Achieving Zero Level Malaria Infection —Biliqis Bakare

Recent statistics on malaria undeniably validate the great danger that malaria poses to the world. A 2011 World Malaria report indicates that there were about 216 million cases of malaria and an estimated 655,000 deaths in 2010 with 90% of these deaths occurring in sub-Sahara Africa where the disease is endemic. In Nigeria, it is estimated that malaria contributes to 11 per cent of maternal mortality; 25 per cent of infant mortality and 30 percent of under-5 mortality. In most cases, pregnant women, because of low immunity and young children under the age of five, are mostly affected. Aside Africa, countries of Asia, Latin America and to a lesser extent the Middle East were also affected in 2010.

Malaria, a disease commonly associated with unhygienic environment and a major hindrance to economic growth, is a mosquito borne infectious disease of humans and animals like monkeys caused by Eukaryotic protists of the genius plasmodium. Five species of plasmodium can infect and be transmitted by humans, namely: plasmodium falciparum, plasmodium vivax, plasmodium ovale, plasmodium malariae and plasmodium knowlesi.

Severe cases of malaria are largely caused by plasmodium faliciparum, while those caused by plasmodium vivax, ovale and malariae are generally milder. On the other hand, plasmodium knowlesi is a Zoonosis that causes malaria in monkeys but can also infect humans. This specie of malaria occurs in certain forested areas of South East Asia.

Each specie of Anopheles Mosquito has its own breeding preference. For instance, while some prefer shallow collection of fresh water such as puddles and rice fields, others prefer stagnant water and drainage.

In the early stages of infection, malaria symptoms are sometimes similar to those of many other bacteria. Viral or parasitic infection symptoms can appear in seven or sometimes the time between exposures and signs of illness, may be as long as 8 to ten 10 months with plasmodium vivax and plasmodium ovale. These symptoms may include fever, chills, headache, sweats, fatigue, nausea and vomiting.

One of the major indications that one is infected with malaria is the cyclic pattern of the symptoms due to the life cycle of the parasites as they develop, reproduce and are released from the blood cells and the liver. Other common symptoms are non-productive (dry) cough, muscle or back pain, enlarged spleen. In rare cases, malaria can lead to impaired function of the brain and spinal cord, seizures or loss of consciousness which is termed cerebral malaria. Children with malaria frequently exhibit abnormal posturing.

In diagnosing malaria, a blood sample is taken out of which a blood smear is prepared. This is used to determine the amount of malaria parasite in the blood. It is also used during treatment to see whether the number of parasites in the blood are decreasing.

Other tests that may be done include: Liver function test to check for liver damage, complete blood count (CBC) to check for anaemia or evidence of other possible infections. Anaemia sometimes develops in people with malaria because its parasitism damages red blood cells. Genetic tests or other blood tests, urine and saliva test that highlight parasites by using special stains, are not frequently used like the blood smear.

The treatment of malaria depends on the severity. The milder cases are treated with oral drugs in which the most preferred strategy recommended by the World Health Organization, WHO, is the use of the Arthemism Combination Therapy, that is the combination of Artesunate with other malaria drugs to avoid the development of drugs resistance. Over the years, resistance to several malarial drugs has developed, most notably chloroquines.

When treated with an oral artemisinim (Artesunate) alone, as monotherapy, patients may discontinue the treatment prematurely following the rapid disappearance of malaria symptoms. These results in incomplete treatment and such people still have persistent parasites in their blood. Therefore, without a second drug given as part of a combination (ACT) these resistant parasites survive and can be passed on to a mosquito and then to another person.

Among pregnant women, intermittent treatment (IFTp), which consists of at least two doses of sulfadoxine-pyrimethamine received during the second and third trimesters of pregnancy, is highly effective in reducing the prevalence of anaemia and placental malaria infection among women at delivery. It is, thus, a vital intervention for pregnant women in endemic areas.

At the community level, the vector controls can reduce malaria transmission from very high level to close to Zero. This is by using indoor Residual spraying, environmental cleanliness, and preventing young children in endemic areas who have not yet developed immunity form getting the disease by placing them under bed nets from dusk to drawn, the period when the malaria vector (Anopheles Mosquitoes) mostly bite pregnant women. Because of their lowered immunity pregnant women should be given anti-malaria prophylaxis to prevent passing of the illness to the unborn child.

Recently, Recket Benckiser, owner of the Mortein (insecticide) brand, commenced an enlightenment campaign aimed at educating the public, especially expectant mothers and children, who are increasingly becoming vulnerable to malaria. Officials of the company would visit ante-natal and post-natal clinics in the country to sensitise mothers on the danger malaria constitutes and give out products in the company’s stable.

In Nigeria, the malaria burden is enormous as the country alone accounts for 25 per cent of global malaria cases. Statistics from the Carter Centre Malaria Control Programme show that over 300,000 Nigerians — mostly children — die from malaria attack each year. Malaria is said to be responsible for about 66 per cent of all clinic visits in the country and 30 percent of hospital admissions. It also accounts for 25 per cent of deaths in children under one year old; and 11 per cent of maternal deaths —a heavy burden on Nigeria’s families, communities, health system, and workforce. The National Malaria Control Programme (NMCP) puts the financial loss to malaria annually at N132 billion ($906 million) in form of treatment costs, prevention, loss of man-hours, etc.

It is pleasing, however, to note that through the Roll Back Malaria Partnership and other such initiatives, Nigerians have been encouraged to sleep under insecticide-treated nets, improve diagnosis, get highly effective anti-malarial drugs and spray interior walls of houses with long-lasting insecticides.

In Lagos State, Local Government Areas mostly those surrounded by water like Kosofe, Agboyi/Ketu, Eti-Osa, etc. commenced indoor residual spraying of all houses to guard against the outbreak of malaria. Also, pregnant women and children are being given free anti-malaria drugs in all the government owned hospitals and health centres. All households in the state were also given two insecticide treated mosquito nets free.

The United Nations has earmarked 2015 as the year to end death from malaria. Therefore, it is imperative to increase funding to enhance the fight against the disease. Similarly, intensive efforts with regards to controlling the disease should be spearheaded by the federal, state and local government health authorities. Similarly, the adoption of vector-control strategies to stop malaria will go a long way in winning the war against malaria. There is also need to pay better attention to eliminating environmental factors that promote the breeding of mosquitoes. Adherence to environmental issues such as clearing of drainages and proper refuse disposal are also necessary if the war against malaria is to be won.

As we approach three years to the UN deadline for the elimination of death by malaria, it is hoped that all stakeholders put up a common front to ensure that in accordance with the theme of this year’s World Malaria Day we are able “to sustain past gains, save lives and invest in malaria”.

—Bakare is of the Features Unit, Ministry of Information and Strategy, Alausa, Ikeja.