Malaria is preventable and curable, yet many people die from it. Why? Because they do not pay attention to the disease until it is too late. The World Malaria Day was celebrated last Friday. OYEYEMI GBENGA-MUSTAPHA and WALE ADEPOJU examine the simple ways of eliminating the disease.
Compared to other ailments, the public tends to treat malaria lightly. People do not take the disease serious until it appears to be getting out of hand. That is when they start to run helter-skelter in search of treatment. Malaria kills faster than diseases, such as cancer, diabetes and tuberculosis (TB).
Malaria is a life-threatening ailment caused by anopheles mosquito.
The parents of a child suffering from malaria may not take it seriously until the child is almost dead.
According to the World Health Organisation (WHO), about 627,000 deaths mostly among African children, occurred in 2012. They were caused by malaria. In Africa most deaths among children are caused by malaria with a child dying every minute.
However, malaria mortality rates since 2000 among children in Africa have been reduced by an estimated 54 per cent .
Drawing attention to the importance of eliminating the disease, WHO from 2013 to 2015 has chosen “Invest in the future, defeat malaria,” as the theme for its campaign against malaria. April 25 of every year is set aside to highlight the need for continued investment and sustained political commitment to malaria control and elimination.
According to WHO Director- General Dr Margaret Chan increased political commitment and the expansion of global malaria investments have saved some 3.3 million lives since 2000. And she has certified four countries malaria-free. They are the United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010) and Armenia (2011). She wished more countries would obtain such certification.
WHO said: “It has been discovered that increased malaria prevention and control measures can dramatically reduce the malaria burden in the countries with malaria, such as Nigeria. And with increased political commitment, advances in diagnostic testing and treatment and financial support from the Global Fund to fight AIDS, Tuberculosis and Malaria, Nigeria can win the war against malaria and move from the seven countries described by WHO as having reduced transmission to zero and are in the “prevention of re-introduction phase”.
To put the epidemic behind as a nation, Lagos State Health Commissioner, Dr Jide Idris, said attitudinal change on preventive measures, including use of long-lasting insecticide treated nets (LLITNs), keeping the environment clean and presumptive treatment of fever cases as malaria should be adopted by all.
“Accurate diagnosis of malaria will significantly improve the quality of patient care, ensure that antimalarial medicines are used rationally and correctly and serve as basis for more accurate surveillance data. For example in Lagos, transmission of malaria is stable and all year round.
“About 570, 000 cases were reported last year compared to 566, 215 cases in 2012 on the disease surveillance and notification report. This could be attributed to the cosmopolitan nature of Lagos, the abundant distribution of coastal areas, and the behavior of many of its inhabitants, which encourage the availability of stagnant water resulting in breeding sites for the anopheles mosquito.”
Dr Jide Idris said Lagos was able to record such stability because the presumptive treatment of all fever cases as malaria has been phased out, “as all our health facilities have been equipped with Rapid Diagnosic Test (RDT) kits and or microscopes for diagnosis, while Artemisinin Combination Therapy (ACTs) antimalarials are provided free for treatment. “Pregnant women are also given Sulphadoxine Pyrimethamine (SP) for intermittent preventive treatment of malaria during antenatal clinics,” he said.
According to a Senior Medical Officer /Malaria Programme Officer, Lagos State Ministry of Health, Dr. Victoria Omoera, the simple understanding of mode of transmission, control and elimination are important in defeating the disease.
Dr Omoera said: “Malaria is transmitted exclusively through the bites of Anopheles mosquitoes. The intensity of transmission depends on factors related to the parasite, the vector, the human host and the environment. About 20 anopheles species are locally important around the world. All of the important vector species bite at night. Anopheles mosquitoes breed in water and each species has its own breeding preference; for example some prefer shallow collections of fresh water, such as puddles, rice fields, and hoof prints.”
She continued: “Transmission is more intense in places where the mosquito lifespan is longer (so that the parasite has time to complete its development inside the mosquito) and where it prefers to bite humans rather than other animals. For example, the long lifespan and strong human-biting habit of the African vector species is the main reason why about 90 per cent of the world’s malaria deaths are in Africa.
“Transmission also depends on climatic conditions that may affect the number and survival of mosquitoes, such as rainfall patterns, temperature and humidity. In many places, transmission is seasonal, with the peak during and just after the rainy season. Malaria epidemics can occur when climate and other conditions suddenly favour transmission in areas where people have little or no immunity to malaria. They can also occur when people with low immunity move into areas with intense malaria transmission, for instance to find work, or as refugees.”
“Human immunity”, Dr Omoera said, “is another important factor, especially among adults in areas of moderate or intense transmission conditions”.
She said: “Partial immunity is developed over years of exposure, and while it never provides complete protection, it does reduce the risk that malaria infection will cause severe disease. For this reason, most malaria deaths in Nigeria occur in young children, whereas in areas with less transmission and low immunity, all age groups are at risk.”
Though experts are researching into ways of treating malaria, especially developing a vaccine, but according to the Medical and Regulatory Affairs Director, Sanofi, a pharmaceutical firm, Dr. Fifen Inoussa, “there are currently no licensed vaccines against malaria or any other human parasite”.
A research vaccine, RTS S/AS01, against P. falciparum, the parasite responsible for malaria, is the most advanced. This vaccine is being evaluated in a large clinical trial in seven countries in Africa.
A WHO recommendation for its use will depend on the final results from the large clinical trial. The final results are expected later in the year, and a recommendation whether or not it should be added to the existing malaria control tools is expected late next year.
“At the moment, there are pharmaceutical products that conform to WHO recommendations of combination therapy. For several years, Sanofi has had strong ambition for Africa’s generics market. Through its subsidiary Zentiva, Sanofi is developing a portfolio of affordable quality generics,” said Dr Inoussa.
Deputy Director, Health Education, Lagos State Ministry of Health, Dr Omowunmi George said keeping the environment clean; cutting grasses low; keeping the drains free of materials that can block same and desisting from lining walls with objects that can retain water for mosquitoes to breed are some of the proactive measures in eliminating malaria.
She said: “For individuals, personal protection against mosquito bites represents the first line of defense for malaria prevention. Two forms of vector control are effective in a wide range of circumstances. They are insecticide-treated mosquito nets (ITNs) and indoor residual spraying (IRS).”
She continued: “Lagos has tried these and they worked. Long-lasting insecticidal nets (LLINs) are the preferred form of ITNs for public health distribution programmes. WHO recommends coverage for all at-risk persons; and in most settings. The most cost effective way to achieve this is through provision of free LLINs, so that everyone sleeps under a LLIN every night.
“Indoor residual spraying (IRS) with insecticides is a powerful way of rapidly reducing malaria transmission. Its full potential is realised when at least 80 per cent of houses in targeted areas are sprayed. Indoor spraying is effective for three to six months, depending on the insecticide used and the type of surface on which it is sprayed. DDT can be effective for nine to 12 months in some cases. Longer-lasting forms of existing IRS insecticides, as well as new classes of insecticides for use in IRS programmes, are being developed. Antimalarial medicines can also be used to prevent malaria.”
