The battle to eliminate the malaria parasite has evolved over the years. Yetunde oladeinde reports.
MALARIA is an infectious disease caused by the parasite of the genus plasmodium, which is transmitted by the bite of an infected female anopheles mosquito. There are four species of the parasite that have been identified to be causing human malaria; Plasmodium falciparum (Pf), Plasmodium vivax (Pv), Plasmodium malariae (Pm) and Plasmodium ovale (Po). In Nigeria, 98% of malaria infections are due to Pf. This parasite causes the most deadly form of malaria, known as severe malaria. Other forms of malaria present in Nigeria include P. ovale and P. malariae which play a minor role with the latter being quite common as a double infection in children.
Malaria is a disease that could be easily prevented and a leading cause of morbidity and mortality in Nigeria. Statistics show that more than 60% of the outpatient visits in Nigeria are due to malaria, and over one million children and pregnant women die yearly from the disease. The objectives of the malaria treatment according to the malaria treatment are curing the disease and eliminating the parasites from the body. It is also important to prevent progression to a severe disease.
Busola Bamishaiye has been working on the field, monitoring and sensitising people about new trends in malaria in some states in the past few years. She disclosed that ACT is the approved drug. According to her, “even these drugs are a combination of two different anti malaria; it cures and eradicates the parasite completely.”
Bamishaye added that “in malaria we have treatment for complicated and non-complicated malaria. If the complicated type is discovered then they are referred to the comprehensive centres for proper management where this can be handled. We cover over 21states. In 2004 when we came in, the rate of malaria was very high but with the interventions things have changed. So far the prevalence of malaria in the state is changing and we hope that by the time we get into the second phase of the programme things would get better.”
To facilitate the project, Bamishaye said that there has been support from some donor organisations, the federal government as well as some state governments. “We work in conjuction with the World Bank to fight malaria in Nigeria. Presently, we are working in Ekiti State. Malaria is one of the major health issues in sub Saharan Africa, especially in Nigeria. Out of every ten patients in the hospital at least four are affected by malaria. The rate at which it kills is faster than any other disease in Nigeria. The latest drugs in use now are so expensive and so many states cannot afford them; that is why the federal government and other stakeholders are involved.
She stated: “Between 2009 and now about 1.5 million nets were brought to Ekiti State and there has been lots of campaigns. If nets are used properly, the rate of malaria would have reduced drastically. As at now things have changed and the primitive beliefs about the things that cause malaria have changed. In the past they used more of herbs and concoctions, but now there is the awareness of free treatments.”
Her organisation, SHI-Nigeria, is one of the initiatives that have helped to reduce malaria. Bamishaiye said: “We are involved in malaria programming as a sub recipient to the National Malaria Control Programme in some states of the federation. Other activities of the organisation include procurement and supply chain management and distribution of health commodities for other organisations.”
As a sub recipient to the National Malaria Control Programme in the Global Fund R8 Malaria grant, SHI is working to ensure effective malaria control delivery in line with the National Strategy for combating malaria. “This is aimed at achieving timely and equitable access to malaria diagnosis and treatment by all Nigerians through some key intervention programmes. The first is the introduction of parasitological confirmation of malaria cases by quality assured microscopy or Rapid Diagnosis Test. We also have the treatment of uncomplicated malaria with an ACT within 24 hours of fever onset through health care providers,” said Bamishaiye.
Malaria could be suspected malaria: A patient with a fever or history of fever in the last 48 hours who lives in Nigeria, or has come from anywhere or any other endemic country. Uncomplicated malaria: A patient with a fever or history of fever in the last 24 hours who has a positive parasitological test and no symptoms of severe disease.
Severe malaria: A patient with parasitologically confirmed malaria who is ill and has one or more of the clinical manifestations which could be severe anemia, unrousable coma, multiple /repeated generalised convulsions etc.
It is also important to note that chloroquine and sulphadoxine/ pyrimethamine (SP) are no longer effective in treating malaria in Nigeria due to high treatment failures resulting from widespread resistance. Efficacy studies that test the ability of anti-malarial medicines to kill and clear malaria parasites have shown that ACTs are better than chloroquine. ACTs are widely available in all the Global Fund supported health facilities (public and private)
Artemisinin derivatives are the most effective drugs against malaria in the world at the moment and yet if misused the parasites can potentially develop resistance to them. A technique to prevent resistance developing to artemisinin derivatives is to combine them with other anti-malarials so that as a combination there is less possibility of the parasites developing mechanisms to avoid both medicines. It is for this reason that artemisinin derivatives such as artemether, or artesunate are combined with one other anti-malarial medicine to form various types of ACTs
