26th April, 2020
By: Amir Abdulazeez
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hen the decision was reached to
spare a date for the observance of ‘World Malaria Day’ in May 2007 by the 60th
session of the World Health Assembly, which is the World Health
Organization's decision-making body, there were about 100 countries and
territories that have eradicated Malaria, set the path for eradicating it or
have reduced the disease to the barest or negligible level. In spite of this,
Malaria was still regarded as a global disease, perhaps not for its spatial
coverage, but for its high prevalence among a significant number of the global
population mostly domiciled in Africa.
The World Malaria Day itself was an offshoot from
the Africa Malaria Day, an event that had been observed since 2001 by
African governments. The first World Malaria Day was held on 25th
April, 2008 with the theme ‘Malaria: a disease without borders’. The day was
established to provide education and understanding of malaria and spread
information on annual implementation of national malaria-control strategies,
including community-based activities for malaria prevention and treatment in
endemic areas. Its observance served as a time to assess progress toward goals
aimed at controlling malaria and reducing its mortality in affected
countries.
A review of different reports
suggests that globally, 3.3 billion people in 106 countries are at risk of
malaria. In 2012, malaria caused an estimated 627,000 deaths, mostly among
African children. Asia, Latin America, and to a lesser extent the Middle
East and parts of Europe were also affected. According to the most recent World Malaria Report, the
global tally of malaria reached 212 million new cases and 429,000 deaths in
2015. The rate of new malaria cases fell by 21% and death rates fell by 29% globally
between 2010 and 2015. Children under 5 years of age are the most vulnerable
group affected by malaria; in 2018, they accounted for 67% (272,000) of all
malaria deaths worldwide. Malaria is the 3rd leading cause of death
for children under five years worldwide, after pneumonia and diarrheal disease.
According to the latest World
malaria report, released in December 2019, there were 228 million cases of
malaria in 2018 compared to 231 million cases in 2017. The estimated number of
malaria deaths stood at 405,000 in 2018, compared with 416,000 deaths in 2017. African
continues to carry a disproportionately high share of the global malaria burden.
In 2018, the region was home to 93% of all malaria cases and 94% of all malaria
deaths. Malaria transmission is more intense in places where the mosquito
lifespan is longer with the parasite getting adequate time to complete its
development and having preference to bite humans rather than other animals. The
long lifespan and strong human-biting habit of the African vector species is
the main reason why approximately 90% of the world's malaria cases are in
Africa. Thirty countries in Sub-Saharan Africa account for 90% of global
malaria deaths.
How has Malaria been faring in Nigeria? In
2018, six countries accounted for more than half of all malaria cases
worldwide: Nigeria (25%), the Democratic Republic of the Congo (12%), Uganda (5%),
and Côte d’Ivoire, Mozambique and Niger (4% each). With this, Nigeria is the
World Malaria Capital constituting a risk for 97% of Nigeria's population.
The remaining 3% of the population are reported to only be relatively safe because
they live on the highlands. According to the United States Embassy in Nigeria,
there are an estimated 100 million malaria cases with over
300,000 deaths per year in Nigeria. This compares with 215,000 deaths per
year in Nigeria from HIV/AIDS. Malaria is a major public health
problem in Nigeria where it accounts for more cases and deaths than any other
country in the world. This explains why the World Malaria Day is an important
event in Nigeria.
Malaria is not the only deadly health challenge in
Nigeria. According to various reports, the top causes of death in Nigeria
are; malaria, lower respiratory infections, HIV/AIDS, diarrheal diseases,
road injuries, protein-energy malnutrition, cancer, meningitis, stroke and
tuberculosis. The Nigerian office of the International Center for Disease Control
and Prevention listed the top 10 Causes of Death in Nigeria as at 2018 to be lower
respiratory infections, neonatal disorders, HIV/AIDS, Malaria, diarrheal
diseases, Tuberculosis, Meningitis, lschemic heart disease, Stroke and Cirrhosis.
Researches have suggested that Malaria
accelerates other diseases, including some of the ones mentioned above.
In most cases, malaria is
transmitted through the bites of female Anopheles mosquitoes. According
to WHO, there are more than 400 different species of Anopheles mosquito;
around 30 are malaria vectors of major importance. All of the important vector
species bite between dusk and dawn. The intensity of transmission depends on
factors related to the parasite, the vector, the human host, and the environment.
Anopheles mosquitoes lay their eggs in water, which hatch into
larvae, eventually emerging as adult mosquitoes. The female mosquitoes seek a
blood meal to nurture their eggs. Each species of Anopheles mosquito
has its own preferred aquatic habitat; for example, some prefer small, shallow
collections of fresh water, such as puddles and hoof prints, which are abundant
during the rainy season in tropical countries.
Transmission also depends on
climatic conditions that may affect the number and survival of mosquitoes, such
as rainfall patterns, temperature and humidity. In many places, transmission is
seasonal, with the peak during and just after the rainy season. Malaria
epidemics can occur when climate and other conditions suddenly favour
transmission in areas where people have little or no immunity to malaria. They
can also occur when people with low immunity move into areas with intense
malaria transmission, for instance to find work, or as refugees.
No matter how severe Malaria has become, it is time to
eradicate it in Nigeria and all other places. Doing it is not rocket science
provided sustainable and dedicated efforts are put in place. Globally,
the elimination net is widening, with more countries moving towards the goal of
zero malaria. In 2018, 27 countries reported fewer than 100 indigenous cases of
the disease, up from 17 countries in 2010. The WHO Framework for
Malaria Elimination (2017) provides a detailed set of tools and
strategies for achieving and maintaining elimination. From 1999 to 2019, if Nigeria
had a solid and implementable vision against Malaria, the disease may have been
history by now. This would have eased the pressure on our health facilities and
saved billions of Naira spent on drugs.
Countries that have achieved at
least 3 consecutive years of 0 indigenous cases of malaria are eligible to
apply for the WHO certification of malaria elimination. Over the last
decade, 10 countries have been certified by the WHO Director-General as
malaria-free: Morocco (2010), Turkmenistan (2010), Armenia (2011), Maldives
(2015), Sri Lanka (2016), Kyrgyzstan (2016), Paraguay (2018), Uzbekistan
(2018), Algeria (2019) and Argentina (2018). Some of these countries do not
have half the resources that Nigeria commands.
Fighting and defeating Malaria even in advanced countries
has not come without challenges. But the key issue is that prevention is always
better than cure. Over the years, hundreds of millions of Insecticides Treated
Nets have been distributed and used in most parts of Nigeria, yet the problem
still persists. Sometimes, mosquitoes that transmit Malaria bite their victims
before the bed time in which they might have been inside the nets. Therefore,
they major way out is comprehensive town and environmental planning which will rehabilitate
slums, poor unplanned settlements and stop the emergence of new ones.
Government must rise up against the disease-breeding shanties we call
settlements. Drainage network planning and rehabilitation is also essential.
One key control measure is
vaccination. RTS,S/AS01 is the first and, to date, the only promising vaccine
against severe malaria, in young African children. It acts against P.falciparum,
the most deadly malaria parasite globally and the most prevalent in Africa.
Among children who received 4 doses in large-scale clinical trials, the vaccine
prevented approximately 4 in 10 cases of malaria over a 4-year period. This
shows, even the vaccine is not a permanent ultimate solution. The WHO’s top
advisory bodies for malaria and immunization have jointly recommended phased
introduction of the vaccine in selected areas of sub-Saharan Africa. Three
countries – Ghana, Kenya and Malawi – began introducing the vaccine in selected
areas of moderate and high malaria transmission in 2019.
Eradicating Malaria can best be achieved first by
individual and then community efforts. It is not a coincidence that the themes
for the 2019 and 2020 World Malaria Days have been "Zero
malaria starts with me". If we all make a resolve to take good care of our
environment and personal hygiene, we stand a chance to defeat Malaria. Community
efforts towards regularly sanitizing the environment and getting rid of
stagnant waters through clearing of drainages and water ways is equally
important. Community contributions for the periodic spray of insecticides will be
far be better than sticking to the individual mosquito coils that drain our
micro-economy. It is also far better than waiting to be infected and then spend
hundreds or thousands on treatment.
The current efforts to defeat
Malaria and other diseases by various stakeholders, even if inadequate yet, must
be commended. Alongside the World Malaria Day, the WHO has dedicated days for
seven other global public health campaigns; World Health Day, World
Blood Donor Day, World Immunization Week, World Tuberculosis Day, World
No Tobacco Day, World Hepatitis Day and World AIDS Day. With current
developments, we may soon have World Coronavirus Day.
Twitter: @AmirAbdulazeez
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