Winning the battle against malaria

Malaria occurs in nearly 100 countries worldwide, exacting a huge toll on human health and imposing a heavy social and economic burden in developing countries particularly in sub-Saharan Africa and South Asia.

Nigeria and Democratic Republic of Congo account for more than 40 percent of all malaria deaths worldwide. In spite of several years of research and rigorous efforts at control, attainment of a malaria free world remains a vision. The World Health Organisation (WHO) in its 2013 World Malaria Report estimates that 207 million cases of malaria occurred globally in

2012 and 627,000 associated deaths recorded. Most of these cases and deaths occurred in Africa and mostly among children under 5 years of age.

Linguistically, the word malaria is derived from 18th century Italian “mala” meaning “bad” and “aria” meaning “air” attesting to the belief of the people that the disease was caused by foul air in marshy areas. But later in 1880, scientists discovered that malaria was a parasitic disease transmitted by the Anopheles mosquito which infects the host with a one cell parasite called plasmodium. It is transmitted from one person to another through the bite of female specie of the anopheles mosquito which needs blood for her eggs.

The female anopheles mosquito transmits the malaria parasite to a human being when it bites after having previously bitten an infected person.

It carries the parasite in its saliva and in the process of biting the host it deposits the plasmodium in the blood stream. Malaria can also be transmitted from mother to her baby during delivery, through organ transplant, sharing of needles and syringes and during the process of blood transfusion.

There are 5 types of malaria named after the causative specie of plasmodium. Plasmodium vivax is a milder form that has the widest demographic distribution globally and it has an incubation period of 12-18 days. Plasmodium ovale like its vivax counterpart also has an incubation period of 12-18 days and it is also a milder form that can remain in the body for years without causing sickness.

Malaria caused by plasmodium malariae is a milder form that stays in the body for several decades and it has an incubation period of 18- 40 days.

But Plasmodium falciparum on the other hand is a severe form of malaria.

It is most common in Sub Saharan Africa while Plasmodium knowlesi mainly affects animals but in rare cases can affect humans.

Depending on the type, the sufferer’s level of immunity and the condition of the host’s spleen, malaria can present with a number of symptoms. These include; high temperature, chills, headache, sweats, tiredness, nausea and vomiting. Other common symptoms are, dry cough,

dry cough, back pain and muscle ache. It can also present with rare symptoms like impairment of brain and spinal cord functions, seizures and loss of consciousness among others.

Malaria is preventable and treatable and history shows that it can be eliminated because less than a century ago, it was prevalent across the world, including Europe and North America. But by the mid 1930s, it was eliminated in most of West Europe, while the United States achieved elimination of the disease in 1951. The disease is endemic throughout Nigeria and it has continued to pose a major challenge to our healthcare delivery system as a large number of outpatient hospital attendances are people suffering from malaria. Of deep concern to discerning minds about this, is the effect of this on maternal and child health as well as bi-

directional link between malaria and economic development.

 In its bid to control and consequently eliminate malaria, the World Health Organisation recommends a multi-pronged strategy. This encompasses vector control interventions, preventive therapies, diagnostic testing, treatment with quality assured Artemisinin based

Combination Therapies (ACTs), and strong malaria surveillance. Due to the cosmopolitan nature of Lagos, the abundant distribution of coastal areas, and the behaviour of many of its inhabitants, which encourage the availability of stagnant water resulting in breeding sites for the anopheles mosquito, transmission of malaria is stable and all year round.

Therefore, the Lagos State Government, under the auspices of the Lagos State Malaria Research, Technical and Advisory Committee (LASMARTAC)- with members drawn from Teaching Hospitals, Research Institutions, College of Medicine, Ministries, Parastatals and Development Partners- which is tasked with ensuring that all malaria control interventions implemented in the state are backed by scientific evidence and are cost effective, has employed this recommended multi-pronged approach for malaria elimination. The strategies are in line with the newly developed National Malaria Strategic Plan for 2014- 2020.

This comprises the use of Long Lasting Insecticide Nets (LLINs) distributed throughout the state and Indoor Residual Spraying (IRS) and Larviciding- the application of chemicals to mosquito breeding sites in communities for larva control. The State Government, in collaboration with its partners, has equipped all its health facilities with Rapid Diagnostic Test (RDT) kits for diagnosis; while Artemisinin Combination Therapy (ACTs) anti malarias are provided free for treatment in all its health facilities.

Also, in order to eliminate malaria, the Bill and Melinda Gates Foundation has provided about 50% of international funding for malaria control worldwide by making the eradication of the disease a top priority through its new multi-year malaria strategy; Accelerated to Zero, adopted in late 2013.

However, in order to sustain and successfully win the battle against malaria in the country, everyone must come on board. Just as governments, at all levels, have the responsibility to strengthen the health system, individuals and other groups in the society also have a big stake in the project. For instance, we all have the responsibility of protecting ourselves and loved ones from malaria by using insecticide treated nets, draining stagnant water and keeping our environment clean.

As Nigeria joins the rest of the global community to celebrate the World Malaria Day with the theme “Invest in the future: defeat malaria”, it is essential that investment in malaria control continues, so that the gains made so far would be sustained towards preventing further deaths from the disease. And in the long run, complete eradication, which is the ultimate goal can become achievable.

BILIKIS BAKARE