 392 million ACT courses were procured by malaria-endemic countries in 2013 which was a marked increase from the 2005 figure of 11 million. But even at that, reports are rife that so many millions of people still do not get treated adequately for malaria due to the fact that the communities most affected lack adequate access to drugs and healthcare facilities.
For effective treatment and control however, WHO recommends that proper diagnostic testing be carried out on patients who present symptoms to ensure that only patients with malaria are treated with malaria drugs. It also states that whereby the diagnoses prove negative for malaria then other causes of fevers must be investigated and dealt with accordingly.
The world body further recommends that the most vulnerable groups in the malaria-endemic areas of Sub-Saharan Africa – pregnant women, children under 5, and infants, be made to receive preventive malaria treatments so as to curtail the risk of getting infected at this stage. In the long run however, it is believed that this pattern is able to eventually drastically reduce the cost of controlling the disease apart from the huge economic benefits and preservation of so many lives that will be gained.
But reports state that this form of preventive care is still highly limited in its coverage areas and therefore needs to be stepped up. Also the Roll Back Malaria (RBM) Partnership worldwide has over the last few years been able to draw attention to the needs arising from these shortfall and gaps emanating from inadequate preventive treatment; this is of course with due emphasis on the need for increased national coverage regarding treatment in pregnancy.
Prevention
Pending when the world would have completely eradicated malaria perhaps through the total extermination of the parasite vector – mosquito, the only option we are left with now is preventive measures. The measures for malaria prevention are equally as varied as they apply to different people. If for instance you are travelling form a non-endemic region to an endemic location e.g. Western Europe to West Africa, you will need to take preventive medication. The medication should be taken before, during and after you are exposed to the mosquitoes in those areas.
Even if you are permanently living in a malaria endemic place such as Nigeria, you can also be placed on a weekly anti-malarial medication which the doctor can prescribe for you. Moreover, there are other common preventive measures and control you can adopt to stay free of the disease as much as possible. These will include making sure your house is screened with mosquito netting at the doors and windows, etc. Another important way to surviving the mosquitoes menace is for you to sleep under bed net.
Also, ensure to either stay away from stagnant water or prevent stagnant water from being anywhere around your environment. Stagnant water such as in gutters, potholes, old and disused tyres are ready breeding grounds for mosquitoes and need to be taken care of. Other methods of prevention may include the use of insecticide sprays and mosquito coils, as well as the wearing of long sleeves and pants so as to drastically reduce the number of mosquito bites you are likely to get.
As we celebrate this April, prevention must be at the forefront of our exploits to combat malaria. And in the words of Dr. Hiroki Nakatani, WHO Assistant Director-General “… we must recognise the urgent need to expand prevention measures and quality-assured diagnostic testing and treatment to reduce the human suffering caused by malaria.”
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