Although a preventable and treatable disease, malaria continues to have a devastating impact on the health and livelihood of people around the world. According to the World Malaria Report, in 2020, there were about 241 million new cases of malaria and 627,000 malaria-related deaths in 85 countries.
However, the African region carries a disproportionately high share of the global malaria burden. Africa was home to 95 percent of malaria cases and 96 percent of malaria deaths in 2020, with children under 5 accounting for about 80 percent of all malaria deaths in the region. Four African countries (Nigeria, the Democratic Republic of the Congo, Tanzania, and Mozambique) accounted for just over half of all malaria deaths worldwide.
Despite steady advances in reducing the global burden of malaria, progress has stalled in Africa in recent years, particularly because of disruptions to health services caused by COVID-19. There is an urgent need for African governments to take concerted actions to reignite the momentum towards achieving the 2030 targets of the global malaria strategy.
There is also a challenge of the growing rate of mosquitoes’ resistance to older insecticides and parasites’ resistance to antimalarials. These factors, compounded by the weak health systems in Africa, result in difficulty curbing malaria on the continent
Impact of malaria on public health in Africa
Malaria is one of the most severe public health problems globally. In Africa, it is a leading cause of death and disease, with the most vulnerable groups being young children, who have not developed immunity to malaria yet, and pregnant women, whose immunity have been decreased by pregnancy. These groups make up the most fatal cases of malaria in Africa.
Apart from the direct impact of malaria on morbidity and mortality, the human and economic costs are also significant. Malaria negatively affects school attendance, productivity at work, and evidence shows it can also impair intellectual development. Direct costs (such as illness, treatment, and premature death) have been estimated to be at least $12 billion per year, with the cost in lost economic growth many times more than that.
Challenges impeding the fight against malaria in Africa
Effective malaria control in Africa must take into account the unique challenges faced by the region. One major challenge is the predominant poverty level and poor economic policies. Poor living conditions encourage the breeding of the mosquito vectors, and poor socio-economic conditions limit people’s access to quality healthcare.
There is also a challenge of the growing rate of mosquitoes’ resistance to older insecticides and parasites’ resistance to antimalarials. These factors, compounded by the weak health systems in Africa, result in difficulty curbing malaria on the continent.
Read also: Malaria and child survival in Nigeria
Opportunities and strategies to tackle the malaria burden in Africa
Globally, the last two decades have seen increased access to malaria prevention tools and strategies, including effective vector control and the use of preventive antimalarial drugs. Recent innovations have also created new opportunities for malaria control and elimination. A major achievement is the RTS, S/AS01 malaria vaccine recommended by WHO in October 2021, for children aged six months to five years, living in moderate- to high-transmission settings. The vaccine has been shown to significantly reduce malaria, and deadly severe malaria, among young children.
While this vaccine is a groundbreaking achievement in the development of new tools to fight malaria, supplies are currently limited. African governments must therefore leverage on this opportunity to ensure that the doses that are available are utilized for maximum impact, while ensuring continued availability of other preventive measures to those most at risk.
Other preventive measures that must be strengthened include:
1. Vector control: Vector control is highly effective in preventing infection and reducing disease transmission. The two major interventions are insecticide-treated nets (ITNs) and indoor residual spraying (IRS). However, the emerging resistance to insecticides significantly threatens malaria control. African governments need to invest more in research to develop newer insecticides as well as focus on new strains of malaria arising in the region, which are more difficult to detect and treat.
2. Preventive chemotherapies: This refers to the use of medicines to prevent malaria infections and their consequences. Preventive chemotherapy focuses on vulnerable populations, generally infants, children under the age of 5, and pregnant women. Examples of preventive chemotherapy are seasonal malaria chemoprevention (SMC), and intermittent preventive treatment of malaria in pregnancy (IPTp) and school-aged children (IPTsc), among others. Preventive chemotherapies are safe and cost-effective strategies intended to complement ongoing malaria control activities, including vector control measures, prompt diagnosis of suspected malaria, and treatment of confirmed cases with antimalarial medicines.
Tackling the malaria burden in Africa requires strong political willpower, continuous investment, and commitment from ministries of health, with support from WHO, international and country-level partners. In a World Bank-funded program, Bloom Public Health and its strategic partners will support the Nigerian government in addressing existing gaps in the coverage of malaria control interventions across Nigeria. The project aims to improve the delivery and uptake of malaria prevention and treatment activities in 11 states across the country, to achieve at least 80 percent universal coverage in vector control, seasonal malaria chemoprophylaxis, and case management.
Conclusion
The malaria burden in Africa, although enormous, can be tackled through concerted efforts to scale up innovation and the deployment of new tools in the fight against malaria, while advocating for equitable access to malaria prevention and treatment, and building resilient health systems.
Anyakora is the CEO of Bloom Public Health and a public health expert & Odibeli is a pharmacist and the regional communications manager at Bloom Public Health
