HIV/AIDS continues to make the headlines, rightly so as the pandemic tearing apart Sub-Saharan Africa. However, behind the scenes is malaria, the most important parasitic disease affecting humans. One billion people are affected by malaria worldwide with over 3,000 children dying each day and one to three million deaths per year. Although the burden of malaria is heaviest in sub-Saharan Africa, it also afflicts South Asia, Latin America, Middle East and some parts of Europe. Malaria has also been demonstrated to impact economic growth imposing an economic burden of over 12 billion dollars on African nations—-slowing growth by up to 1.3% per year.
As we approach the second annual World Malaria Day on April 25th, it is a great opportunity to raise awareness about the plight of millions and reflect on why malaria continues to ravage many communities—-yet we know its cause, prevention and treatment. When drugs are used right, they can cure malaria, bed nets and insecticides can offer protection and environmental management can be effective in containing mosquito breeding. Why can’t these strategies be implemented to reduce the suffering?
A roadmap was established by the UN in 2008 for achieving universal access to malaria prevention. This global plan called for action from governments, international institutions and private citizens to collectively control malaria—–with a 2010 deadline of delivering effective and affordable treatment and protection to all people in malaria prone areas. Many remain skeptical whether these ambitious goals can be achieved, with fresh memories of the numerous Africa’s ‘to do lists’ spearheaded by the United Nations—-such as the Millennium Development goals for 2015 which appear to have remained on paper. However, we cannot afford to overlook the devastation of malaria– making it critical to understand the challenges being faced today and what action ought to be taken.
Lack of access to medication continues to be one of the key hurdles. Malaria drugs have been available for decades but many continue to die needlessly without receiving any form of treatment. It is estimated that 200 million doses of effective treatment need to be delivered worldwide by 2010 to meet the global need. Achieving this feat would require a concerted effort from local governments, health service organizations, international agencies and drug companies. Research is also needed to refine and integrate effective malaria control programs into the health care systems of the affected communities.
Secondly, drug resistant malaria is increasing in distribution, frequency and intensity. Inadequate treatment due to self diagnosis and un-regulated anti-malarial drug distribution are endemic in many developing countries. Anti-malarial drugs continue to be sold in shops and on street corners by vendors without any medical expertise. This accounts for the inadequate dosing and adulterated quality of medication— a precursor for drug resistance. As a result, treatment with single drugs is currently ineffective necessitating use of combination regimen and newer agents which are mostly expensive. This challenge is affecting healthcare as a whole in Africa. More regulation and control of drug sale, distribution and importation is quintessential to eradicate drug resistance to malaria and other diseases.
Thirdly, malaria lacks a sufficient diagnosis. Malaria cannot be diagnosed clinically with accuracy. The most sensitive test available today is the use of blood smears—which have to be repeated every six to twelve hours for two days in case of a negative test. These resources are not available or accessible to many communities in the developing countries. Other testing methods exist but have inferior sensitivities and require more time, training and equipment. In fact many continue to rely on non-specific clinical manifestations such as fever spikes, chills, nausea and rigors. Due to the diagnostic complexities, many live with the malaria parasite in their blood without knowledge— children in particular end up developing more acute conditions such as cerebral malaria. Research is being conducted to devise more effective, simpler and cost-effective diagnostic tools—but in the meantime it is recommended to aggressively treat patients in malaria prone areas who exhibit any symptoms even in absence of a confirmed diagnosis.
As a result of the above barriers, we are still lagging behind in our quest to eliminate malaria. At the moment, preventive strategies offer an ideal starting point of action. These mostly focus on mosquito avoidance—avoiding exposure to mosquitoes at their peak feeding times usually dusk and dawn—and also throughout the night. Use of insect repellants containing DEET, suitable clothing, and insecticide-impregnated bed nets are some of the other strategies. It is also important for communities to drain stagnant water and eliminate any potential breeding areas around homes.
To meet the 2010 deadline, some of the initiatives that were set include indoor spraying of around 200 million homes annually, providing approximately 1.5 billion diagnostic tests annually—and supplying more than 700 million insecticide-treated bed nets to endemic areas. These nets have been shown to reduce child mortality due to malaria by over 20%. However, it is important to keep in mind that economic development and poverty eradication is necessary to empower people to reduce the burden of disease in Africa and other developing countries.
In order to make the 2010 goals a reality, we can be proactive by:
· Contributing to providing protective nets to affected communities.
· Volunteering and participating in education activities to increase awareness about the spread and prevention of malaria.
· Supporting research efforts to further our understanding of malaria prevention, diagnosis and treatment.
· Raise funds for malaria projects
· Network and create a community committed to tackling global health crisis
· Utilize available technology to connect and join the millions of people who are recognizing the 2nd annual world malaria day—and lay the foundation for global action.
· There are many organizations that are proactive in fighting malaria—and a simple online search can provide you with channels to contribute and put our collective energy into action. A few include:
April 25th is a reminder to all that malaria is not a forgotten disease—it is a day that should not only be a symbol for suffering but rather a call for service and action to eradicate malaria.
© Kawuma Daniel Busuulwa