30th July, 2015
Deadly yet so easily contracted, malaria parasites are transmitted through the bite of female anopheles mosquitoes that cause grave impact on Nigeria and Sub-Shaharan Africa, OLUREMILEKUN OSOBU-ASUBIOJO reports
With the proboscis, a pointed tube-like mouth that makes it unique in nature, a head containing all the sensors as well as scaly wings which showcase its flight muscles, the mosquito remains one of the most dreaded insects across the world. With just a bite on its prey it, enacts a tingling and itchy sensation which causes a scratch. But one cannot underestimate the dangers it causes to human existence.
In Makoko, one of the largest slums in the city of Lagos, western Nigeria, the mosquito finds a habitable environment to operate. The average mosquito survives on accumulation of stagnant water clogged with wastes, gutters and septic tanks and these are characteristics that makes up Makoko, a community close to the Lagos lagoon where some of the residents live on land just at the bank of the lagoon and others on water.
A journey to this community would leave anyone perplexed, not because of the name of the community, but a consideration for how possible it is for people to inhabit the vast land and carry on as if they do not have or see the health challenge that steers them in the face each day they wake up. The number of stagnant waste materials clogged underneath the wooden structures that stands on the muddy water are enough for mosquitoes to find a conducive environment to reproduce.
Chief Emmanuel Shemede, the Baale of Makoko, who spoke through Noah Shemede, his brother told our correspondent that despite the obvious environment, their father died at age 115 year in 2014 and was among the first settlers that migrated from Badagry in search of portions of lagoon rich in fish. In their tour they discovered Makoko and settled in Makoko.
It was obvious that the major occupation of the people of Makoko is fishing. But the same water in which they fish serves other purposes. It is their home, dumping ground, toilets, school, restaurants, boutiques, markets and of course a breeding ground for mosquitoes.
The Whanyinna Nursery and Primary School in the community, the pupils seemed happy despite the various scars on their skins caused by mosquito bites.
According to Dr. Gowon Idowu, one of the doctors that treat the people of Makoko, the slum records one of the highest incidents of malaria cases on a daily basis because of the environment. “The record of reported malaria cases between January and June 2015 is 542 patients in addition with other patients who might have been treated by other doctors and those who might have undergone self medication and treatment. This occurrence is quite alarm,” he said.
Malaria is one of the top three killers among communicable diseases in tropical Africa. It is a major public health problem and a negative factor in the socio-economic development and medical burden in endemic region, particularly in Sub-Saharan-Africa.
According to experts, the mosquito is a parasitic disease responsible for the death of thousands every hour and, in the least, millions of people annually, 90 per cent of whom live in Sub-Saharab Africa. In Nigeria, malaria is said to account for 50 percent of all outpatient visits and 10 to 30 percent of all hospital admissions. Furthermore, every year in Sub-Saharan Africa, over 50 million pregnancies are threatened by falciparum malaria, is an important contributor to maternal morbidity, perinatal morbidity and mortality malaria and is said to cost Africa an estimated $12 billion in lost productivity.
In areas of Africa with stable malaria transmission, P.falciparum infection during pregnancy is estimated to cause as many as 10,000 maternal deaths each year, contributes to approximately 15 percent of maternal aneamia eight to 14 percent of all low birth weight infants, an important contributor to infant mortality and three to eight percent of all infant deaths with 509 million cases every year.
In 2012, the World Health Organisation reported 216 million clinical cases globally, with 650,000 deaths mostly among children less than five years old. And in 2013, 198 million cases were reported globally including 540,000 death rate. According Professor Wellington Oyibo, a tropical disease specialist at the Lagos University Teaching Hospital, LUTH, Nigeria loses over N132 billion – a figure that factors in cost of health care, absenteeism, days lost in education, decreased productivity – due to brain damage from cerebral malaria and loss of investment and tourism. “Malaria has significant measurable direct and indirect costs. And is a major constraint to economic development with large disparity between counties with malaria and countries without malaria yearly,” he said of this health challenge.
Severe malaria presents with one or more clinical conditions with the evidence of vital organs dysfunction, such as multiple convulsion, abnormal bleeding, jaundice, circulatory collapse, brain damage and renal impairment among others. Unfortunately, despite the global efforts to control its prevalence rate, the disease remains very high. Indeed, WHO affirms that “malaria continues to claim the lives of children and incapacitating adults. The disease is holding back the development of the entire continent.”
Its resulting symptoms include high temperature, fever, vomiting, abdominal pain, sweating, inflammation of the spleen, headache, dizziness, lethargy, excessive sleeplessness, loss of libido in men, jaundice and anaemia. Diagnosis of malaria is complex and requires equipment such as microscopes or rapid diagnostic test. There is frequent over-diagnosis of malaria in many hospitals due to the historical tendency to treat all fevers with anti-malarials.
In addition, Dr. Nnenna Ezeigwe, the National Coordinator of National Malaria Elimination Programme, mentioned that there is large-scale under-diagnosis of malaria as many do not seek, or are unable to reach health care facilities. “The situation is worsened by the fact that symptoms of malaria are non-specific and many people with malaria also have other illness,” the doctor said further explaining that there is need for laboratory investigation on blood sample to detect the presence of the malaria parasite in the blood and also to determine if the disease is at an acute or chronic stage. She warned Nigerians on the use of malaria drugs based on assumption when presented with similar symptoms as such could eventually lead to the abuse of malaria drugs.
Treatment of malaria is not as easy as one would imagine. The parasites undergoes some changes in the liver before invasion of the blood. One tends to attack the parasites in the blood while some parasites are still in the liver waiting to invade the blood. Therefore attacking the parasites in the blood alone does not necessarily put an end to the disease.
According to Pharmacist Fredrick Adedeji Oduwole, Treasurer of Pharmaceuticals Society of Nigeria, Lagos State branch, drug treatment option for malaria is based on whether the patient has acute, uncomplicated or severe malaria. WHO, he said, recommends that anti-malarial treatment for acute uncomplicated falciparum malaria in Nigeria is artemisinin-based combination therapy, ACT. “The ACT, remains the first line of treatment of malaria because of high level of treatment failures due to the growing resistance to limited number of anti malarial drugs available,” he said.