About 90 per cent of deaths due to malaria occur in Africa south of the Sahara, and most of them occur in children under five.
According to the African Malaria Report released last month by the WHO and the United Nations Children’s Fund (UNICEF), new effective anti-malaria drugs are not yet accessible to those who need them most, and that only a small proportion of children at risk are protected by the highly effective insecticide-treated nets.
The report, officially launched in Kenya by Vice-President Michael Wamalwa in commemoration of the Africa Malaria Day, gives a continent-wide picture of the struggle against malaria and highlights the urgent need to make effective treatment available to those most at risk.
Wamalwa admitted that the war against malaria was far from over and called on African governments to share information on research on the disease. “No child or pregnant woman should be allowed to die of malaria,” he said.
WHO Regional Director for Africa, Dr. Ebrahim Samba, said the increasing malaria burden in Africa is not an indication that the intensified efforts of governments, communities and their development partners to control the disease in the last few years had failed.
“Indeed, without these concerted efforts, the situation may have been worse still,” said Samba.
Dr. Urban Johnson, the UNICEF Regional Director for eastern and southern Africa, in a speech read by the Kenya country representative, Dr. Nicholas Alipui, said tools to tackle the malaria problem in Africa were available. But he admitted that sufficient rapid progress was not being made to reach the goals set in Abuja, Nigeria, in 2000.
Malaria, said Johnson, could be prevented through the widespread use of insecticide-treated nets (ITNs). But he regretted that today, less than 5 per cent of young children in Africa are sleeping under them.
“Pregnant women and their unborn children can be protected from the effects of malaria through intermittent presumptive treatment with safe and effective drugs, but very few African women are receiving this treatment,” he noted.
“We acknowledge the fact that Chloroquine, the cheapest anti-malaria drug and the mainstay for treatment for many years, is losing its effectiveness in many countries in Africa due to the spread of parasite resistance. However, there are several alternative and effective drugs that are available to us, including the recently developed combination therapies such as the SP (Sulphadoxine –Pyrimethamine drugs like Fansidar and efforts are constantly being made to produce new drugs,” he said.
The report challenges the world community to step up the momentum by increasing global investment to support the implementation of programmes to control malaria in endemic countries.
According to the report, proper use of ITNs, combined with prompt treatment at the community level, could reduce transmission by as much as 60 per cent and the overall young child death rate by at least one-fifth. But the question is whether this in itself is a sufficient reduction
So far, some progress has been made; for example in Tanzania, a three-year community pilot project has seen the proportion of infants using ITNs rise from 10 to 50 per cent and the child death rate fall by more than 25 per cent.
Similarly, a community programme in Zambia has achieved net coverage of more than 60 per cent of individuals at risk.
Interim results suggest a definite decline in the number of outpatient cases in children under five. Ghana and Nigeria have also introduced the home-based approach.
“Our challenge is to live up to the commitments made five years ago and not to fail yet another generation of African children. This would be unacceptable,” stated Dr. Nafo-Traore, executive secretary for the Global Partnership for Roll Back Malaria (RBM).
Since its launch, international spending on the disease has more than trebled to the current figure of $200 million a year. However, in monetary terms, it is estimated that malaria costs Africa US $12 billion in lost productivity due to its morbidity and direct mortality annually. This, therefore, means that what is being used to treat and control malaria is only 1.7 percent of what it costs the continent!
At the Abuja summit in Nigeria on April 25, 2000, up to 44 African leaders reaffirmed their commitment to RBM and set interim targets for Africa. They challenged other world leaders to join them in recognising the importance of tackling malaria as a disease of poverty.
Following the summit, April 25 was declared the Africa Malaria Day, and a subsequent UN resolution declared 2001-2010 the Decade to Roll Back Malaria, especially in Africa, giving prominence to the disease in the UN’s Millennium Development Goals.
Only eighteen endemic countries have now reduced or eliminated taxes and tariffs on anti-malaria products, including mosquito nets and insecticides, helping to make these essential products more accessible.
But despite all these achievements, a new threat looms in the horizon and threatens to change the malaria situation in Africa for the worst. Research conducted by scientists at the International Centre for Insect Physiology and Ecology (ICIPE) reveals that the malaria vector, the Anopheles mosquito, is adapting to breeding in dirty polluted waters that are characteristic of many African cities and towns.
In Kenya where Anopheles gambiae and Anopheles arabiensis are major vectors, the head of the Human Health Programme at ICIPE says this change in behavioural ecology may spell doom for African towns and cities which have been in the past largely free of major malaria outbreaks.
But some countries in southern Africa have opted to use DDT (Dichloro-diphenyl trichloroethane) in their war against mosquitoes and malaria. It is still the most potent weapon known against malaria. In fact there is no country that has not used DDT and has managed to control malaria. However, despite its effectiveness, it was banned in 1971 by the US and a lot of other countries followed suit, citing that it was an environmental pollutant and was killing birds, especially the Bald eagle and the Peregrine falcon by making eggshells thin. It is now what has recently been referred to as one of the most notorious Permanent Organic Pollutants (POPs) and banned.
But these countries argue that when weighed against the toll taken by malaria, there is no justification for banning it, especially when it is selectively used only for indoor spraying. In Kenya, this debate was recently ignited in the local media when one daily suggested that the banning of DDT was a conspiracy to keep African populations in check.
A former Kenyan Director of Medical Services, Dr Wilfred Koinange argued that there is no chemical that has no side effects and that the use of each chemical is a balance between its benefits and its side effects.”After all what studies have been carried out to determine the persistence of DDT in Africa where temperatures are much higher than in temperate countries? Dr Koinange posed, saying that he was not aware of any. In fact he went on to add that the malaria endemic places such as Kisumu and Mombasa are extremely hot and questioned the stability of DDT under such conditions.
As for the much touted impregnated bed-nets, ICIPE’s Dr John Githure, said there is no guarantee that the mosquitoes will not develop resistance against the synthetic pyrethroids currently being used to impregnate the nets, permethrin and deltamethrin adding that they are also quite pricey. Other experts are questioning why those using nets are not using natural pyrethrum to impregnate them yet Kenya remains the biggest producer of pyrethrum in the world.
“Even at present there is a real threat because when people sleep under nets, they tend to concentrate body volatiles within the net and this attracts more mosquitoes. If the net is damaged somewhere, you end up with more mosquito bites than normal, increasing the threat of contracting malaria even more,” Githure said. He said that currently, they are in fact using the bed net as a sampling device since it attracts more mosquitoes and this gives more precise population estimates.