Malaria is fighting back! Recently, the World Health Organization declared that Algeria and Argentina have eliminated malaria. They joined 38 other countries that have bade malaria farewell.
Algeria will be regarded as a particular success because it is in Africa as the continent suffered 90 percent of an estimated 219 million cases worldwide in 2017.
Despite the Algeria success rests two big clouds which darkens the outlook. One, is the stubborn persistence of malaria, south of the Sahara. The other, is the emergence of new strains of the disease resistant to the available treatments.
About three-quarter of the $3.1bn the world spends to fight malaria each year goes to Africa, but no thanks to abundance of problems particularly, shoddy public-health systems in most African countries, the growing drug resistant strains of malaria parasite, the inconsistent use of insecticide treated bed nets and the sheer resilience of the mosquito, malaria persists.
The trouble malaria parasite causes especially with children under age five is alarming.
According to the WHO, newborns and infants less than 12 months of age are one of the most vulnerable groups affected by malaria.
During pregnancy, malaria infection in the mother can cause low birth weight and result in infant death.
In malaria-endemic areas, infants once again become vulnerable to Plasmodium falciparummalaria at approximately three months of age, when immunity acquired from the mother starts to wane.
Infants are at increased risk of rapid disease progression, severe malaria and death. The most frequent and widely distributed cause of recurring malaria, Plasmodium Vivax is one of the five species of malaria parasites that commonly infect humans as it is a protozoal parasite and a human pathogen.
Plasmodium vivax malaria is traditionally viewed as a relatively benign form of the disease, can also be a major cause of morbidity and mortality, particularly in infants and young children. Some studies report that a high proportion of severe malaria episodes may be caused by Plasmodium vivax in this age group.
A case of one year old Bryan Udechukwu, taking anti-malaria drugs is almost part of his life. Diagnosed of malaria, November 2018 at seven months of age, little Bryan still suffers from the disease despite all medical intervention.
His mother, Mrs Caroline Udechukwu, 35, public servant and who resides in the Aguda area of Lagos state, said in an interview, “my son has being suffering like this. Since that November, every month, he takes anti malaria drugs after a laboratory test is carries out.”
Despite following WHO recommended interventions for the prevention and control of malaria in infants, Bryan still suffers from malaria.
WHO recommends; the use of Long-Lasting Insecticidal Nets, LLINs, ; Intermittent Preventive Therapy with sulphadoxine-pyrimethamine for infants ,IPTi, in areas of moderate to high transmission in sub-Saharan Africa; prompt diagnosis and effective treatment of malaria infections.
As malaria fight back with strong resistance to drugs, baby Bryan could not get treated even with the best of anti-malaria drugs.
The mother of Bryan, Mrs Udechukwu, who bears the burden of looking after her child whenever he falls sick says.
“I am heartbroken. While he was taking the drugs, the temperature was still the same between 37° and 38.8°. The feverish feeling was still there, I felt maybe after he finishes with the prescribed dosage, all will be fine but between two to three days after, the temperature increases again,” she explained tearfully.
According to World Malaria Report 2018, an estimated 93 percent of all malaria deaths occurred in Sub-Sahara Africa and in children under five who accounted for 61 percent of all deaths.
However, the Malaria Indicator Survey 2015 revealed a decline in malaria prevalence from 42 percent in 2010 to 27 percent in 2015.
The report also said in 2018, there are 219 million cases of malaria globally in 2017 and 435,000 malaria deaths.
These represent a global decrease in malaria cases and death rates to 18 percent and 28 percent respectively between 2010 and 2017.
Despite this report, malaria has remained a major public health challenge in Nigeria, as it is responsible for 30 percent of childhood morbidity, 25 percent mortality and among the pregnant women, it accounts for more than 1 in 10 deaths.
In Lagos State, malaria is responsible for more than 70 percent of the outpatient attendance in the public health facilities. More than 400,000 cases are reported annually.
This is more reported in children under five years and in pregnant women where the infection can be very serious
But with the growing drug resistance, Dr. Babatunde Puddicombe, President, Nigeria Society of Malaria, said it is high as most malaria drugs coming in are substandard.
Giving an instance, he said, “there was a survey at Idumota where about 20 different brands of malaria drugs that were not registered are being sold. The control is not as what it used to be. Fake drugs are getting into the country left, right and centre.”
Puddicombe advised that government should put in adequate control measures to curb fake drugs, adding that, “for drug purchase, people should buy drugs with Scratch Pads and from credible pharmacy.”
He said government should channel more efforts to drugs generally not just malaria as more people may be dying from malaria with the thought of taking adequate treatment.
He further added that NAFDAC should be adequately funded as it will spur the agency to perform excellently as well as carry out more activities to control the influx of fake substandard drugs in Nigeria.
On the need for research, Dr. Sam Awolola, Director, Malaria Research at Nigeria Institute for Medical Research, NIMR, said government should provide the enabling environment to carry out research.
He said that, “we all need to recognise the fact that malaria is still a major problem and we need to do something by playing our own role in our environment by ensuring we don’t have stagnant water around.”
He however said that as a Nation, a lot of progress have been made. “In the past, you will hear, malaria has been over diagnosed. We are getting it right through figures of malaria prevalence in the country now. In terms of intervention, we have moved forward but a lot is still needed to be done as Nigeria’s malaria prevalence is still high.”
According to him, Nigeria is still very far from malaria elimination, hence government as well as partners need to do more work, stressing that it should make sure that malaria intervention is evidence base as research is key to fighting malaria.
Awolola added that Nigeria’s budget for research is poor, “we depend on donor and we can’t do that forever. The country should own up to research funding, then we can say that we are in control and be able to make much impact.”
A medical doctor and chief medical research fellow, Dr. Bamboye Afolabi, said malaria has been with the country for a long time.
He said the fund allocated to combat malaria is not as it should but with the huge support from partners like WHO, USAID, DFID, in Nigeria, is gradually fighting malaria.
Dr. Afolabi, who is also the Chief Executive Officer of Health and Environment Foundation, said that “Nigeria is a diverse country with different eco system like; desert, coastal, savannah, low land and high land, malaria in all these system is different and it needs a systematic approach to control it.”
According to Afolabi, “there is challenge of poor power supply as once one sleep under the insecticide treated net and there is no power, the heat it generates would make one remove the net.”