Challenges, opportunities of malaria scourge in Africa

In the 2020 World Malaria Report, there were about 241 million new cases of malaria and 627,000 malaria-related deaths in 85 countries. Malaria, although a preventable and treatable disease, continues to have a crushing impact on the health and livelihood of people around the world.

The African region carries a higher share of the global malaria burden. At the time, 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, according to the report.

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 joint actions to reignite the momentum towards achieving the 2030 targets of the global malaria strategy.

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

Meanwhile, for any fight against malaria in Africa to be successful, effective malaria control must take into account the unique challenges faced by the region. One major challenge is the predominant poverty level and poor economic policies, as poor living conditions encourage the breeding of the mosquito vectors, and poor socio-economic conditions limiting 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 in curbing malaria on the continent.

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 the young children, who have not developed immunity to the disease yet, and pregnant women, whose immunity have been decreased by gestation period. 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. It 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.

The last two decades, globally, have seen increased access to malaria prevention tools and strategies, including effective vector control and the use of preventive antimalarial drugs. Also, recent innovations have created new opportunities for malaria control and elimination. A major achievement is the RTS,S/AS01 malaria vaccine recommended by World Health Organisation 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.

Read also: Floods: Communities at risk of water borne diseases, malaria

While this vaccine is a ground-breaking achievement in the development of new tools to fighting malaria, supplies are currently limited. African governments must therefore leverage on this opportunity to ensure that the doses that are available are utilised for maximum impact, while ensuring continued availability of other preventive measures to those most at risk.

Preventive measures, such as vector control, must be strengthened, as this is highly effective in preventing infection and reducing disease transmission. The two major interventions are insecticide-treated nets and indoor residual spraying. 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 arising in the region, which are more difficult to detect and treat.

Also, preventive chemotherapies, which refers to the use of medicines to prevent malaria infections and their consequences. This focuses on vulnerable populations, generally infants, children under the age of five, and pregnant women. Examples of preventive chemotherapy are seasonal malaria chemoprevention, and intermittent preventive treatment of malaria in pregnancy and school-aged children, 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 programme, Bloom Public Health and its strategic partners 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, to achieve at least 80 percent universal coverage in vector control, seasonal malaria chemoprophylaxis, and case management.

The malaria burden in Africa, although large, can be tackled through concerted efforts to scale up innovation and the deployment of new tools in the fight against the disease, while advocating for equitable access to malaria prevention and treatment, and building resilient health systems, according to Chimezie Anyakora and Ofure Odibeli of Bloom Public Health.