Anti-malaria campaign on the upswing

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...As world marks ‘Malaria Day’, April 25

Next week Monday, April 25, Nigeria will join the rest of the world to celebrate “World Malaria Day”; a day set aside to recognise the global effort aimed at providing effective control of malaria. It is an opportunity for countries in the affected regions to learn from one another’s experiences and support their efforts;
for new donors to join a global partnership against malaria; for research and academic institutions to flag their scientific advances to both experts and general public and for international partners, companies and foundations to showcase their efforts and reflect on how to scale up what has worked.

The debilitating fever, caused by the parasite Plasmodium species that mosquitoes inject into the human blood stream, has led to death if untreated, with Africa seeing the majority of the world’s 300 million cases of malaria annually. Sadly, with about 90 percent of these deaths occurring in Africa and primarily among children, this has made malaria one of the top three childhood killers, accounting for approximately 20 percent of childhood deaths in Africa.

According to the United Nations Children’s Fund (UNICEF), the Nigerian situation is even more precarious with malaria seen as the highest child-killer disease in the country. Annually, Nigeria is said to lose about 300,000 children to this disease. It is also estimated that half of the adult population suffer from, at least, one episode of malaria annually. All this imposes a heavy social and economic burden, amounting to about N130 billion ($900 million) lost to malaria annually, in prevention, treatment and productivity loss.

With malaria become seemingly intractable due to some strains of the parasite developing resistance to some of these drugs, including Artemisinin-based Combination Therapy (ACT), health experts have called for a proactive approach towards addressing the menace caused by this disease.

Speaking with BusinessDay, Shilaj Chakravorty, consultant pathologist, BT Health and Diagnostic Centre, Lagos State University Teaching Hospital (LASUTH), Ikeja, disclosed that one major reason why malaria fever is still on the upswing is the filthy environment in which many people live, that creates breeding grounds - such as stagnant water, heaps of debris and wild grass for the mosquito vector to thrive.

Chakravorty noted that lack of public enlightenment on preventive measures and on the best drugs to take and when, are among other factors responsible for the continued spread of malaria.

According to the pathologist, “There is a risk of artemisinin resistance emerging silently in areas without ongoing surveillance. Since ACT is the drug of choice, there is the need for increased monitoring and surveillance for artemisinin resistance. Also, there is the need to improve access to malaria diagnostic testing and rational treatment with ACTs. This is because these therapies are frequently used to treat causes of fever other than malaria.

“Don’t forget that unnecessary use of ACTs can increase the risk of resistance. There is an urgent need to develop more rapid techniques for detecting resistant parasites, and to develop new classes of anti-malaria medicines to eventually replace the ACTs. The success of the global plan will depend on a well-coordinated and adequately funded response from many stakeholders at global, regional and national levels,” Chakravorty added.

Wellington Oyibo, consultant medical parasitologist, College of Medicine , University of Lagos , Idi-Araba, Lagos , disclosed that those who suffer most from malaria are some of the continent’s most impoverished even as an indigent family living in malaria may spend up to 25 percent or more of its annual income on prevention and treatment. Oyibo noted that appropriate treatment needs to be made available and accessible to the poorest groups in the community even as maximum vigilance is done by health authorities to prevent the re-emergence of malaria.

In his words, “there is the need to stimulate the development of malaria vaccines appropriate for Africa and provide similar incentives for other anti-malaria technologies. More importantly is the need to strengthen and sustain collaboration of research institutions in Nigeria and with partners throughout the world. In this way, appropriate drugs to combat resistant parasites is developed thus reducing the chances of frequency of parasite developing resistance to some anti-malaria drugs.

Taking a cursory look at the African continent, malaria has continued to slow economic growth by 1.3 percent annually. With the Federal Government spending about N135 billion on the treatment of malaria annually as revealed by Babajide Coker, coordinator, Roll-Back-Malaria Programme, there is no gain saying that malaria treatment is putting a lot of pressure on the nation’s resources.

For Coker, “the spending would be reduced now that government only picks part of the bill under a programme known as Affordable Medicine Facility for Malaria (AMFM). Under AMFM, the Nigerian government and some development partners is co-funding an anti-malaria drug supply programme to make the drugs available and affordable. The Federal Government, the Global Health Funds, and other health partners are subsidising the cost of Artemisinin; for instance, by as much as 95 percent of its cost, leaving the remaining 5 percent to be paid by the consumer.

Together with the Global Funds and other partners, what happens is that we needed to subsidise the cost of ACTs. We are subsidising the cost to the ACTs to the tune of about 95 percent so that the manufacturers would bring the ACTs at the cost that could be comparable to the cost of Chloroquine. We are thinking that by the time it rolls out, we should be able to access the ACTs between N75 and N100. It is believed that this will be affordable even up to the community level.”

No doubt, combating the menace of malaria and child health care in general involves all tiers of government and must be sustained in order to achieve the related lofty objectives of the Millennium Development Goals.
In addition, effective mosquito control tools (including long-lasting insecticidal nets and indoor residual spraying) and medicines for early, effective termination of human infections (including artemisinin-based combination therapy) are available today, with which substantial reductions in the malaria burden have and can be achieved.

With these tools, elimination of local transmission can be possible in areas where transmission is marginal.