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Battle against malaria not yet over

MalariaRecent local and international studies published ahead of the World Malaria Day (WMD), today, April 25, show that new malaria cases and deaths are on the decline, although gaps persist. Chukwuma Muanya, Assistant Editor (Head Insight Team, Science and Technology, reports on why this is so.

According to the World Health Organisation’s (WHO’s) World Malaria Report 2015, there has been a major decline in global malaria cases and deaths since 2000. Progress was made possible through the massive distribution of effective tools to prevent and treat malaria, such as insecticide-treated mosquito nets, diagnostic testing and antimalarial medicines.

WHO in a statement, however, noted significant challenges remain. Globally, about 3.2 billion people – nearly half of the world’s population – are at risk of malaria. In 2015, there were an estimated 214 million new cases of malaria and 438,000 deaths, mainly in sub-Saharan Africa. Millions of people are still not accessing the services they need to prevent and treat malaria.

According to the world health body, between 2000 and 2015, malaria incidence among the populations at risk (the rate of new cases) fell by 37 per cent globally. In that same period, malaria death rates among the populations at risk fell by 60 per cent globally among all age groups, and by 65 per cent among children under five.

Sub-Saharan Africa carries a disproportionately high share of the global malaria burden. In 2015, the region was home to 88 percent of malaria cases and 90 percent of malaria deaths.

WMD offers an annual opportunity to highlight advances in malaria control and to commit to continued investment and action to accelerate progress against this deadly disease.

To achieve the targets of the “Global Technical Strategy”, WHO notes that, annual investment for malaria control will need to triple from current levels, reaching $8.7 billion annually by 2030.

In Nigeria, the National Coordinator National Malaria Elimination Programme (NMEP), Dr. Nnenna Ezeigwe told The Guardian that with the support of the Roll Back Malaria partners, especially the Global Fund, World Bank, United States Agency for International Development (USAID), British Department for International Development (DFID), United Nation Children Fund (UNICEF) and others, Nigeria has made progress in the fight against malaria.

“If you recall, before 2000 the prevalence of malaria was well above 50 percent in most parts of the country. By 2010, the Malaria Indicator Survey (MIS) demonstrated an average prevalence of 42 per cent. Recently in 2015, another MIS was conducted. The preliminary results we have from this survey indicate that the prevalence has come even further down. Finishing touches are being put in the survey report and as soon as this is concluded the result will be made public and I believe it will be exciting to all stakeholders,” she said.

Ezeigwe said in spite of the progress recorded, there are many challenges that are slowing down the speed of uptake. Significant amongst this, she said, is the recalcitrance of people to uptake the interventions. “Simple as it is many people still do not use Long Lasting Insecticide Nets (LLIN). Although Nigeria has attained 80 percent coverage of LLIN, the usage is lagging below 40 per cent in most parts of the country.
Similarly, Nigerians, including health care workers shun the policy on mandatory diagnosis before treatment; and where they test with Rapid Diagnostic Test (RDT), doctors still go ahead to treat negative cases. This must stop if we all are committed to a malaria-free Nigeria,” she said.

…Nigerians, including health care workers, shun the policy on mandatory diagnosis before treatment; and where they test with Rapid Diagnostic Test (RDT), doctors still go ahead to treat negative cases. This must stop if we all are committed to a malaria-free Nigeria

To address this, Ezeigwe said NMEP has reached out to various health professional groups to encourage them to do the right thing. We have developed guidelines and Standard Operating Procedures to enhance their compliance.

The NMEP boss said the other challenge is dwindling resources. She said some major sources of funding for the malaria programme have ceased. “The World Bank Malaria Control Booster project ended in 2015. The DFID Support for Nigeria Malaria Programme (SuNMaP) and USAID Malaria Action Programme for States (MAPs) have also just ended. These developments connote reduced funding for malaria programme in Nigeria and unless the Federal Government commits more funds to the programme, there could be a catastrophic rebound of cases,” Ezeigwe said.

Also, the results of clinical trials on the first ever non-blood rapid test made by a Nigerian, Dr. Eddy Agbo, using only a few drops of urine, Urine Malaria Test (UMT), showed that malaria is on the decline in Lagos but is being over diagnosed and over treated.

Principal Investigator & Director ANDI Center of Excellence for Malaria Diagnosis, College of Medicine, University of Lagos (CMUL), Prof. Wellington Oyibo, told The Guardian that malaria should only be treated after a test, which confirmed that the fever was due to malaria. The malariologist warned that not all fevers are malaria.Oyibo said there are dire consequences of treating malaria without testing.

He explained: “In many locations just like in Lagos, the malaria cases are very low. We are beginning to see lower rates. It depends on the place where you are looking at it from. Like in a place like Lagos, you will see far lower; like 20 per cent.”

Oyibo who is also a consultant malariologist with the World Health Organisation (WHO) said cancers could cause fever when they are developing as well as viruses.Oyibo said that most times people take malaria medicines and they never got well, it means they never had malaria.

The malariologist added: “One of the point I want to make as we celebrate World Malaria Day, is how do we increase demand for testing? I have listed the dangerous things that could be involved if you do not test. You may have other conditions. So we should tell people, ‘if you have fever, why don’t you go for a test?’”

Each year, WHO and partners unite around a common World Malaria Day theme. This year’s theme “End malaria for good” reflects the vision of a malaria-free world set out in the “Global technical strategy for malaria 2016-2030”.

Adopted in May 2015 by the World Health Assembly, the strategy aims to dramatically lower the global malaria burden over the next 15 years. Its goals are ambitious but attainable: reducing the rate of new malaria cases by at least 90 percent; reducing malaria death rates by at least 90 percent; eliminating malaria in at least 35 countries, and preventing a resurgence of malaria in all countries that are malaria-free.

The timeline of 2016-2030 is aligned with the “2030 Agenda for sustainable development”, the new global development framework endorsed by all United Nations (UN) member states.

On the issue of resistance, Ezeigwe said the NMEP is monitoring across the country. “I want to confirm that we have recorded resistance of mosquitoes to some of the insecticides in use. However, the pattern of resistance is not uniform across the country or even within a community. We are concerned about this but it is not at a level that we need to worry too much. Because the LLINs also serve as physical barriers (in addition to killing the mosquitoes) even when the insecticides in them fail they remain useful in protecting individuals from malaria,” she said.

Ezeigwe added: “Therefore it is recommended that we continue to use them. To deal with the issue of resistance, the Federal Ministry of Health is developing National Insecticide Resistance Management Plan to ensure that the available tools are deployed wisely to remain useful for as long as possible.”

Ezeigwe said as Nigeria commemorates the 2016 World Malaria Day today, she wants to lend her voice to the global statement of promise that “we can end Malaria for good.” She added: “I want Nigerians to know that elimination of malaria is achievable in Nigeria, and that would only happen when everyone of us plays our part as individuals, communities, governments at various levels, partners and so on. If all of us decide to play our role, malaria would be history in Nigeria…..as soon as we want.”

According to the WHO, countries that have achieved at least three consecutive years of zero local cases of malaria are eligible to apply for the WHO certification of malaria elimination. In recent years, the WHO Director-General as having eliminated malaria has certified five countries: United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), Armenia (2011) and Maldives (2015). Recently three other countries started the certification process: Argentina, Kyrgyzstan and Sri Lanka.

There are currently no licenced vaccines against malaria or any other human parasite. One research vaccine against P. falciparum, known as RTS, S/AS01, is most advanced. This vaccine has been evaluated in a large clinical trial in seven countries in Africa and received a positive opinion by the European Medicines Agency in July 2015.

President, Nigerian Medical Association (NMA), Dr. Kayode Obembe, said pursuing malaria eradication focuses on global and regional public good as this will remove the threat of a deadly and epidemic-prone disease.

He said the economic benefits of malaria eradication includes sustained gains in human capital which may alter the trajectory of investment decisions of individuals, foreign investors and local firms that together change the productivity of the countries and regions involved.

Meanwhile, the President, Pharmaceutical Society of Nigeria (PSN), Ahmed Yakasai, told The Guardian: “It is pertinent at this juncture to state that to end malaria for good in sub-Saharan Africa in general, and in Nigeria in particular, all hands must be on deck and all stakeholders must work round the clock to achieve this.”



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